Version 2 – 10th November 2016
Plan on a page 2016-17
Background
The purpose of the winter plan for Sirona services within South Gloucestershire is to ensure that robust arrangements are in place to enable the flow of patients from hospital to home within the capacity available. The plan demonstrates how the services are able to be responsive to allow for increases in pressure felt within the acute trusts and to demonstrate resilience within the system. The responses to escalation over the winter now reflect the new operational pressures escalation level framework.
There is robust leadership over 24 hours 7 days a week provided by senior operational managers and by strategic director level. Clear communication channels will ensure effective and timely decisions are made to ensure clear decision making is communicated at all levels of the organisation.
Leadership and Escalation
Operational managers participate in daily system management calls with support as required from director level to manage escalation. All services have a minimum staffing level across 7 days per week including the bank holiday periods. There is an on call rota covering 365 days a year covering 7 days a week. Internal escalation actions are in place and activated through the on call escalation process (see appendix A)
Available Capacity 2016-17
Current plans for the winter of Nov 2016-March 2017 includes investment for additional resource with 4 permanent beds on Elgar ward and new service development for Dementia Advisors, Diabetes, Falls and Respiratory Care. The currently commissioned community health resources are expected to meet the demands of the urgent care system in South Gloucestershire
We have set targets for discharge to assess pathways for bedded and non-bedded facilities following our work with In power. Pathway 1 is set at 38 discharges per week and pathway 2 is 20 per week
South Glos front door in-reach is 1 per day Monday to Friday which is preventing admissions to specialist wards by supporting people to return home with additional support.
Community Hospital Beds / 58 inpatient rehab bed – 20 in Thornbury Hospital and 38 Elgar 2 ward at Southmead Hospital.Community Rehabilitation beds Pathway 2 / 21 beds in Nursing and Residential homes.
District Nursing teams / 9633 contacts per month (currently running over capacity by 18%) – this includes capacity to manage 6 new OD IV boluses per week
Community Rehabilitation Team / 38 D2A per week plus Planned rehab
ECP Admission Avoidance / 105 per week
MIU - Yate / Yate MIU opens to patients from 08.00am until 7.30pm daily.
Average attendance figures are currently around 1612 per month ( 36% increase from 2015)
We have developed escalation plans in line with system flow to ensure we work with our partners to flex capacity to react to pressures in the system. We regularly review and bring forward discharges as appropriate and review flexibility of criteria in Pathway 1 discharges in conjunction with social care Rapid Response at times of greatest pressure. Daily reviews of any available capacity are highlighted at the daily system management call (ALAMAC) and also use our capacity effectively for prevention of admissions. By participating in the daily calls we are able to monitor any available capacity and respond to requests from the call from partners. JCAP escalate to managers when capacity is reached and if demand is exceeding capacity
On-going work is happening with system wide partners to improve efficiencies in capacity management and flow through the IDS and enabling discharge work streams. We are currently participating on the ECIP work programme in relation to NHSI 30/60/90/120 days review with all partners to ensure robust and joined up vision to improve flow.
We ensure that we maximise the use of Community rehab beds (CRB’s) in Pathway 2 with a review of admission thresholds with flexibility to offer beds to Bristol in a shared home if no South Glos patients are suitable to transfer on that day. We offer regular support for patients at home with a higher acuity and dependency to enable them to remain safely at home rather than an admission to hospital. The frailty team has been of particular value in continuing to support such patients to remain at home much longer than previously.
Capacity across the South Gloucester community services are monitored on a weekly basis as below:
Referrals are received via single point of access (JCAP) which is now a 7 day a week service via HAT /JCAP at weekends . Capacity continues to be monitored and tracked over a weekend via this access point. Sirona discharge team operate as part of the IDS team transferring to community beds and facilitating discharges over 7 days. Individual patient escalation plans are discussed in specific cases and at weekly LHPD meetings. We monitor and clinically review delays with partners weekly at those meetings.
Flu Vaccination
There is a planned programme in place to offer vaccinations for housebound patients meeting the criteria. Staff planned flu campaign is in operation where staff are given maximum opportunities to receive flu vaccinations (aiming for 75% take up for front line staff). Flu vaccination sessions are being held across Sirona services as below as well as attending team meetings for maximum coverage.
Tue 4 Oct / 09.30 - 12.30 / Room 16, First Floor, Keynsham Health CentreWed 5 Oct / 13.30 – 15.30 / Thornbury Hospital
Tue 11 Oct / 14.30 – 16.00 / Combe Lea CRC
Wed 12 Oct / 09.30 – 12.30 / Downend Clinic Meeting Room
Thu 13 Oct / 09.30 – 13.30 / Winter Garden Room, St Martins Hospital
Tue 18 Oct / 09.30 – 12.30 / Turner Room, Paulton Hospital
Tue 18 Oct / 11.30 – 13.00 / Charlton House CRC
Thu 20 Oct / 12.00 – 14.30 / Large Meeting Room, Bath NHS House
Tue 1 Nov / 13.30 – 15.30 / Yate Conference Room
Wed 2 Nov / 09.30 – 12.30 / Connections
Thu 3 Nov / 09.30 – 11.00 / Cleeve Court CRC
Tue 8 Nov / 10.30 – 13.30 / Turner Room, Paulton Hospital
Thu 10 Nov / 11.00 – 13.00 / Thornbury Hospital
Tue 15 Nov / 09.30 – 11.30 / Rose Room, Carrswood Day Centre
Thu 17 Nov / 13.30 – 15.30 / Room 16, Keynsham Health Centre
Tue 22 Nov / 13.00 – 16.00 / Room 2.2, The Hollies, Midsomer Norton
Wed 23 Nov / 09.30 – 13.30 / Winter Garden Room, St Martins Hospital
Infection control Management plans formulated with partners
Infection control is covered as part of induction and mandatory training for all clinical staff. Newsletters, training and awareness raising for staff to manage and contain an outbreak is highlighted through team meetings and the intranet. Infection control plans are in place for all services including pandemic flu plans. Senior leaders have all been involved with major incident scenarios.
Bank Holiday Service Delivery for Christmas and New Year
· Robust plans in place for festive season with off duty published for all teams – this will be input into the NHSE template over the next 3 weeks.
· Adequate staffing is in place for bank holidays
· Staffing levels have been determined with allowance to flex the workforce to meet the demands around bank holiday days and in between Christmas and New Year
· Escalation plans are in place with On call director/managers as per rota below. (Escalation card in appendix A)
· On Call Manager Christmas Rota 2016
· Via St Martin’s Switchboard 01225 831500
·
· From:
·
· 5pm to 8am - workdays
· 8am to 8am - weekends and Bank Holidays
CHRISTMAS WEEK 2016date / On call manager
Sat 24th / Bev Mason / Richard Tarring
Sun 25th / Simon Allen / Clive Bassett
Mon 26th / Rosemary Carroll / Julie Sharma
Tues 27th / Sue Parris / Liz Richards
Wed 28th / Alison Tucker / Liz Richards
Thurs 29th / Alison Tucker / Liz Richards
Fri 30th / Alison Griffiths / Linda Frankland
Sat 31st / Cathy Daffada / Janet Rowse
Sun 1st / Geoff Watson / Janet Rowse
Mon 2nd / Carrie Wedgwood / Janet Rowse
Tuesday 3rd -8th Jan 17 / Carrie Wedgwood / Linda Frankland
ON CALL flow chart
On Call other TasksEPRR Exercises Telephone cascades
Table top
Teleconferences
Live play (role play)
· Escalation
· Setting up an ICC / Running an ICC / Recovery – Hot and cold debrief delivery
· Managing Major Incidents and Business Continuity incidents
· Undertake appropriate training as recognised by NHS England or internal awareness training on an annual basis / When on Call you MUST:
· Carry your phone with you at all times
· Ensure On Call pack is easily accessible
· You have pocket log book and pens
· You have mobile phone signal and/or landline telephone number for contact
· Be within 2hrs of an ICC
· Be sober
· Ensure EVERYTHING is logged
Areas of Identified Risk
· Both district nursing and ECP demands have grown significantly this year with no additional capacity Risk has been discussed with commissioners and measures have been put in place to manage demands within capacity (e.g. defining IV capacity resource as only for OD bolus IVs)
Perfect week
Sirona is involved with partners in the planning of a perfect week event for the week commencing 9th January.
Appendix A: Escalation cards
NBT Declared Level 1 statusOr Sirona Declared Level 1 as below / Team Manager or nominated deputies / · Provide community capacity across the system.
· Provide capacity, staffing and delays information to JCAP by 8.30 daily via capacity report – acceptable levels are for local determination.
· Maintain staffing capacity assessment.
· Maintain routine demand and capacity planning processes including a review of non-elective inpatient cases.
· Active monitoring of infection control issues.
· Maintain routine active monitoring – external risk factors: Influenza and Severe Weather. (Horizon Scanning) – Liaise with EPRR.
· Alamac report by 11am daily
· Daily alamac operational conference call at 11am
· Report number of green patients awaiting discharge, DTOCs, Rehab bed capacity to JCAP by 09.00
· Triage referrals, site meeting or Ward MDT attendance on a daily basis to highlight where there are requirements to manage flow. Identify patient pathways and co-ordinate movement.
· Escalate decision making requirements to Head of Adult Services (HoAS) / Senior Leadership Team (SLT) where needed.
· Patient flow demand is matched with available capacity
· Overnight services (DNs, support ward staff and Rehabilitation) reporting good staffing levels
· Rehab beds available for transfer
· Rehab beds full but with clear flow defined on a daily basis, including weekends
· No beds closed with infection
· Capacity in Pathway 2 teams to support discharge into the community
· Delayed Transfers of care identified with clear strategies in place for patients’ effective discharge
· Specialist services availability to manage patients from NBT and Community
· Choice protocol effectively implemented / Locality Managing
JCAP team
IDS
Urgent Care Lead / Nominated deputy
Community Care - Community capacity available across system.
Conditions: / Who / Local Actions
OPEL Level 2 (Amber) Escalation
NBT or Sirona Declaring Level 2
4 or more conditions apply
Sirona Local Actions – In addition to Green Escalation – Level 1 – Normal Operating Process
Conditions:
• Capacity only in one community hospital for transfer
• Infection control issues reported with potential bed closures
• Specialist teams reporting no capacity for >2 days
• Patient flow levels not maintained for >1 week
• Rehab reporting limited capacity for urgent
• Rehab beds full with no discharges expected for 3 days
• Numbers of DTOCs above required level (1% in NBT, 5% in community hospital)
Patients identified appropriately as green unable to access suitable pathways / JCAP / Inform all team managers / nominated deputies and Urgent Care Lead of increased escalation status.
Participate in 11:00 tactical call if requested to feedback actions taken
Escalate any impact / decisions needed to Urgent Care Lead
Patient Flow Coordinator, Discharge Liaison Nurses, / Delays in transfers identified and action plans expedited
Patients expected to transfer into Community hospitals identified early and all information communicated between teams
Community Hospital Teams / Review of bed base to ensure demand will be met and any potential requirement to change actioned
Additional ward rounds initiated to expedite discharge and review EDD Daily.
Team Managers or nominated deputies / Review caseloads to identify where patients could be discharged with support from other agencies to create additional capacity
Identify people waiting for dom care and escalate to urgent care lead
Liaise with staff to identify those that could support other teams where required
Report outcome of actions to JCAP by 11
Urgent Care Lead / Expedite patients waiting for PoC to the council
National Requirement / National Actions
Community Care
· Patients in community and/or acute settings waiting for community care capacity
· Lack of medical cover for community beds
· Infection control issues emerging
· Some unexpected reduced staffing numbers (due to: e.g. sickness, weather conditions) but are sufficient to maintain services.
· Maximise use of Reablement beds/ intermediate care beds.
· Bring forward discharges to allow transfers as appropriate.
· Maintain liaison with Healthcare providers to expedite discharge from community hospitals. / Community Care Providers
· Escalation information to be cascaded to all community providers with the intention of avoiding pressure wherever possible. Maximise use of re-ablement / intermediate care beds
· Task community hospitals to bring forward discharges to allow transfers in as appropriate. Community hospitals to liaise with Social and Healthcare providers to expedite discharge from community hospitals.
· Additional ward rounds within community providers to expedite discharge and create capacity
· Community providers to lower admission / treatment thresholds wherever possible through implementation of previously agreed flexible working arrangements to alleviate pressure.