National Winter Planning Conference

Beardmore Hotel & Conference Centre, 15 June 2010

Summary of Discussion Sessions

Session 1: 2009/10 winter review report – key findings
Norovirus:
Guidance should be revised to include:
  • protective measures for NHS staff carrying out home visits
  • policy for local authorities and private nursing homes regarding patient management to facilitate discharge and avoid admission.
  • clear andconsistent advice around co-horting and efficient movement of patients
  • clarification on whether full ward closures are required in all circumstances.
  • clear and consistent advice around hospital visiting policies
  • relevant criteria for identifying non-essential staff in affected wards.
  • provide more flexibility in local decision making and better integration with social care.
Boarding:
  • key to reducing boarding levels is good liaison with social care / Community Hospitals.
  • CommunityHospital policy may conflict with boarding policy.
  • homecare packages should be prioritised for elderly / vulnerable patients to free up hospital beds.
  • consider how boarder information is collated.
OOH:
  • local OOH services now have greater ability to access 4x4 vehicles potentially from Councils and Voluntary Agencies.
Escalation Plans:
  • challenge is to establish clear‘quantifiable’ triggers.
  • considering tie-in of specific clinician to plans.
  • ensure that plans enable targets to be maintained.
Business Continuity:
  • consider provision of IT access to enable key staff to work from home.
  • consider strategic co-ordination of NHS board, local authority and police capacity (e.g. agree statement on staffing).
  • ensure system-wide / senior management awareness training in Business Continuity Planning process.
Engagement with Local Authorities:
  • agreed that some NHS Boards had issues around gritting priorities with local authorities.
  • Scottish Government can provide demographic data to identify areas where slips, trips and falls took place. This might helpNHS Boards calculate the cost of slips, trips and falls in their area to strengthen negotiation and influencing ability with local authorities.
  • recognised that social work services currently rely on staff volunteering to work over 4 day / weekend holiday periods to maintain service levels. However, demand and expectation for social work services can no longer rely on volunteers to ensure sustainability of service.
  • in some cases NHS Board and Social Work Management worked well together in local management units which had shared accountability for outcomes.
  • assessment of patients at risk needs to be better managed and understood to avoid unnecessary admission and to ensure appropriate management of patients discharged into community care.
Communications:
  • consider holding a public consultation on winter planning and review results.
  • emphasis on importance of sharing of local information and in promoting‘centrally led’ self care information campaigns.
  • important to have frontline shift presence to disseminate information.

Session 2: Developing lessons learned
Norovirus:
  • consider establishing a multi-agency norovirus group to help community services support people at home.
  • take steps to prevent hospitals becoming the default for GPs and social care.
  • important to effectively manage the risk between closing wards and managing admissions of acutely ill patients.
  • extend the H1N1 reporting system to include D&V.
  • consider suspension of electives for norovirus toenable better management of services.
Capacity & Demand:
  • important to consider how OOH and primary care capacity might impact upon secondary care capacity.
  • discussions around Scottish GP contract needed to consider activity peaks and predicted patient demand.
  • consider capacity of NHS24/SAS to triage and respond to patients and how this might impact on OOH services.
  • gather further statistics about reasons for attendance in primary and secondary care settings over the severe weather period.
  • address lack of social work capacity to facilitate the discharge of patients over holiday periods.
  • recognise that local authority employees who provide social work services over holiday periods are volunteers and this may not be a sustainable model for future service delivery. Might be a need to review terms and conditions of contract of social work staff.
  • consider implications of squeeze on public sector budgets which are likely to impact upon number of beds available within the system and number of care packages available year on year.
  • consider a central/regional register of 4x4 vehicles that services can access.
Boarding & Discharge
  • consider role of primary care in supporting discharge of boarders.
  • discharge process still very Consultant dependent.
  • increased use of ‘Expected Date of Discharge’ would be helpful.
  • consider use of ‘Patient Safety’ methodology to create discharge ‘Bundle’.
  • increase availability and awareness of anticipatory care plans.
  • increase communication between SAS / NHS 24 / local services to maximise efficacy of algorithms and agree alternatives to admission where appropriate.
  • recognise and address pressure placed on social services through discharge policies.
Communications:
  • key decisions made within local authorities likely to impact on Health services need to be moreeffectively communicated.
  • early dialogue with SAS about risks relating to transporting discharged patients home from hospital in poor weather is important.
  • important to document experience for future learning / reference.
  • recognise importance of clarity and consistency in communicating information and policies to staff, patients and the public.
  • consider developing contact centre model for handling communications.
Planning:
  • important to pro-actively manage winter planning to anticipate real pressure points.
  • business continuity planning- important to consider who should be in the ‘bunker’, to ensure a whole systems perspective.
Governance & Risk Management:
  • consider developing shared risk management arrangements between all partners (including social work depts.)
  • suggested need for a governance framework to support managers and clinicians.
  • support GPs to manage the risks of not intervening.
  • Government support/understanding for boards who have difficulty meeting targets under extreme winter pressures.

Session 3: Development of regional winter planning events
Programme Themes:
1. Collaboration & Engagement:
  • Norovirus & Multi-Agency Working; control measures.
  • Building successful community services
  • Single Shared Assessment Service - NHS Fife/ Fife Council
  • Partnership working with local authorities
  • Shifting the Balance of Care
  • Focus on Primary Care for CHP clinical staff and Social work staff
  • H1N1 – transferring theory into practice
2. Capacity Planning
  • Workforce planning
  • OOH Capacity – developing creative solutions
  • Escalation – clarification of definitions and coordination of local/board level plans to build a better whole system approach.
  • System Watch Review - Update
  • Implications of tighter budgets.
  • Social care interface – funding
  • Managing balance of admissions and discharges (Admission / Discharge Profiling)
  • Testing Business Continuity Plans
  • Maintaining Targets - At what cost
3. Boarding:
  • Eliminating Boarding and patient safety (clarification on defining and recording)
4. Communications
  • Improving information transfer between service sectors
  • Promoting key winter messages
  • Promoting self-care.
5. Promoting Good Practice
  • Presentations by Best in class to promote good practice (Poster or Oral)
  • Admission Avoidance – sharing good practice
  • Emergency Ambulatory Care – Pilots Best Practice
  • Decision Log – for recording lessons learned and facilitating reflection (SBAR tool)
  • Focus on no delays
  • Focus on good examples of unscheduled care.
Potential Venues:
  • Dunfermline (VineChurch)
  • Stirling
  • Fife Council
  • Glasgow (Atlantic Quay)
  • Optimal timing 09.00-15.00
Improvements to Winter Planning Guidance:
Guidance should:
  • include priority recommendations for boards to plan around
  • provide clarity on what / how boarding should be recorded.
  • provide clear links to Quality Strategy, Patient Safety and Patient Centeredness
  • read across lessons learned from GP experience of managing H1N1 in the community (e.g.) use of other care home providers.
  • circulate draft guidance prior to regional planning events to facilitate discussion at events and provide opportunity for feedback.
Other Issues:
  • consider flexibility to pay appropriate rates for OOH staff, especially over 4 day holiday weekends)