National Winter Planning Conference 20 th June 2011 The NHSL Experience

1. National Winter Planning Conference 20th June 2011 The NHSL Experience

2. Debrief for Winter 2008/09 All Quiet on the Western Front • Command & Control was set up • Additional Troops were in place at the frontline • Totally unexpectedly • All of a sudden • Without warning Nothing happened!

3. Slightly different this year! • Command & Control was set up • Additional Troops were in place at the frontline • Totally unexpectedly • All of a sudden • Without warning

4. Slightly different this year! • Command & Control was set up • Additional Troops were in place at the frontline • Totally unexpectedly • All of a sudden • Without warning This happened

5. So What Happened 1 ?Infection Control • Norovirus rate was down – only 27 beds days lost • ICNs integrated in the winter planning • Consistent approach across sites • Staff were better informed and prepared for Norovirus • However, the plan was not really tested

6. So What Happened 2 ?Flu • Staff Vaccination only 15% - up to 26% • Too much variation at GP Practices • Pressure was put on intensive care with patients being ventilated in recovery areas • Significant levels of Respiratory Illness incl H1N1

7. So What Happened 3 ? Prevention of admission to hospital • Risk assessments for care managed patients • SPPARA used to identify vulnerable groups and additional visits were put in place • Anticipatory care plans were introduced incl all care homes – but had minimum impact this year • There were few real alternatives to admission

8. So What Happened 4 ? OOHs • BUSIEST YEAR EVER • The CPN service / Hub pharmacy staff valuable, • Patients could not regularly be redirected from A&E due to capacity

9. So what happened 5 ? Acute beds • Overall A&E activity was up on 2 sites • Emergency/respiratory activity up all sites • Offsite beds were utilised as planned • More delayed discharges than anticipated • The reduction in elective activity helped but still some pressure on beds • Winter exposed some UCCP issues – breaches were up • District nurses were PERCEIVED as a great support in acute

10. So What Happened 6 ?Discharges • There was a negative balance of discharges, although weekends and public holidays were better – • 2 Jan to 9 Jan – Very Pressured • Managers had to continually push for discharges • EDD were implemented but not kept up to date • Additional emergency diagnostic capacity did expidite discharges • An agreement with SAS supported transport of patients

11. So What Happened 7 ?Boarders • There was a significant number of boarders on each site Boarded patients were part of the daily bed management conferences • The main focus on boarded patients was to keep patients with similar issues in the same area rather than repatriate them, this allowed patients to remain in clinical specific areas longer and boarded towards the end of their stay

12. So What Happened 7 ?Adverse Weather • Impact was severe • Staff gave 130% -The Dunkirk Spirit • Different interpretations made on the policy • Staff were exhausted after walking miles in the snow to get to work, and then walking for miles to get to patients

13. Conclusions 2010 • The plan worked ? – but 12 hour breaches • The Single System approach worked • Staff worked above and beyond in difficult situations • Escalation and resolution was good • ERC reduced work for GPs

14. Where to for Winter 2011 (1) • Better Business Continuity Plans • Earlier Escalation and resolution of DDs • Agreements with SW re Homecare / Re Starts • Further Streamlined discharge arrangements • Clearer role for Community Staff at times of extreme pressure • Improved Boarders Performance • Senior Decision Makers in EDs – A Worry • Medical Staff on Wards – A worry too • Winter 2010 cost £500k plus – Another worry

15. Where to for Winter 2011 (2) • What would success be:- UCCP Performance / Trolley Waits - Elective Programme Re - Start- Numbers of Complaints- Escalation Events - Number of times system at RED- Flu targets Staff & Population- 7 day working