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NHS GREATER GLASGOW AND CLYDE WINTER PLANNING REPORT

NHS GREATER GLASGOW AND CLYDE WINTER PLANNING REPORT. Grant Archibald Director Emergency Care & Medical Services. Winter Planning Process (1).

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NHS GREATER GLASGOW AND CLYDE WINTER PLANNING REPORT

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  1. NHS GREATER GLASGOW AND CLYDEWINTER PLANNING REPORT Grant Archibald Director Emergency Care & Medical Services

  2. Winter Planning Process (1) • The 2010/11 Winter Plan for NHS Greater Glasgow and Clyde was developed on a single system basis and included partners who are involved in the delivery of services • Scottish Ambulance Service • NHS 24 • GP OOH Service • Mental Health and Addiction Services • ACUTE • CH(C)Ps • Dental Services • Pharmacy

  3. Winter Planning Process (2) • Board approved the Winter Plan in October 2010 • Final plan signed off by Chief Executive in November 2010. • Plan uploaded onto the Board website and sent to the Scottish Government • To support Winter Plan • Board wide Escalation Plan signed off in November 2010 – supported by Agency Escalation Plans • Senior On-Call Rotas for each agency • Winter Planning Group

  4. Timeline of Winter Pressures (1) • October 2010 – November 2010 • Key pressures re Delayed Discharges overall impact on A&E performance – • dropped to 96% and 94% respectively • 27th November 2010 – • Scottish Government introduced daily Severe Weather Winter Reporting to brief Cabinet Secretary. This required reporting on series of key indicators : • Number of Staff absences – Nursing/Medical/Other • A&E Activity • Number of 12 hour breachers • Cancelled outpatient clinics – • Cancelled electives • Discharges – number of patients occupying a bed who could not return home due to weather • Out of Hours – description of activity • Description of what plans were in place to manage over the next 24 hours

  5. Timeline of Winter Pressures (2) • 6th December 2010 – 27th December 2010 • Extreme snow fall/freezing icy conditions – sustained from this date until 20th December 2011 • Immediate impact on • SAS – transport fleet • Discharging of patients from hospital to home • significant numbers of staff had difficulty in getting to work during the first few days of the extreme weather • Increase in emergency orthopaedic trauma • Community Day Centres closed and some Health Centres closed • GP OOH – home visits • significant increase in emergency activity and admissions • reductions in outpatient and elective activity

  6. Timeline of Winter Pressures (3) • 29th December 2010 • Prevalence of H1N1 increases • 31st December 2010 • Severe Weather Reports extended to include Flu reporting • January 2011 – first two weeks • continued increase in emergency admissions • increased number of H1N1/Flu like/Respiratory illnesses • ITU demand increased significantly

  7. Winter Activity (1) • Wider Position : • GP OOH – 24th December 2010 to 5th January 2011 • 10% increase in overall activity • 25% increase in PC EC attendances • 90% Home Visits managed within the KPI timeframes • NHS 24 – 24th December to 5th January 2011 • 25% increase in call demand • 3rd January 2011 – highest daily call demand since festive period in 2004 • Category 3 calls – did not manage to respond to all within the KPI timeframes • SAS – 6th December 2010 to 5th January 2011 • 12% increase in GP calls to service • 5% increase in urgent (999) calls

  8. Winter Activity (2) • ACUTE : • A&E attenders • 24th December to 7th January 2011: 5% increase on previous year • Emergency Admissions • 25th December to 7th January 2011 : 9% increase on previous year • 1st to 5 th January Emergency medical admissions increased by more than 20% compared to 2009/10 • 3 days when emergency admissions exceeded 500 patients • 3 days when emergency medical admissions exceeded 300 patients • ITU activity increased significantly • UCC Performance • December : 94% • January to date: 90% • 12 hour breachers during period 24th December to 17th January - 9

  9. Winter Activity

  10. Winter Activity

  11. Winter Activity

  12. Winter Activity

  13. Response to Exceptional Pressures (1) ACUTE • Daily COO / Director level Winter Planning Meetings • Opened additional capacity – 98 beds • Extended opening of 5 day wards and CDU at Stobhill/SGH – 20 beds • Increased Paediatric ITU beds from 16 to 18 • 9 additional Adult ITU beds opened at peak time of activity during first two weeks in January 2011 • Elective programme reviewed - converted elective to emergency capacity – 24 beds • Increased number of consultant ward rounds • Increased Consultant input within A&E • Additional ambulances available Out of Hours • Improved utilisation of Minor Injury Units

  14. Response to Exceptional Pressures (2) GPOOH • Additional GPs available for PCEC centres at peak times of activity • 4 wheel drive vehicles used to support SAS accessing patients NHS24 • Category 3 calls – GP OOH supported managing this demand • Established Scottish Flu Response Line CH(C)Ps • Increased Home Visiting SAS • Implemented Escalation Plan • British Army, Coastguard, British Red Cross, and GPOO services called upon to assist in transportation of patients • Significant number of Outpatient and Day Hospital transport of patients cancelled • Ambulances focussed on hospital transfers and emergency cancers/renal patients

  15. Future Winter Planning (1) • Continue to progress planned improvements in length of stay and bed usage • Ongoing management of delayed discharges • Review plans to deal with exceptional surges in emergency activity • Review policies and procedures for managing in severe weather conditions • Continue to review patient pathway through A&E to reduce attendances/ admissions • improve utilisation of Minor Injury areas • assessment areas

  16. Future Winter Planning (2) • Review of all out of hospital measures – • alternatives to admission • early supported discharge • access to community services including mental health and addiction • GP Out of Hours Services • SAS - Review of Transport Fleet • GGHB Whole System Review of Winter Planning • National Review to consider experiences of all Scottish Boards and agencies

  17. Managing Activity Pressures • All Year Response to managing key pressures in system • System wide Improvement Action Plan for Unscheduled Care (ATOS) • March 2011 – Flow Mapping • Local team engagement to identify patient processes • May 2011 – Stakeholder Engagement Event – whole system • Presentation of data analysis • Identified key priority issues to be addressed • 17th June 2011 – Stakeholder Event to agree future workplan

  18. Managing Activity Pressures WAY FORWARD • Essential to recognise this is not just a product of extreme winter • A new paradigm in demand and capacity • Using structured analysis and tools to devise specific, hard edged solutions • Develop a programme of sustained improvement • Achieve a new system-wide steady state, which is also capable of managing demand variations

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