Bath and North East Somerset (BaNES) A&E Delivery and ......2016/11/03 · Bath and North East...

Bath and North East Somerset (BaNES) A&E Delivery and Winter Plan

2016/17

Summary A&E Delivery and Winter Plan 2016/17

Prepared by BaNES Clinical Commissioning Group

in partnership with:

BaNES Council (LA)

Royal United Hospitals Bath NHS Foundation Trust (RUH)

Wiltshire Clinical Commissioning Group

Wiltshire Council

Sirona Care & Health (Sirona)

Wiltshire Health and Care

South Western Ambulance Service NHS Foundation Trust (SWASFT)

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP)

Care UK (NHS 111 provider)

Bath and North East Somerset Doctors Urgent Care (BDUC)

Dorothy House Hospice, Care UK (DH)

Bath Emergency Medical Services (BEMS+)

Arriva Transport Solutions Ltd (non-emergency PTS provider)

Bath and North East Somerset (BaNES) A&E Delivery and Winter Plan 2016/17 of 25

Version Control

Version Date Changes Made by: Comments

0.1 05/10/2016 Dominic Morgan 1st Draft

0.2 28/10/2016 Dominic Morgan

2nd Draft – updated provider

winter plans and A&E RIG

assessment


3rd Draft updated with

further provider winter plans

and latest A&E

Improvement Plan


4th Draft provider updates

and updated to address

NHSE assurance

3

Contents

Executive Summary .................................................................................................. 4

1. A&E Delivery and Winter Plan Development ................................................... 6

1.1 Learning from 2015/16 .......................................................................................... 7

1.2 Allocation of ORCP Resilience Funding .................................................................. 7

2. A&E Delivery Board Four-Hour Performance .................................................. 9

2.1 Governance: How the RIG actions and Winter Plan will be monitored and

implemented ......................................................................................................... 9

3. Operational Performance Management Framework (OPMF) & Escalation . 10

3.1 Operational Performance Management Framework (OPMF) ................................ 10

3.2 Daily Operational Management of the UCS ........................................................... 10

3.3 Common Understanding of Escalation .................................................................. 11

3.4 Individual Provider & System Status Reporting Daily Status Report (DSR) ........ 11

4. Provider Winter Plans and Demand & Capacity Modelling .......................... 12

4.1 Royal United Hospitals NHS Foundation Trust (RUH) ........................................... 13

4.2 SWASFT ............................................................................................................... 14

4.3 CareUK (NHS 111) ................................................................................................ 14

4.4 Sirona (BaNES Health & Social Care.................................................................. 15

4.5 AWP (Liaison Mental Health) .............................................................................. 15

4.6 BDUC (GP Out of Hours) .................................................................................... 16

4.7 BaNES Primary Care .......................................................................................... 16

5. Communications .............................................................................................. 19

6. Flu Vaccination ................................................................................................. 20

6.1 Public Vaccination ................................................................................................. 20

6.2 Health organisations internal protection ................................................................ 20

6.3 Pandemic Flu......................................................................................................... 21

7. Infection Control ............................................................................................... 21

8. NHSE A&E Improvement and Winter Plan Guidance – Self-Assessment ... 22

9. Other CCG’s Winter Plans ............................................................................... 24

10. Conclusion ........................................................................................................ 25


Executive Summary

The purpose of the Bath and North East Somerset (BaNES) A&E Delivery and Winter Plan

(referred to as ‘the Plan’ throughout the document) is to ensure that the BaNES health and social

care system is aligned in its delivery of the five main actions contained within the A&E Rapid

Improvement Guidance (RIG) and is also prepared and coordinated to respond to the anticipated

increased needs and service demands throughout the 2016/17 winter period (Q3 & Q4) and in

response to known periods of pressure across the health and care community.

2015/16 was very challenging both a local and national level resulting in the failure to deliver the

A&E standard. The BaNES Health and Care community did not experience recovery during quarter

1 or quarter 2 of 2016 as seen in previous years. High escalation at the Royal United Hospitals

Bath (RUH) has become the norm with increased demand, combined with increases in Delayed

Transfers of Care (DToC) impacting on limited capacity.

In response to the A&E pressure and associated poor performance NHSE has mandated System

Resilience Groups (SRG) to become A&E Delivery Boards (A&EDB) and provided a set of Rapid

Implementation Guidance (RIG) which sets out five main areas for action to be implemented ahead

of this winter. These areas are:

1. Streaming at the front door to ambulatory and primary care. This will reduce waits and

improve flow through emergency departments by allowing staff in the main department to

focus on patients with more complex conditions.

2. NHS 111 – Increasing the number of calls transferred for clinical advice. This will decrease

call transfers to ambulance services and reduce A&E attendances.

3. Ambulances – Dispatch on Disposition (DoD) and code review pilots; Health Education

England (HEE) increasing workforce. This will help the system move towards the best

model to enhance patient outcomes by ensuring all those who contact the ambulance

service receive an appropriate and timely clinician and transport response. The aim is for a

decrease in conveyance and an increase in ‘hear and treat’ and ‘see and treat’ to divert

patients away from the ED.

4. Improved flow – ‘must do’s that each Trust should implement to enhance patient flow. This

will reduce inpatient bed occupancy, reduce length of stay, and implementation of the

‘SAFER’ bundle will facilitate clinicians working collaboratively in the best interests of

patients.

5. Discharge – mandating ‘Discharge to Assess’ and ‘trusted assessor’ type models. All

systems moving to a ‘Discharge to Assess’ model will greatly reduce delays in discharging

and points to home as the first port of call if clinically appropriate. This will require close

working with local authorities on social care to ensure successful implementation for the

whole health and care system.

The A&EDB has undertaken a comprehensive assessment of the RIG and the conclusions and

actions are contained in the attached A&E Rapid Implementation Guidance (RIG) Detailed

Baseline Assessment and associated briefing.

5

20160930 A&E RIG Detailed Baseline Assessment.pdf

20160930 A&E RIG Detailed Baseline Assessment Briefing.pdf

The Bath and North East Somerset (BaNES) draft A&E Delivery and Winter Plan 2016/17 was

submitted to NHSE on 5th October and the received NHSE feedback embedded below has been

include within this revised version for the 4th November submission deadline.

161011 BaNES

improvement winter assurance.pdf

To aid identification of the updated areas within the plan and the actions taken to address the

assurance criteria these have been highlighted in the table below

A&E Improvement Plan Criteria 2 - A&E Delivery and Winter Plan Section 4.5 - AWP (Liaison Mental Health) & 4.1 Royal United Hospitals NHS Foundation Trust (RUH) Criteria 3 - A&E Delivery and Winter Plan Section 4.3 - CareUK (NHS 111) (updated) and Demand & Capacity Modelling Section 4.12 - Combined Clinical Hub (added) Criteria 5 - A&E Delivery and Winter Plan Section 1 - A&E Delivery and Winter Plan Development (Updated) Criteria 6 - A&E Delivery and Winter Plan Section 1 - A&E Delivery and Winter Plan Development (Updated) & the DToC Sub Group updated ToRs Criteria 7 - A&E Delivery and Winter Plan Section 1 - A&E Delivery and Winter Plan Development (Updated)

Criteria 8 - A&E Delivery and Winter Plan Section 4 - Provider Winter Plans (updated) and Section 3.6 - Multi Agency Discharge Event (MADE), MFFD Action Plan and Mandated Pre-Christmas 85% Occupancy Levels (updated) A&E Winter Plan assurance framework

Criteria 2 - A&E Delivery and Winter Plan Section 1.3 - System Capacity and Demand Plans (added)

Criteria 4 - A &E Delivery and Winter Plan Section 4.6 - BDUC (GP Out of Hours) & Section 4.7 - BaNES Primary

Care

Criteria 5 - A&E Delivery and Winter Plan Section 4.2 - SWASFT Winter Assurance Event (updated)

Criteria 6 - A&E Delivery and Winter Plan Section 4 - Provider Winter Plans (updated) and Demand & Capacity

Modelling Section 4.12 - Combined Clinical Hub (added)

Criteria 8 - A&E Delivery and Winter Plan Section 4 - Provider Winter Plans (updated)

Criteria 12 - A&E Delivery and Winter Plan Section 4.5 - AWP (Liaison Mental Health)

Criteria 15 - A&E Delivery and Winter Plan Section 4 - Provider Winter Plans (updated)

Winter Plan Further Updates

A&E Delivery and Winter Plan Section 4.8 - ATSL (NEPTS) Further Business Continuity


1. A&E Delivery and Winter Plan Development

The BaNES A&E Delivery Board will oversee the delivery of the NHSE A&E Rapid Improvement

Guidance (RIG) 5 main actions and the resilience of the BaNES Health and Care system across

the winter months. The plan has been developed with consideration against NHSE’s Winter and

A&E Improvement Plan Guidance (Section 8 NHSE A&E Improvement and Winter Plan Guidance -

Self-Assessment).

The plan has been in development since April 2016 and in collaboration with key partners across

the Health and Care system surrounding the RUH catchment area and takes into account the

NHSE RIG. It incorporates:

BaNES System Improvement Plan (SIP)

BaNES CCG ORCP Investments

Urgent Care QIPP programme

BaNES Operational Performance Management Framework (OPMF)

BaNES Escalation Framework

Planning, analysis and preparation for 2016/17 including the winter period has been undertaken in

a number of key events including:

Urgent Care Summit 24/03/2016

Dom Care Summit 21/04/2016

SUECN Repatriation Event 12/09/2016

Hospital to Care Home event 20/09/2016

NHSE South Central Winter Escalation Workshop 28/09/16

The RUH have refreshed their internal plan and have updated their role within the SIP and revised

their ToR for their programme board to reflect the RIG action. In addition to the RUH’s internal

Improvement Board actions, there has been on-going emergency and urgent care planning

undertaken by various supporting groups and forum to develop both ORCP schemes and

additional capacity across the winter period within BaNES to support system delivery. These

include:

DToC Action Group (Now A&E Delivery Board Sub Group)

CCG Urgent Care QIPP Group

SRG Clinical Sub Group (Now A&E Delivery Board Sub Group)

Arriva Operational Group (AOG)

There are a number of agreed next steps now completed and to further support the final

development of the A&E Delivery and Winter Plan and include:

Final Provider Winter Plans by 24/10/2016

Review of providers Winter Demand and Capacity assumptions 03/11/2016

A&E Delivery Board review of BaNES A&E Delivery and Winter Plan 03/11/2016

Review of NHSE revised Escalation Guidance (now released by NHSE)

7

BaNES Winter Workshop (24/11/2016)

Commissioned Discharge Demand and Capacity Modelling (03/11/2016)

Priority Actions for Next Month

Winter plan finalised and STP resilience workshop on 24th November

RUH multi-discharge event (MADE) arranged for 29th and 30th November with preparatory

workshop on 17th November

D2A workshop in November supported and facilitated by ECIP

Further output of demand & capacity modelling by SCWCSU

20161103 Four Hour Performance A&EDB Briefing.pdf

06. 20161031 4-Hour System Improvement Plan.pdf

1.1 Learning from 2015/16

To ensure a more robust approach in 2016/17 the CCG developed a number of key actions based

on the identified learning from 2015/16. The key lessons learnt have been set out below and this

plan has been designed to address each of the areas of concern.

Each provider has been required to develop robust demand and capacity modelling across the

winter period to include the latest demand intelligence to build strong planning.

Review of the whole system escalation policy and internal provider actions to support both

provider internal and whole system escalation.

All partners to take key action in advance of winter to reduce NEL demand and NEL

admissions with the RUH.

Increased action to reduce Ready for Transfer (RfT), DToC and stranded patients within the

RUH and Community capacity.

Early allocation of ORCP resilience funding and to support external acute capacity to

support flow.

1.2 Allocation of ORCP Resilience Funding

The CCG has agreed ORCP schemes worth £1.136m into 2016/17. The funding includes

£300,000 of ring-fenced funding to existing schemes within BaNES to reduce NEL and support

NEL activity within the RUH, with £836,000 to support agreed ORCP resilience schemes in

2016/17 to further reduce impact on the RUH and improve patient flow. These schemes have been

centred on external support to the RUH to cover the agreed priority areas of:


Continuation of 2015/16 ORCP resilience schemes into April 2016 (NHSE Requirement)

Sirona expansion of Discharge to Assess (D2A)

Dorothy House Additional EOL support capacity

Supporting 7 day Discharge Liaison from Sirona within the RUH

Supporting Earlier Presentation model within BaNES to reduce NEL admissions

Further funding has been held for potential further winter capacity in BaNES following the

outcome of the SCWCSU’s Discharge Demand and Capacity Modelling

The table below summarises the ORCP resilience spend and funding decisions in 2016/17

20160630 BaNES ORCP Allocation 2016-17 Briefing Note v1.pdf

1.3 System Capacity and Demand Plans

BaNES A&EDB has commissioned additional CSU capacity to support the creation of a new

Discharge Demand and Capacity Planning tool. The initial headline findings have been shared

within the November A&EDB. The planning tool has shown the purchase of the 17 additional beds

into the BaNES UCS in 2015/2016 made no material difference to the UCS and to the RUH 4 Hour

Standard performance.

The Planning tool has shown the main areas that need where capacity needs to be flexed to

support whole system flow. BaNES CCG and LA are working through the capacity and flow

recommendations. The Planning Tool will allow the UCS to test the effectiveness of demand and

capacity interventions.

9

2. A&E Delivery Board Four-Hour Performance

The BaNES A&EDB was established on 1st September in shadow form following NHS England

and NHS Improvement’s letter of 28th July 2016 which set out a clear expectation to get four hour

performance back on track.

As a result of the continued poor four-hour performance, the RUH agreed to an offer of intensive

ECIP support. ECIP visited the RUH on 7th September 2016 to review emergency flow across the

internal acute pathway. The areas identified for improvement included:

SAFER bundle benefits realisation through collaboration with medical specialties

Increasing non-elective ambulatory medical activity and % of medical take through

ambulatory care

Medical outlier management

The consistency of offer around discharge to assess (D2A) at home pathway, a whole

system priority

20160930 Four Hour Performance A&EDB Briefing.pdf

2.1 Governance: How the RIG actions and Winter Plan will be monitored and

implemented

The Chief Officer of BaNES CCG has been confirmed as the Chair of the A&EDB. Revised terms

of reference and executive level representation along with a revised governance structure to

oversee the A&E Improvement Plan have been circulated and are expected to be signed off at the

A&EDB on 6th October.

The main purpose of the Board is to drive improvement in performance by managing the delivery

of the A&E Improvement Plan, holding to account the local urgent and emergency system to

ensure effective working and to identify and respond to risks that would prevent the system

meeting its core responsibilities.

An Urgent & Emergency Care STP Programme Board is overseeing delivery of the identified

priorities across the STP footprint. This Programme Board meets on a monthly basis with

fortnightly telephone conference calls between the three CCGs in between to ensure momentum is

maintained.

The current work stream priorities, identified through a series of workshops earlier this year,

incorporate and focus on the delivery of the key “must dos” that feature within existing and the

recently published 2017-19 Operational Planning and Contracting Guidance. Work within the STP

for Urgent and Emergency Care is and will continue to add value to the existing work currently

targeting the delivery of these “must do’s” (in particular implementation of the five A&E rapid

improvement initiatives) and continuous effort is being made to ensure that duplication of reporting

is minimised as a collaborative and information sharing approach across the Footprint is

established.


Figure 1. Draft AE Delivery Board Governance Structure

05. AE Delivery Board ToR Draft V4.pdf

3. Operational Performance Management Framework (OPMF) & Escalation

The primary responsibilities of the A&EDB is to ensure patients within BaNES Local Health & Care

Economy (LHE) receive safe and effective care, while maintaining financial stability of all partners.

These requirements do not change during times of increased pressure created by demand

throughout the year, but should be integral to normal system planning. To ensure this approach is

maintained, all service providers are required to complete National Health Service England (NHSE)

directed Operational Resilience and Capacity Planning (ORCP), based on robust demand

predictors, to ensure the correct levels of demand throughout the planning cycle and incorporating

appropriate service level provision at all times.

3.1 Operational Performance Management Framework (OPMF)

To ensure the delivery of safe services across the LHE, an OPMF is in place.

3.2 Daily Operational Management of the UCS

To measure and assist in forecasting the ‘heat’ within the system on a daily basis the OPMF

establishes the management of the daily operational performance supported by a daily Urgent

Care Dashboard (UCD).

11

The UCD has been designed to be information rich and not data rich to allow an increased focus

and oversight of the LHE measures that support better real-time operational pro-active decision

making.

3.3 Common Understanding of Escalation

To help create a more uniformed approach there is a common language and common

understanding of escalation used within the LHE below. This has helped to remove some

confusion and decreased the conversations around interpretation, to allow partners to further

concentrate on finding solutions.

Planned Escalation – provider demand and capacity planning has identified a degree of

flexible capacity which is used as part of managing flexible demand.

Unplanned Escalation – provider demand and capacity planning has been exceeded due

to significant unforeseen additional demand pressure (Major incident, rising tide event etc.)

3.4 Individual Provider & System Status Reporting Daily Status Report (DSR)

To enhance this approach the OPMF has established the daily operational status declaration

processes for both all providers by 10.00am and across the whole UCS, set by the CCG by

11.00am. These processes have been established to provide daily operational leadership of the

whole UCS and recorded within the shared Daily Status Report (DSR). All providers are required to

determine their daily status when measured against the agreed matrix set out within the BaNES

A&E Delivery Board – Operational Performance Management Framework (OPMF) and Escalation

Policy

2016 BaNES A&E Delivery Board – Operational Performance Management Framework (OPMF) & Escalation Policy v1.pdf

3.5 NHSE South Central

NHSE South Central is putting in place the following support:

The NHSE SC Escalation Standard Operating Procedure and supporting Action Cards will

be refreshed to reflect this new guidance before distribution locally across SC;

A new NHS England-SC web page will be set up to store information relevant to winter,

escalation and urgent & emergency care. The webpage is in development and the link will

be shared in due course

All the presentations from the recent winter workshops will be saved here alongside key

information including relevant articles, papers, guidance and other related documents.


3.6 Multi Agency Discharge Event (MADE), MFFD Action Plan and Mandated Pre-

Christmas 85% Occupancy Levels

To further prepare for winter a Multi Agency Discharge Event (MADE) has been arranged for 29th

and 30th November with preparatory workshop on 17th November. This event will follow the NHSI

Rapid Improvement Guide (RIG) and will bring together the local health system to:

Support improved patient flow across the system

Recognise and unblock delays

Challenge, improve and simplify complex discharge processes

The UCS will be monitored to consider further MADE weeks if required.

The A&EDB is working with all system partners to produce a revised bespoke Multi Agency

Discharge Event (MADE) action plan including 2015/2016 lessons learnt to conduct a reduction of

delays in downstream delays and to achieve the mandated Pre-Christmas 85% occupancy level.

The A&EDB has further requested the A&EDB DToC Sub Group to formulate the updated MFFD

Action Plan.

Rapid Improvement Guide to Multi Agency Discharge Event - FINAL.pdf

4. Provider Winter Plans and Demand & Capacity Modelling

To further aid the preparation for this winter and provide some mitigating actions for January’s

performance the STP Urgent Group has agreed to hold an STP Winter Workshop. All partners

want to be sure they are in as good a position as possible and provide the A&EDBs with confident

in the system’s ability to improve and sustain delivery over the winter months and this event will be

an opportunity to further test system resilience. The event will cover:

Systemwide, what we know – demand and surges across the period (Dec16 to April 17)

and the role of Leadership

Escalation Review - Operational Pressure Escalation Framework (OPEF)

MADE Events - what’s needed to achieve these?

Winter Plans - including risks and mitigations

Presentations from RUH, SFT, GWH, SWASFT, CareUK, AWP, WC&H, SEQUEL/GWH,

Sirona and Medvivo. Please use the attached presentation template to aid timings.

BSW STP Systemwide Communication Plan

Next Steps

This STP event will support the delivery of the overall system KPIs in additional to the good

progress made with demand & capacity modelling work which will provide further focus for the

A&EDB.

13

20161027 STP Winter

Workshop Provider Presentations Draft v1.pptx

4.1 Royal United Hospitals NHS Foundation Trust (RUH)

The Royal United Hospitals NHS Foundation Trust (RUH) has provided their internal board paper

which provides an overview of their Operational Resilience and Capacity Plan (ORCP) for Urgent

Care which has been developed in parallel to planned care. The overall aim of the plan is to

provide assurance that there is system resilience and robust planning to achieve and sustain the

key acute trust performance targets;

4 Hour emergency access

RTT

Cancer Waiting Times

The plan details Trust operational resilience planning including;

Assessment and admission

Clinical site management

Transfer and discharge

Patient and carer involvement

Severe weather procedures

Pandemic flu planning

Infection control

Business continuity

The plan provides assurance that there is a robust Urgent Care Programme in place for 2016/167

at the RUH with a clear governance structure reporting into both the transformation Board and

Management Board, and can demonstrate core membership of the three A&EDB’s and urgent care

operational delivery groups. Programme performance monitoring is monthly against both project

and trust wide KPI’s and metrics as part of the agreed 2016/17 Urgent Care Programme. The

2016/17 programme also provides assurance of the 2016/17 programme delivery, sustainability of

benefits and current risks to delivery.

The plan details the capacity modelling undertaken to determine the capacity required to

deliver non-elective care including planned and unplanned escalation requirements

RUH - Winter Plan Paper.pdf

The RUH has provided further assurance within the A&E Improvement Update and to A&EDB on

the RUH target of 30% use of Ambulatory Care and have predicted achieving this by the end of

January 2017.


4.2 SWASFT

The purpose of the SWASFT Winter Plan is to provide an overview of South Western Ambulance

Service NHS Foundation Trust’s (SWASFT) arrangements for the sustainable delivery of Urgent

and Emergency Care Services within its operational area from 1st November 2016 to 1st March

2017.

The plan details arrangements for the provision and delivery of the following core services:

999 Accident & Emergency Services including Clinical Hubs

NHS 111 Services within Cornwall and Dorset

Out of Hours (OOHs) services within Dorset and Gloucestershire

Tiverton Urgent Care Centre (UCC) Service

The SWASFT Winter Plan reflects the live and continuous nature of the Trust’s planning for the

winter period and as a result this plan will be updated regularly to ensure that it provides an

accurate reflection of the Trust’s preparedness at any given time.

The plan also sets out how the Trust will contribute to NHS England’s requirements on A&E

Delivery Boards to accurately forecast activity for the winter period.

Since the submission of the first draft commissioners have held a South West SWASFT Winter

Assurance Event, while assure overall, the North Division (Old GWAS area) have requested further

assurance on the mix of Double Crew Ambulances (DCA) virus Rapid Response Vehicles (RRV)

following the introduction of the Ambulance Response Programme (ARP). SWASFT is providing

this the North Division commissioners as separate assurance action.

Winter Plan 2017 1 19 Trust Format 241016.pdf

4.3 CareUK (NHS 111)

The CareUK Winter Plan describes the detailed understanding of the historic volumes, service

level achievement, external influences and technical changes that will have impacted on historic

volumes, or have the potential to impact on future volumes.

CareUK rolling forecast has been developed to replace the Supply versus Demand model originally

produced at the start of the service and replaced the original model in September 2014. The

rolling forecast is based on the volumes seen from September 2013, with allowances for additional

contracts and seasonal variation. Bank Holiday Modelling is contained within the Rolling Forecast,

but allows for planning on a day by day rather than weekly volume basis, with

validation/commentary as adjustments made based on volumes seen closer to actual dates. This

rolling forecast is updated on a daily basis, to ensure prompt reaction to trends seen.

As a seasonal trend is now visible in terms of volume data now being available for more than 12

months, showing the variation between the winter and summer months on a day by day and week

15

by week basis). This pattern is used as the baseline for all forecasting processes (to include the

full impact of the winter 2014/5 and Winter 2015/2016) As the historical 2015 volumes and the

2016 volumes to date will reflect the expected uplift between Summer and Winter, a further 7.5%

has been added to the volumes from Winter 2015/2016 to provide additional resilience.

For winter and Christmas 2016/2017, actual call volumes from the same period last year were

used as a guide for planning. Detailed planning for Christmas and New Year 2016/7 has been

undertaken on a day by day basis.

Care UK 111 2016-2017 Winter Plan.pdf

4.4 Sirona (BaNES Health & Social Care

Current plans for the winter of Nov 2016-March 2017 do not include any investment for additional

resource or services. In addition there is a level of uncertainty within the existing teams due to

change of provider in April 2017 which is increasing vacancy levels within the community teams.

There is a risk that it is not possible to provide continuity of service as a result of emerging winter

pressures during mobilisation. Risk assessments are being carried out for each service to

understand any capacity/staffing issues. Appropriate risk-mitigation plans agreed with

commissioners to be put in place on a case-by-case basis. This risk has been included within the

A&EDB Risk Register.

BANES Winter Plan 16 17.pdf

4.5 AWP (Liaison Mental Health)

AWP’s Winter Plan has been developed in order to ensure minimum disruption to mental health

service delivery throughout the winter, and specifically, across Christmas and the New Year 2016 -

2017. This plan will link in with the Winter Plans of partner organisations, including the CCGs,

Acute Trusts, Local Authorities and Ambulance Trusts.

The AWP Winter Plan is shared externally with NHS England Area Teams and is available through

the Local Health Resilience Partnership to group members. Internally, the Plan is developed by

relevant teams, shared through relevant Operations meetings and the Trust Resilience Group.

The LDU Management Teams are responsible for ensuring that all staff within their LDU

understands the content of the Plan, their roles and responsibilities and the implications of the

Plan.

The A&EDB agreed not to pursue 24/7 liaison mental health services at this time as to meet this

standard would not be cost effective and would require significant investment.


AWP Winter Plan V7 8 Final.pdf

4.6 BDUC (GP Out of Hours)

The BDUC Winter Plan has been developed in collaboration with all members of the Bath

Operational Team and aims to demonstrate how plans will ensure the delivery of safe and high

quality services during potential periods of pressure. The Winter Plan:

Reflects a whole system approach to the delivery of services over the forthcoming winter

period

Builds upon lessons learnt over the previous year

Identifies the potential risks and sets out options and solutions to mitigate against them

BDUC have taken a pragmatic review of the anticipated winter pressures expected and drawn

information from all available sources to provide the best possible assumptions across the South

West. It should be noted that any remedial changes identified will be implemented prior to

December 2016 as it is vital that the standard of care, quality of services and legal requirements

are maintained even during the most challenging of situations. The potential impact on the patient

experience is considerable and during the winter period we will aim to ensure:

No unnecessary waiting or delays

No inequality of access to our services

BaNES is leading with other STP CCGs on the reprocurement of NHS 111 and OOHs working with

the other CCGs across the STP footprint to transform services towards the combined clinical hub

model.

Bath Doctors Urgent Care Winter Plan 2016-17_V1 3.pdf

4.7 BaNES Primary Care

Out of hours services are currently provided by BDUC. However, for core hours GP Practice PMS

contractual obligations note arrangements for access to ‘essential services’ – i.e. the management

of its registered patients or temporary residents that are ill (or believe themselves to be) within core

hours and to have in place arrangements for access to such services in core hours in case of

emergency.

The majority of practices also offer ‘Extended Hours’ providing appointments at times outside of

core hours in the evening and weekends in line with the NHSE specification. As part of the CQC

inspection process, key lines of enquiry include a review of how risks are anticipated and planned

17

for in advance by the practice (e.g. seasonal fluctuations in demand, the impact of adverse

weather, or disruption to staffing).

For registered patients aged over 75 there should be an accountable GP to ensure the essential

services are provided under the main GP contract, and to ‘work co-operatively with other health

and social care professionals who may become involved in the care and treatment of the Patient to

ensure the delivery of a multi-disciplinary care package’. In addition all BaNES practices are

expected to be offering additional appointments during 28th December – 31st March 2017 (approx.

10,000 expected in total) as part of the Urgent Care Escalation scheme.

The majority of practices also participate in the NHSE commissioned the Avoiding Unplanned

Admissions Directed Enhanced Service (AUA DES), which funds proactive case finding and review

for vulnerable people at risk of hospital admission. This describes a care coordination role for the

2% at risk registered population covered by this scheme. The AUA DES outlines the creation of a

register, and (where applicable) the development of personalised care plans, or, for all patients on

the register, undertaking at least one care review in the previous 12 months. The development or

review of care plans will be undertaken with the patient and (where applicable), their carer.

Alongside this, the CCG has funded three Early Home Visiting Service (EHVS) pilot schemes

running from October 2016 – March 2017. All three have now been mobilised. The aim of the

service is focussed on Primary Care patients who might otherwise be at risk of an unnecessary

overnight admission to Hospital, should they present later in the day.

BaNES has agreed to extend and fund the BaNES HCP Transfer third party vehicle through to 31st

March 2017 to provide further availability to GPs to maximise the use of Amb Care at the RUH and

to further reduce late presentations and reduce NEL admissions within the RUH.

4.8 ATSL (NEPTS)

Commissioners continue to work with Arriva Transport Solutions Limited (ASTL) to formulate their

Demand and Capacity their approach to winter. The A&EDB has requested further business

continuity planning to minimise the impact of the NEPTS performance on the wider system.

BaNES has agreed to extend and fund the BaNES HCP Transfer third party vehicle through to 31st

March 2017 to provide some additional on day transfer support to the RUH. NEPTS are continuing

to work with ATSL to deliver further system wide contingency. ATSL South West updated Winter

Plan to follow.

The A&EDB have requested that ATSL provide further assurance at the STP Winter Workshop on

24th November 2016.

4.9 Medvivo

The aim of Medvivo’s Operational Resilience and Capacity Plan (ORCP) is to describe Medvivo

Group’s approach to capacity planning in establishing and maintaining sustainable year-round

service delivery. The ORCP replaces the traditional winter plan in recognition that, whilst winter is

clearly a period of increased pressure, health and social care systems are experiencing year round


sustained and increasing pressure. A proactive, rather than reactive, approach is required in order

to build on lessons learned and to deliver robust, consistent operational resilience.

Medvivo Operational Resilience and Capacity Plan 2016.pdf

4.10 Wiltshire Health and Care

The Wiltshire Health and Care Winter Plan sets out the preparations and priorities for the operation

of adult community services over the winter of 2016/17. In doing so, it draws upon lessons learnt

from previous winters and summarises the main service developments that will have an impact on

the resilience and responsiveness of the services.

Wiltshire Health and Care Winter Plan 2016-17.pdf

4.11 Dorothy House Hospice Care (DHHC)

Continued demand on the Hospice at Home (H@H) service, which is partly funded by the 3 CCGs,

runs up to and beyond the SLA capacity being topped up by charitable monies. This year, as in the

rest of the NHS, we have not seen the quiet period so often seen in previous years over the

summer period. Our forecast is that at the end of this financial year DHHC will have provided over

24,000 hours of Hospice at Home care across our region (compared to the 17,000 hours paid for

by the SLA).

Coordination of our H@H care is now delivered 7 days a week 8am-7pm as standard, and the

RUH and community nursing and primary care teams have direct access to a registered nurse

during this time.

20160930 Dorothy House Hospice Care BaNES Winter Resilience Update.pdf

4.12 Combined Clinical Hub & Pharmacist Trial

The Severn Urgent and Emergency Care Network (UECN) is supporting a network trial to meet the

Commissioning Standards for Integrated Urgent Care by implementing a three month trial of an

Integrated Clinical Hub model Wiltshire are commencing on 3rd October 2016.

Providing a single point of access, the ICH will support and facilitate patient access to a clinical

advice and treatment services. Services will include NHS 111 providers, ambulance services, and

potentially expand to include emergency departments, social care, community services and GP out

of hours services, depending on early evaluation during the trial.

19

Pharmacist trial in the Virtual Clinical Hub (VCH). Following the national requirement to develop

clinical hubs to support earlier clinical review in patient pathways from NHS111, BaNES is leading

the use of pharmacists in the NHS 111 CareUK call centre as a means to enhance clinical review

for medicines issues. The preferred model is to leverage existing resources in the community via

the Directory of Services. Date to be confirmed.

5. Communications

Locally we will continue to support NHSE’s ‘Stay Well This Winter’ national campaign, and is part

of locally targeted activity through the CCG’s winter communications planning.

Stay Well This Winter is designed to ensure that people who are most at risk of preventable

emergency admission to hospital are aware of and, wherever possible, motivated to take actions

that may avoid admission over winter.

The campaign this year focuses on self-care, taking action to prevent getting ill (including taking up

flu vaccinations where offered) and getting advice from pharmacists when the first signs of illness

appear.

Specific communications activity includes:

Monthly press releases throughout winter period focusing on the four main

stages of the national campaign. Releases shared with local stakeholders,

partners and media and include local stories such as 2-year old receiving nasal

flu vaccine. Published on CCG website (approx. 550+ hits per week), shared on

social media (approx. minimum reach of 11,000 accounts per week).

Social media scheduled weekly, using national and local materials where

possible, and linking with local groups/prominent accounts to reach target

audiences (i.e. Age UK B&NES, Carers’ Centre, Bath Mums, B&NES Council,

Sirona, RUH).

News articles published in Bath Mums newsletters and website (online forum

with 6K members).

Council ‘Connect’ residents’ magazine double page spread (delivered early

December to 76K households).

Internal communications to CCG/provider/partner staff to gain support for the

campaign as well as take up of flu vaccination.

Paid advertising scheduled for end of November and early January in regional

press and on social media with ‘first signs’ messaging as well as being

prepared for Christmas/stocking up on medication.

Printed resources sent to local organisations including dentists and opticians,

children’s centres, health visitors, Viv Hollis learning disability nurses, leisure

centres, care homes.

Training/talks (specifically about flu) given to practice managers, practice

nurses, health visitors, district nurses, midwives, reablement team.


Communications activity for Stay Well This Winter will be evaluated where

possible including website and social media analytics, and questions testing

public awareness in B&NES Council’s annual Voicebox survey.

6. Flu Vaccination

Preparations for the impact of flu this winter covers three main areas, Public vaccination, Health

organisations internal protection and Pandemic Flu, each response being undertaken to ensure the

system is prepared is set out below:

6.1 Public Vaccination

Last year across Bath & North East Somerset, Gloucestershire, Swindon & Wiltshire (BGSW)

uptake of the seasonal flu vaccination amongst all of the eligible groups e.g. pregnant women, over

65’s, under 65’s at risk and eligible children were above the England average. However uptake of

the seasonal flu vaccination amongst health care workers’ across BGSW was 44.9%, lower than

the England average of 49.5%.

6.2 Health organisations internal protection

There is a National CQUIN that sits under the heading of NHS Staff Health and Wellbeing and has

been incorporated into 2016/17 contracts with SWASFT, AWP, RUH, Sirona, Dorothy House, BMI,

Circle. BDUC were strongly encouraged to take up this CQUIN however continued to decline but

they would actively promote flu vaccination to their staff.

The rationale for the CQUIN is Frontline healthcare workers are more likely to be exposed to the

influenza virus, particularly during winter months when some of their patients will be infected. It has

been estimated that up to one in four healthcare workers may become infected with influenza

during a mild influenza season- a much higher incidence than expected in the general population.

Influenza is also a highly transmissible infection. The patient population found in hospital is much

more vulnerable to severe effects. Healthcare workers may transmit illness to patients even if they

are mildly infected. The green book recommends that healthcare workers directly involved in

patient care are vaccinated annually. It is also encouraged by the General Medical Council and by

the British Medical Association.

There is a contraction expectation that they will be a 75% uptake of the flu vaccination and the

CQUIN will be paid in Quarter 4 because of the natural of the vaccine availability and roll out.

There is a lot of staff engagement involved in this CQUIN because last year we saw a national

drop in staff vaccination. There are rules within the CQUIN for partial payment but anything under

64% will receive no money.

RUH Occupational Health is very committed to achieving this target. They have engaged with

public health and asked for assistance in reviewing their CQUINS plans to ensure that they are

doing everything possible to promote the flu vaccination in an innovative and positive way.

Public Health had a Flu Myth Busting Seminar in September. Target audience were any provider

that had a Flu Staff Vaccination CQUIN attached including in this group were Care Home staff.

21

Those that attended found the session very useful. The RUH, Sirona, Dorothy house, BMI and

care home staff attended. BaNES LA are leading on the Care Homes on encouraging their staff

vaccinated to protect their patients.

6.3 Pandemic Flu

Significant arrangements are in place through the Avon and Somerset Local Health Resilience

Partnership, Influenza Pandemic Framework. The framework builds upon existing arrangements

for escalation and winter planning and should be read in conjunction with:

Avon and Somerset LHRP Communicable Disease Framework

Avon and Somerset LHRP Health Community Response Plan

Individual Organisations Business Continuity and / or Operational Influenza Pandemic

Plans

Avon and Somerset Local Resilience Forum (LRF) Excess Deaths Plan

Avon and Somerset LRF Pandemic Influenza Plan

This framework has been produced on behalf of Avon and Somerset Local Health Resilience

Partnership (LHRP) to support the delivery of an effective response in the event of an Influenza

Pandemic.

Avon and Somerset LHRP Influenza Pandemic Framework V1 0_1st Issue 29 September 2015.pdf

7. Infection Control

Each provider is responsible and has in place individual plans around the management,

containment and avoidance of infectious diseases such as norovirus and gastroenteritis and the

impact of infectious diseases closing beds are monitored as part of daily UCD. Further impact on

the community beds or care provision is also recorded and significant outbreaks are managed in

conjunction with the daily system calls. Routine system monitoring of any community outbreaks for

the Avon, Gloucestershire and Wiltshire areas is provided on a weekly basis by Public Health

England.

A new Outbreaks Information Pack for care homes is being prepared with Public Health which will

be highlighted in the Care Homes Forum newsletter. The CCG is also considering the possibility of

training on how to use this pack with care homes. The Care Homes Forum has had a presentation

on Infection and the Care Homes Information Pack.

Infection Control is a standing agenda item with sharing of information on outbreaks between

providers, council and CCG and avoidance support. The CCG’s Quality dashboard will capture

infection outbreak information so that we have up to date information at all times and can monitor

impact.


8. NHSE A&E Improvement and Winter Plan Guidance – Self-Assessment

BaNES A&EDB has undertaken a review against the NSHE best practice guidance and applied a

RAG status for each area. While 9 areas are assessed as green, there remain 8 areas assessed

as amber and this reflects the evolving nature of the A&E Delivery and Winter Plan for 2016/17.

Further updates will be provided as the plan develops.

23

BaNES A&EDB Self-Assessment - Winter Plan

Winter Plan RAG A&EDB Position

No. Criteria

1

Plans contain evidence that a review has taken place into the

management of winter 2015/16 and lessons are reflected in this year's

plan

GAssured, a number of system wide Demand & Capacity review events have

taken place.

2

Plans contain evidence for flexing capacity in the event of surge, across

the acute, community, residential/home care sectors and packages of

care. This should include the agreed multi agency triggers for extending

and withdrawing this extra capacity in a consistent cohesive manner YES

A

Partly Assured, individual provider and ongoing CSU commissioned system

wide Demand and Capacity modelling being undertaken, due at November

A&EDB

3

Plans contain clear 24/7 leadership arrangements for all organisations

and the mechanism to escalate issues in and out of office hours. These

should include CCG, Provider and Local Authority on-call arrangements

at an executive level. YES

GAssured, both tried and tested shared CCG and LA on call and Operational

Performance Management Framework (OPMF) in place.

4

Plans contain evidence of how Primary Care will work with the rest of

the system to support the management of flow, particularly on Bank

Holidays and out of hours YES

GAssured, additional primary care capacity funding now in place and

additional capacity agreed acroos the winter months.

5Evidence of robust plans for ambulance services providers to deal with

known activity peaks in demand across the winter period YESG

Assured, SWAFST have a Demand and Capacity plan incorporating the

latest Ambulance Response Programme (ARP) impact. ARP 2.2 new codign

set in place.

6Evidence of robust plans for NHS 111 providers to deal with known

activity peaks in demand across the winter period YESA

Partly Assured, robust Demand and Capacity evidenced from CareUK.

(Subject to workforce issues).

7

Plans contain evidence of a comprehensive local flu strategy with a

mechanism to monitor and performance manage provider and

community uptake of vaccination on a regular basis.

GAssured, public programme in place, provider and CQUIN’s to support

uptake in place and Pandemic Planning in place.

8

Plans contain actions for adverse weather which includes the clinical

impact of cold weather and snow as well as the impact on business

continuity. YES

A

Partly Assured, Adverse Weather resil ience remains the primary

responsibil ity of all partners. Further testing planned as part of STP Winter

Workshop (24/11/2016).

9

Plans contain a clear focus on high risk groups and admissions

avoidance best practice including evidence for externally cascading

advance warnings and briefings YES

G

Assured, strong CCGs Comms plans in place. Avoiding Unplanned

Admissions Directed Enhanced Service (AUA DES), this enables care

coordination role for the 2% at risk registered population.

10

Clear evidence of system wide escalation plans in l ine with the new

national framework with agreed consistent local multi agency triggers.

These triggers should include both escalation and de-escalation YES

G

Assured, system wide Escalation Policy in place. This will be subject to

review following any new NHSE guidance and further subject to testing as

part of BaNES Winter Workshop.

11Plans to contain processes for system-wide operational

sitrep/dashboard for daily review and escalation reporting YESG

Assured, tried and tested OPMF in place supported by daily Urgent Care

Dashboard (UCD).

12Plans contain clear evidence of collaborative operational planning with

social services and mental health services YESG

Assured, all partners completing Winter Plans to include robust Demand

and Capacity planning.

13Plans contain processes to manage infectious disease outbreaks to

avoid (and contain) any D&V/norovirus impact YESG

Assured, all partners have robust infection control processes in place.

BaNES Infection Control Collaborative in place.

14

Plans contain clear and consistent multi-agency proactive and reactive

communications actions to promote appropriate use of local services.

YES

G Assured, robust CCG Comms Plans in place.

15Evidence that systems have mechanisms to test, or have tested, these

arrangements ahead of the winter period. YESA

Partly Assured, Full system monitoring in place, further testing being

undertaken as part of STP Winter Workshop (24/11/2016).

16The system has a strong track record of responding well together in a

swift and reactive manner YESG

Assured, long history of working together to resolve issues with OPMF in

place since 2013.


BaNES A&EDB Self-Assessment A&E Improvement Plan

9. Other CCG’s Winter Plans

Wiltshire - Due to the impact of the West Wiltshire demand volumes on the RUH, the Wiltshire

Clinical Commissioning Group’s Winter Plan 2016-17 has been included as support to this plan.

Both CCGs have agreed to capture their individual actions and ORCP investments within each

Winter Plan and for the ongoing monitoring and governance to be completed with the A&EDB.

Wiltshire CCG Winter Plans 1617 v0 4 latest.pdf

Somerset – The Somerset Winter Plan sets out the Somerset Urgent Care System planning and

delivery arrangements for 2016/17. The plan has been developed in collaboration with members

of the Somerset Urgent Care Programme Board to ensure the delivery of safe and high quality

services to the population during potential periods of pressure.

The Somerset Winter Plan:

Reflects a whole system approach to the delivery of services over the forthcoming winter

period

Builds upon lessons learnt within Somerset over recent years and in particular from Winter

2015/16

Winter Plan RAG A&EDB Position

No Criteria

1Plans demonstrate the new governance arrangements and clearly

outlines roles and responsibilities.G

Assured, A&E Delivery Board in place, Revised ToR to be agreed in

November A&EDB. Executive level representation agreed.

2Plans have evidence for delivering ED streaming (against criteria set out

in RIG) by November 2016G

Assured, Front Door ED streaming in place provided by BDUC being co-

located at the RUH ED.

3Plans demonstrate delivery of an increase in NHS 111 calls being

handled by clinicians (against criteria set out in RIG) By November 2016 A

Partly Assured, Robust Demand and Capacity planning in place, however

they remains questions about the workforce and recruitment cover

predicted resources.

4Plans demonstrate delivery of ambulance response programme

initiative (against criteria set out in RIG) ahead of winter 2016/17G

Assured, SWAFST are the national trial leaders for the Ambulance Response

Programme (ARP). ARP 2.2 New coding now in place.

5Plans contain evidence to implement measures to improve flow through

the system (against criteria set out in RIG) by November 2016A

Partly Assured, While some strong action has been achieved a number of

schemes remain as trials or require mobilisation.

6

Plans contain evidence of implementing best practice measures to

improve discharge processes (against criteria set out in RIG) by

November 2016

A

Partly Assured, While some strong action has been achieved a number of

schemes remain to be fully mobilised and are subject to further

development

7

Evidence of delivery of other improvement actions being taken to get

back to delivery of trajectory (if off track) and timescales for when these

will be achieved

A

Partly Assured, SIP in place across the system , it remains early days in the

delivery of the full impact of the multiple projects. This is subject to the

tripartite monitoring process. Recent performance has shown strong

improvement.

8The system has a strong track record of working well together to deliver

multi agency actionsG

Assured, there is a long history of cross system working, however the

effectiveness of collaborative working remains difficult to evidence

sustaining improvement.

25

Illustrates the approaches to infection control and the seasonal flu campaign

Outlines the communications being used over the winter period

Identifies the challenges, risks and mitigating actions required

Somerset Winter Plan 2016-17 final.pdf

Swindon - Swindon’s Winter Resilience Plan 2016-2017 has been developed to address expected

demand over Q3 & Q4 and outline sufficient resilience management across the organisation and

expected planning across partnership provision to cope with this demand and includes:

Identify profile demand across Q3 and Q4 1016 / 2017 and gap from expected normal

system demand

Define additional schemes and actions which contribute to increased capacity management

Quantify contribution to understand demand management and KPI /capacity expectation

Incorporate lessons learnt from Winter 2015/2016

Define clear expected contingency actions across Silver and Gold levels routinely which will

be considered within periods of pressure to regain system control

SWINDON WINTER RESILIENCE PLAN 16-17.pdf

10. Conclusion

The A&EDB recognises the requirement to deliver a robust and comprehensive Winter Plan to

ensure that patient safety is maintained throughout the Winter period and that as a system we are

able to deliver the agreed 4 hour Improvement Trajectory for Quarters 3 and 4.

The A&EDB will continue to plan and challenge all partners to ensure both objectives are

delivered.

The A&E DB has formally reviewed and sign off the plan on the 3rd November 2016.

Bath and North East Somerset (BaNES) A&E Delivery and ......2016/11/03 · Bath and North East...

Documents

Transcript of Bath and North East Somerset (BaNES) A&E Delivery and ......2016/11/03 · Bath and North East...