Winter Plan Prepared by Systemwide Winter Planning Group Approved - - PowerPoint PPT Presentation

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Winter Plan Prepared by Systemwide Winter Planning Group Approved - - PowerPoint PPT Presentation

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2018/19 Oxfordshire System Winter Plan Prepared by Systemwide Winter Planning Group Approved by Integrated System Delivery Board August 2018 1 Aim of the System Winter Plan Winter period is 1 November 2018 to 31 March 2018 To ensure the

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SLIDE 1

2018/19 Oxfordshire System Winter Plan

Prepared by Systemwide Winter Planning Group Approved by Integrated System Delivery Board August 2018

1

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SLIDE 2

Aim of the System Winter Plan

Winter period is 1 November 2018 to 31 March 2018

2

To ensure the Oxfordshire health and care system:

– is Resilient throughout the winter period - providing safe, effective and sustainable care for the local population – has sufficient Capacity available to meet likely demands over winter – is able to deliver Care for Patients/clients in the most appropriate setting – ensures Safe and Effective transfer of patients/clients within the system – Is able to Achieve national and local access targets and trajectories across the system

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SLIDE 3

Home First Ethos

3

  • Prolonged bed rest in older people can lead to substantial loss of muscle

strength and physical activity. 10 days in a hospital bed (acute or community) leads to the equivalent of 10 years ageing in the muscles of people over 80.

  • Patients’ time is the most important currency in health and social care

#Red2Green #Last1000days #endPJparalysis

  • ‘No Wasting of Patient’s Time’ –

Unnecessary Waiting + Sleep Deprivation = Deconditioning Our overarching aim is to prevent deconditioning and enable independence for older people in hospital.

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SLIDE 4

Oxfordshire’s Winter Plan

On a page

The Issues The Risks

Demand risks

  • Significant increase in flu
  • Significant adverse weather event
  • Significant supply chain issue

Capacity Risk

  • Major provider failure
  • Major staff shortages
  • Significant business continuity issue

A shared business continuity approach to managing risks

The Actions

  • Organisational winter plans
  • Shared agreement
  • An investment portfolio
  • Projects to make the difference
  • An integrated winter team to

deliver and manage across the system

The Team

  • A winter director coordinating a

single team (OCC / OUHFT / OHFT / SCAS / OCCG ) managing flow and performance across the health and social care system

  • Seconded in staff, responsibility, and

authority

  • Operating seven days a week, 8 to 8
  • The winter director accountable to

chief executives and works with COOs across the system to build trust and deliver outcomes

The Outcome

  • 600
  • 400
  • 200

200 400 600 800 1,000

  • 600
  • 400
  • 200

200 400 600 800 1,000

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SLIDE 5

THE ISSUES

What is the size of the winter gap and what is driving this?

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SLIDE 6

The A&E department Patient flow

Long stay patients Discharges Bed

  • ccupancy

Flu Resilience Workforce Admissions

Key factors

Who’s occupying the beds

The A&E department, demand and discharges improved in 2017/18 In hospital metrics deteriorated in 2017/18

Rising occupancy reduces performance, with accelerating effects above 92% 1/3rd of the growth in emergency admissions came from flu in winter 17/18 Long stay patients can decrease performance by reducing bed flexibility

NHS Improvement Economic Review Oxford: summary of factors affecting performance

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SLIDE 7

7

362 177 258 173 429 329 344 397 308 387 523 506 702 918 764 811 822 647 777 441 416 590 735 731 557 418

Capacity and Demand Gap Bed Days

Bed day gap (CF)

The Gap Over Winter

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SLIDE 8

THE RISKS

What are the key risks the winter planning group were concerned about?

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SLIDE 9

Demand risks

  • Significant increase in flu
  • Significant adverse weather event
  • Significant supply chain issue

Capacity Risk

  • Major provider failure
  • Major staff shortages
  • Significant business continuity issue

9

Key Risks

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SLIDE 10

Business Continuity (Plan B)

  • Agreement to bring together BC leads across
  • rganisations to plan responses to risks
  • The winter director will lead this in

conjunction with the winter planning group.

  • Shared responsibility and shared plans
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SLIDE 11

THE ACTIONS

What have we done so far

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SLIDE 12

Learning from Winter 2017/18

  • Building on work already started in 2017/18 we aim to

further strengthen our Home First approach

  • There are further opportunities to improve flow out of

hospital through a person-centred approach focussed on people’s strengths and capital. Using the learning from the Age UK work in short stay wards and Red Cross Pilot in ED.

  • We can continue to make significant improvements from

and high quality and consistent MDT approaches and our approach to long stay patients (e.g. OCC-OH work in community hospitals and OUH-OCC work around stranded patients)

  • System focus on long stay patient approach
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SLIDE 13

Partner organisations have created detailed winter plans focused on their areas of work. OUHFT, OHFT,OCC,SCAS are embedded in this slide

13

Organisational Winter Planning

Winter Plan 2018/19 Adult Social Care

Key Summary Information Description This document details Oxfordshire County Council’s approach to supporting health and social care over the winter of 2018/2019. The document records the key areas of focus and the planned changes to be made. These changes are aimed at ensuring people receive the right care, in the right place, at the right time, at a time of increased demand and system pressure. Date 24th July 2018 Author Craig Williams, Rachel Pirie, Victoria Baran, Steve Thomas Sponsor Kate Terroni, Director, Adult Social Care Senior Responsible Officer: Benedict Leigh, Deputy Director, Commissioning Karen Fuller, Deputy Director, Operations Version No 1.8 Final Draft Title Winter Plan 2018/19 (Update June 2018) Status For approval History Presentation to Finance & Performance Committee 13th June; Trust Management Executive 28th June. Board Lead(s) Ms Sara Randall, Acting Director of Clinical Services Key purpose Strategy Assurance Policy Performance SCAS Winter Plans Demand and Capacity Management Using Planning and Forecasting software we are able to accurately predict the demand for the winter period and then match this demand with staff hours. This includes reducing the annual leave capacity over the two week Christmas period as well as increasing OT and bank staff capacity as well as out private ambulance
  • cover. This has been effective of previous years and maintained a higher out put of
staff hours week 1 week 2 week 3 week 4 week 1 week 2 week 3 week 4 week 1 week 2 week 3 Start date End Date Lead 1 Staged Increase of community beds from 142-150 Carol Duncombe 1.1 Didcot increase by 4 beds 17/08/2018 Carol Duncombe 1.2 Abbey increase by 4 beds 01/09/2018 Carol Duncombe 1.3 Bicester will be back to beds by 16/8 due to painting work; then 8 additonal bed will incrementally be available by September bringing total to 132 16/08/2018 Carol Duncombe 1.4 Winter escalation beds at Didcot (+1); wallingford (+4); Linfoot (+2); Wenrisc (+2-4) bringing the total to 143 30/10/2018 Carol Duncombe 1.5 Increase SRU bed capacity from 16 to 20 depending on staffing in line with our core buisness- total bed stock 147 30/10/2018 Carol Duncombe 1.6 City staffing remains tenuous- options paper to be reviewed including considertations for virtual beds to plug the gap 30/09/2018 Carol Duncombe 2 Frailty Pathway- Bronze and Silver Lucia Winrow 2.1 Scheduled: business as usual, staffing and annual leave, training, 17/09/2018 Lucia Winrow 2.2 Two Hour Response: mapping out staff with frailty module training so they can be redeployed to pick up pateints form SCAS in 1 or 2 hour window. Clincal criteria with SCAS, comms to teams and sticker in patients homes. 18/09/2018 Lucia Winrow 3 COPD Lucia Winrow 3.1 proactive care plans 31/08/2018 Lucia Winrow 3.2 responding to scas within 2 hours 31/08/2018 Lucia Winrow 3.3 home oxygen reveiws suspended for some patients 31/08/2018 Lucia Winrow 3.4 PGDs for nebulaisers and steriod. Patient packs with drugs 17/09/2018 Lucia Winrow 3.5 pulmonary rehab for housebound when they discharged 17/09/2018 Lucia Winrow 3.6 staff top tips for other services 13/08/2018 Lucia Winrow 3.7 identify patients (550 per year) that have less than 48 hour stay 13/08/2018 Lucia Winrow 3.8 identify patient with LOS that over 10 days (67 patients) and reduce this by 1 day per patient 13/08/2018 Lucia Winrow 4 Care Home Support Lucia Winrow 4.1 identify five top care home that have most admissions and then undertake targeted work to reduce this 10/08/2018 Lucia Winrow 4.2 visiting weekly on the targeted care home 05/10/2018 Lucia Winrow 4.3 advanced care plans in place for patient 05/10/2018 Lucia Winrow 5 Hospital at Home (PML, OH and OUH) Chris Hewitt 5.1 Identify geographical areas each provider will be covering: north, city, south 13/08/2018 Chris Hewitt 5.2 Review of medical oversight for H@H; this will be funded by OH but can be presented as part of winter planning 13/08/2018 Robbie Dedi 5.3 Improve efficiences and capabilities to support the frailty pathway Gold working together with EMU's 17/09/2018 Jeane Fay 5.4 Roll out outreach programme and virtual ward to support the unscheduled care pathway 12/11/2018 Chris Hewitt 6 Rehab at Home Sandra Allen 6.1 Develop criteria for suitable patients: no medical input; singlehanded care; no night care; suitable for discharge to assess; requiring psychological support to reestablish indepdendence: testing indepedence concept at home 13/08/2018 Sandra Allen 6.2 Develop Rehab Assistant Competences for HCA's aligned with EMU and CTS 13/08/2018 Sandra Allen 6.3 Communications to stakeholders 30/09/2018 Sandra Allen 6.4 Learning from pilot in witney to re-establish Wallingford and roll out to other sites 31/10/2018 Sandra Allen 6.5 Discharge summary for 'Trial at Home' 31/08/2018 Sandra Allen 6.6 Video promoting new service 31/12/2018 Sandra Allen 7 Frailty Pathway Gold (To be confirmed) Robbie Dedi 7.1 Procurement considerations for Healthcare at Home Robbie Dedi 7.2 Consideration of agency ANP's to work with existing staffing Robbie Dedi OH System Wide Initiatives Aug-18 Sep-18 Oct-18
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SLIDE 14

Organisational Winter Planning

Primary Care (via OCCG)

  • Improve the uptake of flu vaccination, particularly in

children, and subject to vaccination availability undertake 75% of vaccination by 1 November 2018

  • Practices will proactively manage their appointments to

manage demand in the most effective way by using an increased proportion of same day urgent compared to routine appointments.

  • Practices will be asked to plan additional measures to

ensure patients have sufficient repeat medications to last them over the bank holiday periods

  • We will work to increase the number of pharmacies

providing the NUMSAS service and improve patient awareness of its existence.

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SLIDE 15

Shared agreement

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  • Collective responsibility for delivery across the system
  • There is system agreement on the target to create the required

bed equivalent capacity to support the Oxfordshire system for winter 18/19

  • We have system assurance on the bed equivalency impact

included within the plan and there is system commitment to close this gap.

  • Through the system winter group a number of out of hospital

initiatives have been developed and agreed which will provide further capacity.

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SLIDE 16

Winter Investment

  • In line with NHSE /I Operating Plan

guidance there is the expectation that funding is included within baseline.

  • The majority of the 18 specific

projects delivering change are in

  • rganisations baseline funding
  • An additional £700k has been

identified to further support winter within OCC/CCG Pooled Budget.

  • The approved projects are in this
  • slide. They are funded on the basis
  • f actual spend from November

2018 only, and is subject to the control of the winter team.

Project Cost

SOS Bus 25,191 Primary Care Visiting Service 40,640 PTS Support to ED and discharge 92,000 Home Care flow 100,000 Age UK Discharge Support* 60,000 Home First expansion 200,000 Mental Health Safe Haven** 30,000 Additional Beds *** 150,000 697,831

* plus £80k of STP funding for a total of £140k **covers 2 months, first call on savings against procurement to deliver for the rest of the winter period *** this is the mid case cost over already committed funding, a best case scenario on procurement could deliver a £391k

  • saving. Actual costs known 11/18
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SLIDE 17

Making the difference

200 400 600 800 1,000 1,200 OH Frailty Oxford and Witney Silver and bronze additional community hospital capacity 134-150 beds Hospital at Home (PML & OH & OUH) falls response 50% reduction in conveyance (based on Berks west) OCC initiatives 10% reduction in NEL from Horton A&E proposed primary care visiting service integrated respiratory team Impact of maintaining stranded /DTOC performance 18/19 Ortho-paedics Neuro ward PTS support Age UK Home first Efficiency in short stay (hub) bed days Extra hub bed days

Operational impact of OUH winter plan schemes John Radcliffe Horton Total NEL beds forecast to be occupied 13 August 2018 (low point) 472 108 580 Capacity increase Capacity increase Demand reduction Demand reduction Capacity increase Capacity increase John Radcliffe (beddays) Horton (beddays) Total (beddays) Extra hub bed days Efficiency in short stay (hub) bed days Home first Age UK PTS support Neuro ward 100% 80% 60% 100% 100% 40% 07-Oct-18 243 119 362 121.0 35 14-Oct-18 91 86 177 124.3 35 21-Oct-18 178 79 258 123.3 35 28-Oct-18 101 71 173 104.0 35 04-Nov-18 297 132 429 148.2 35 11-Nov-18 190 138 329 146.2 35 18-Nov-18 206 138 344 127.2 35 25-Nov-18 260 137 397 124.1 35 02-Dec-18 243 65 308 128.0 35 09-Dec-18 262 125 387 158.5 35 16-Dec-18 366 157 523 168.2 35 23-Dec-18 426 80 506 96.0 35 30-Dec-18 551 151 702 175 64.7 35 06-Jan-19 747 172 918 270 98.2 35 126 13-Jan-19 678 86 764 140 111.7 35 126 20-Jan-19 672 139 811 150 107.4 35 126 27-Jan-19 690 132 822 122 155.9 35 126 03-Feb-19 549 98 647 123.0 35 126 10-Feb-19 678 98 777 89 133.7 35 126 17-Feb-19 342 99 441 42 94.5 35 126 24-Feb-19 297 119 416 82.0 35 126 03-Mar-19 480 111 590 75.1 35 70 10-Mar-19 609 126 735 70 127.3 35 70 17-Mar-19 631 100 731 74 109.4 35 70 24-Mar-19 451 106 557 102.6 35 70 31-Mar-19 327 91 418 116.0 35 70 Total Bed days 10,566 2,954 13,520 1,132 3,071 910 1,358 Note: units expressed in Beddays (except right-hand column) Need to confirm whether new and non-OUH figures in are expressed in bed numbers or bed days The schemes where this still needs confirmation are shown in red Provisionally, I have multiplied the original figures by 7 (days a week) by formula, pending confirmation Confidence of deliverability Incremental NEL demand vs August 2018 (+ = more beddays required) OUH initiatives Brodie Ian (RTH) OUH: In original template these schemes were expressed in bed numbers; now converted into bed days by x 7. Brodie Ian (RTH) OUH: These target figures are now expressed in bed days (x 7) Brodie Ian (RTH) OUH: Includes extra hub beds Brodie Ian (RTH) OUH: Includes extra hub beds Windows User: 20% throughput increase on 123 baseline plus extra hub beds
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SLIDE 18

A system team

  • A winter director coordinating a single team

managing flow and performance across the health and social care system

  • Operating seven days a week, 8 to 8
  • The winter director accountable to chief

executives and works with COOs across the system to build trust and deliver outcomes

  • The integrated team acts for the system not for the

individual constituent organisations

  • The integrated team take responsibility for delivery
  • Members of the team work exclusively to deliver

performance across the whole system

  • The team needs to be largely self-sufficient and over

time will share team responsibilities across

  • rganisational and (where appropriate) practitioner

boundaries.

  • The team will have deployable resources to manage

flow which will be delivered from winter plan investment and prioritisation of business as usual

Provides an integrated approach to planning, daily escalation and delivery

  • f urgent care flow on behalf of the

system to achieve performance of

  • 4 hour trajectory and no 12 hour

trolley waits

  • No ambulance handovers over 30m
  • Super-stranded reduction trajectory

(inc. current level 2 escalation)

  • Better Care Fund DTOC trajectory

and local target to achieve 3.5%

  • Delivers the winter plan
  • Supports the development of a

longer-term approach to integration planning, escalation and delivery of urgent care beyond winter.

  • Manages system risk
  • Reports daily and longer-term

learning

  • Shares good news stories and

improves practice.

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SLIDE 19

Developing the team

  • The winter director job has been advertised.
  • There remains detailed work to be done on

the PID and mandate for the team.

  • In particular around the scope of control of

the team and the team members from each

  • rganisation.
  • This work will be done via a joint workshop of

COOs/winter planning group/winter team development group workshop.

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SLIDE 20

Communications Plan

  • The communication teams from OCCG, OHFT, OUHFT and OCC

are working together to support the production and delivery

  • f the Oxfordshire’s Winter Communications plan.
  • The plan aims to support Oxfordshire’s System Winter Plan
  • bjectives and to ensure that people are aware of and take

action to keep well and help avoid an admission this winter.

  • Activities tie together national initiatives, including the NHS

England ‘Help us, Help you’ campaign, which includes information on self-care and sign posting and the national seasonal flu campaign, with a focus on encouraging targeted groups to ensure they have their flu immunisation.

  • A proactive approach to media is being developed and media

partnerships explored to maximise positive coverage; this will be supported by a team of ‘spokespeople’ from across the system including the Winter Director.

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SLIDE 21

The actions

  • Organisational winter plans
  • Shared agreement
  • An investment portfolio
  • Projects to make the difference
  • An integrated winter team to deliver and

manage across the system

  • A clear communications plan
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SLIDE 22

THE OUTCOME

What have we done so far

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SLIDE 23

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362 177 258 173 429 329 344 397 308 387 523 506 702 918 764 811 822 647 777 441 416 590 735 731 557 418

Capacity and Demand Gap Bed Days

Bed day gap (CF)

The Gap Over Winter

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SLIDE 24

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362 177 258 173 429 329 344 397 308 387 523 506 702 918 764 811 822 647 777 441 416 590 735 731 557 418

  • 206
  • 395
  • 313
  • 378
  • 244
  • 342
  • 307
  • 252
  • 402
  • 359
  • 233
  • 184
  • 133
  • 204
  • 242
  • 207 -217 -243 -213
  • 469 -440
  • 209 -187 -176
  • 277
  • 428

Capacity and Demand Gap Bed Days

Bed day gap (CF) Bed day gap after schemes

The Gap Over Winter

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SLIDE 25

25

362 177 258 173 429 329 344 397 308 387 523 506 702 918 764 811 822 647 777 441 416 590 735 731 557 418

  • 206
  • 395
  • 313
  • 378
  • 244
  • 342
  • 307
  • 252
  • 402
  • 359
  • 233
  • 184
  • 133
  • 204
  • 242
  • 207 -217 -243 -213
  • 469 -440
  • 209 -187 -176
  • 277
  • 428
  • 135
  • 323
  • 241
  • 311
  • 136
  • 235 -204
  • 149
  • 287
  • 237
  • 109
  • 74
  • 28
  • 35
  • 32
  • 263 -236
  • 39
  • 6
  • 100
  • 249

Capacity and Demand Gap Bed Days

Bed day gap (CF) Bed day gap after schemes Bed day gap after risk adjusted schemes

The Gap Over Winter

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SLIDE 26

THE WHOLE PLAN

And questions

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SLIDE 27

Oxfordshire’s Winter Plan

On a page

The Issues The Risks

Demand risks

  • Significant increase in flu
  • Significant adverse weather event
  • Significant supply chain issue

Capacity Risk

  • Major provider failure
  • Major staff shortages
  • Significant business continuity issue

A shared business continuity approach to managing risks

The Actions

  • Organisational winter plans
  • Shared agreement
  • An investment portfolio
  • Projects to make the difference
  • An integrated winter team to

deliver and manage across the system

The Team

  • A winter director coordinating a

single team (OCC / OUHFT / OHFT / SCAS / OCCG ) managing flow and performance across the health and social care system

  • Seconded in staff, responsibility, and

authority

  • Operating seven days a week, 8 to 8
  • The winter director accountable to

chief executives and works with COOs across the system to build trust and deliver outcomes

The Outcome

  • 600
  • 400
  • 200

200 400 600 800 1,000

  • 600
  • 400
  • 200

200 400 600 800 1,000