NHS GRAMPIAN

Grampian Winter Plan2015/16 - Progress Update

1.Actions Recommended

The Grampian NHS Board isasked to note:

  • the approach and progress in the development of the integrated Grampian Winter Plan to ensure safe and effective care for patients, and sustained performance at the required standard over the winter period.
  • that the draft Grampian Winter Plan for 2015/16 will be submitted to the ScottishGovernment by the end of August 2015.
  • that the final draft of the Grampian Winter Plan for 2015/16 will be submitted to the October Grampian NHS Board meeting for approval prior to submitting to the Scottish Government by the end of October 2015.

2.Strategic Context

Winter planning remains an integral part in the Government’s National Unscheduled Care Programme and, in common with other Boards, NHS Grampian must be fully prepared to minimise any potential disruption to services, patients and carers. Local winter plans must demonstrate continuity of safe and effective care for patients and that effective levels of capacity and funding are in place to support service delivery and to meet expected activity levels.

Clear guidance and timescales have been communicated by the Scottish Government to support local Boards and partners in their planning.

  1. Key matters relevant to recommendation
  1. Summary of NHS Board Winter Planning Requirements

Grampian, like other NHS Boards,is required to:

  • pursue further sustainable improvement through the 95% interim target towards the 98% 4 hour Emergency Access Standard, to maintain the Treatment Time Guarantee (TTG), and to meet the zero delayed discharge target over the winter period.
  • take a balanced approach to the effective planning and scheduling of elective and unscheduled care, particularly in light of predicted emergency activity over the festive period and any surge in respiratory and circulatory admissions over the winter.
  • ensure cancer patients who have a diagnostic or treatment target date occurring over the festive period are not delayed and that 31 day and 62 day cancer waiting times are not adversely impacted.
  • monitor any changes in the cohorts of admitted patients and their care requirements,including respiratory, circulatory and Intensive Care Unit (ICU), over the festive period.
  • engage primary care and community services in minimising transfers of care through use of anticipatory care planning. A directory of services and alternatives to admissions should be available and any additional capacity in these areas highlighted.
  • ensure that deliverable plans for workforce capacity over the winter period are agreed by October.
  • ensure safe and effective patient flow.
  • ensure the local plan effectively responds and is performance managed against the following critical areas:
  • Safe and effective admission/discharge continues in the lead-up and over festive period and also in to January
  • Workforce capacity plans and rotas for winter/festive period
  • Whole system activity plans for winter post-festive surge and specifically the respiratory pathway
  • Strategies for additional winter beds and surge capacity
  • The risk of patients being delayed on their pathway is minimised
  • Discharges at weekend and bank holidays
  • Escalation plans tested with partners
  • Business continuity plans tested with partners
  • Preparing effectively for norovirus
  • Delivering seasonal flu vaccination to staff and public
  • Communication plans
  1. Progress in the Development of the Integrated Grampian Winter Plan for 2015/16

The development of the integrated Grampian Winter Plan for 2015/16 is well underway and currently on track to submit a draft plan to the Scottish Government by the end of August and a final plan in October 2015.

Progress is as outlined below.

  • 2014/15 Winter De-brief Event was held on 29th May 2015. This provided an opportunity for a variety of staff across services, sectors and agencies to reflect on the winter experience and highlight any points for learning. A number of suggestions were identified and it was agreed it would be highly valuable for areas to note their highest risksfor winter 2015/16 and regroup in August to share and prioritise with a view to innovative approaches and solutions.
  • The output of the De-brief Event was included in the Debrief Event Report (Winter Report)and submitted to Scottish Government on 12 June, with local circulation to the Unscheduled Care Steering Group.
  • The proposed process and timescales for the development of the local Winter Plan for 2015/16 was submitted to the 24 June Operational Management Board which is chaired by Malcolm Wright and includes General Managers, Director of Finance and Chief Officers as members. As a result of this meeting it was also agreed that Amanda Croft, General Manager – Acute Services,would take the lead role for winter planning for Grampian. Christina Cameron, Programme Manager Unscheduled Care, will lead on the facilitation of the plan given the links to the local and National Unscheduled Care Programme.
  • Robust sector and Integrated Joint Boards (IJBs) plans are under development and expect to be shared by the end of July 2015 in order to inform the development of the overarchingintegrated Grampian Winter Plan. Together Amanda Croft, Alison Hardy (Head or Operations, Acute) and Christina Cameron are overseeing this processand the supporting Business Continuity Templates were issued on 15th July.
  • As per the letter sent by Shona Robison, Cabinet Secretary for Health, Wellbeing and Sport, to NHS Board Chief Executives and Integrated Joint Board Chairs (dated 14th July 2015) arrangements are in hand to provide an opportunity for winter preparation discussions with the Board Chief Executive, IntegratedJoint Board Chairs and Chief Officers. Specific focus is required to ensuring whole system plans are in place, with the focus on delivery of safe and effective care. Partners are also tasked with ensuring that the number of delayed discharges is, as a minimum, reduced to the October 2013 level over the next few months i.e. to 153 across Grampian.
  • The key actions to be included in the draft plan, together with the recently circulated national winter planning guidance and checklists,will be considered at a specific winter planning session convened by the Grampian lead on 12th August. The output of this session will subsequently be submitted to the Operational Management Board (OMB)for approval on 26th August 2015, prior to the submission of the draft Grampian Winter Plan for 2015/16 to the Scottish Government by the end of August 2015.

Following the testing of local business continuity plans and winter plans, and receipt of any feedback received from Scottish Government, a draft version of the final Winter Plan will be submitted for formal approval at the OMB Meeting on 30th September. The outcome will then be communicated to the Grampian NHS Boardon 1 October 2015 prior to submitting to the Scottish Government by the end of October 2015.

A programme for consultation and final approval involving the IJBs, management groups and NHS Grampian has been prepared for the period up to end October 2015.

Key challenges & Risks

A number of challenges currently exist which are outlined below. Plans are being developed and implemented in order to attempt to mitigate/managed these, particularly ahead of the winter period.

  • Delayed discharges – the required reduction in the total number of delayed discharges to 153 (from the July figure of just over 200) represents a significant challenge for Aberdeen City and Aberdeenshire – theChief Officers arefocused on what is achievable and realistic within this timeframe and are preparing specific plans for consideration by the with the Executive Team in early August.
  • Maintaining the 4 hour standard at 95% or above – this is likely to be a challenge in the winter period when demand surges as it has in previous years. Current performance is at 94% during the summer when it is usually high. Earlier planning for surge levels and readiness around increase capacity will provide some mitigation against this risk and hospital management processes such as safety huddles are likely to provide further improvement.
  • Some aspects of surge response depend upon an increased spend on capacity such as emergency beds or agency staff. In winter 2014 these costs were met by non-recurring funding provided by Scottish Government however it is unlikely that a similar funding stream such funds will be available for the coming winter. The early planning on this issue is therefore essential to ensure that appropriate funding is made available from local sources.
  1. Risk Mitigation

The implementation of a comprehensive winter plan will mitigate Strategic Risk 851 – Delivery strategies are not aligned to meet the future needs of the population.

5.Responsible Executive Director and contact for further information

If you require any further information in advance of the Board meeting please contact:

Responsible Executive Director
Graeme Smith
Director of Modernisation
/ Contact for further information
Amanda Croft
General Manager – Acute

Christina Cameron
Programme Manager,
Modernisation Directorate

Date

27July 2015

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