Operational resilience planning template for non-elective care 2014/15
document
Lead CCG:
Lead acute trust:
Hartlepool and Stockton on Tees
North Tees and Hartlepool NHS Foundation Trust
Central Resilience Funding
Marginal Tariff savings to reinvest
Other funding available locally
£1,994,286
N/A
N/A
Total non-elective care support funding for 2014/15
£1,994,286
Section 1: Narrative on local system configuration, key strengths and key challenges
The Hartlepool and Stockton on Tees local system sits within the Hartlepool and Stockton on Tees Clinical Commissioning Group (HAST CCG). It has two local authorities, Hartlepool Local Authority (HBC) and Stockton on Tees Borough Council (SBC), with populations of circa 93,000
and 193,000 respectively.
The acute provider is North Tees and Hartlepool NHS Foundation Trust (NTHFT), which provides district general hospital services over 2 sites in Stockton and Hartlepool. The main site at the University Hospital of North Tees, located in Stockton, provides: a Type 1 A&E with trauma
unit status, acute medicine and hyperactive stroke, critical care beds levels 1,2,3. NTHFT has an ambulatory care unit, 42 bedded emergency assessment unit and a short stay ward. Following service reconfiguration, in October 2013, all emergency and complex elective activity is
performed on the University Hospital of North Tees (UNHT) site with less complex elective surgery, diagnostics and rehabilitation services being provided at the University Hospital of Hartlepool (UHH). NTHFT consistently achieves to manage both elective and emergency demand
within its limited capacity during surges of activity, particularly within the winter period. It also provides community services which include child protection, district nursing, falls service, health visiting, palliative care, musculoskeletal services, podiatry, rapid response team, school
nursing, community stroke team and health trainers.
A walk in centre with a registered list is next to the North Tees hospital site providing a 7 day, 8.00 am to 8.00 pm walk in facility for minor injuries and minor ailments. A walk in centre and minor injury unit is also provided in Hartlepool 7 days a week from 8.00 am to 8.00 pm at One
Life Hartlepool.
Following winter 2013/14 an independent analytical review of services was undertaken. The identified challenging areas which the HAST CCG is focusing upon as part of its plans for winter 2014/15 include:
- Higher than the national recommended average for bed occupancy
- Higher delayed transfers of care
- Long waits in A&E
The key strengths of NTHFT include: a strong Board of Directors; efficient management structures; good clinical quality and outcomes; and supportive relationships with external organisations.
The key challenges faced by the Trust are: continuing to develop streamlined pathways of care to optimise patient outcomes and quality of care, providing appropriate care closer to home; managing demand within limited resources; preparing to provide services within a single site,
new hospital and maintaining efficiency and sustaining financial balance.
Referrals for neurology, major trauma and cardio thoracic are made to a tertiary centre at the James Cook University Hospital nearby in Middlesbrough
The North East Ambulance Service (NEAS) provides transport for emergency, urgent and routine health care. It is an essential component of the plan and require a regional approach for the plan to be most effective. Out of hours provision is provided by Northern Doctors Urgent Care
Ltd, 6.30pm to 8.00am across the locality Monday to Friday and over 24 hours throughout Saturday, Sunday and bank holidays
Within Hartlepool and Stockton there are 40 GP Practices and 55 Pharmacies
The strengths of the local system is its consistent achievement of the A&E 4 hour performance target, minimal ambulance handover and turnaround delays, community rapid response and NEAS R1 & R2 performance consistently achieved.
Challenges include Hartlepool having insufficient capacity to meet demand for nursing care home beds which leads to delayed transfers of care and causes patient flow delays within the trust. During surge the trust is unable to meet demand and requires additional beds during the
winter months which means it cannot always accommodate elective and non-elective care due to the shortage of nursing care home beds in Hartlepool.
Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) provides a range of mental health, learning disability, eating disorders and substance misuse services for the 1.6 million people living in County Durham, the Tees Valley, Scarborough, Whitby, Ryedale, Harrogate, Hambleton
and Richmondshire.
The HAST CCG has commissioned a range of initiatives with the voluntary sector which supports the delivery of these plans.
The work has been developed through the SRG which has worked on the key challenges and has reflected on the following scheme, ensuring that the funding reflects on the key challenges in the system plan.
Section 2: Minimum plan requirements. Please note that development of a sufficient plan to deliver all of these elements is a pre-requisite to qualify for any central resilience funding in 2014/15. More detail on these plan requirements can be found on page 8 of the
operational resilience and capacity planning document.
Text in blue italics is provided as examples only and should be overtyped
Timeframe for
Completion
Ref
Minimum Plan Requirements
1 Enabling better and more accurate capacity
modelling and scenario planning across the
system
Summary of plan to achieve requirement
The SRG has agreed to fund 16 resilience beds, this is additional capacity over and above NTHFTs core bed stock. This will
increase capacity to improve patient experience and patient flow within A&E during times of surge. While it is recognised
that increasing capacity in this area would have a possitive impact on ambulance handover delays, the analytical review
showed that NTHFT experienced very few delays during winter 2013/14.
NTHFT, SBC and HLA are working in partnership to revise the current policy for discharge/patient choice. The development
of this incorporates additional CHC capacity and nurse assessment resources to improve the discharge process. Further
schemes to improve discharges are set out in point 10.
The SRG has commenced work to implement a dashboard of indicators to monitor all funded scheme. Indicators will
include all NHS constitutional key performance indicators and locally agreed key performance indicator. The dashboard will
be in place and monitored every two weeks throughout the winter period, demonstrate impact of schemes on managing
surge pressures, and enable a robost evaluation of schemes post winter. As part of the evaluation process the SRG will
review both qualitative and quantitative meansures and will ultermatly inform future commissioning intentions. Following
evaluation and identification of areas for continuing improvement/ best practice a North East wide debrief event of winter
will enable the SRG and other SRG's across the North East to share and inform future modelling of services where schemes
implemented have proven successful.
All providers of health and social care services within the SRG are reviewing and updating their winter plans and
escalation/de-escalation plans for 2014/15. Winter plans set out how each organisation can meet the challenges of the
winter period, while sustaining service delivery throughout November 2014 to March 2015. These plans will be tested in
October as part of a North East wide event. The North East Escalation Process (NEEP) incorporates clearly defined triggers
and actions to assist in the operational management of surge pressures and identifies a numerical level (1 to 4) of
escalation which is recognised across the North East area. NEEPs will detail baselines at level 1 and as activity increases will
be aligned to escalation levels to ensure timely escalation and associated actions.
The SRG supports the concept of developing a flight deck tool. There will be a phased approach to the implementation of
the flight deck, with the implementation of phase winter 2014/14. Phase 1 will include the review and implementation of a
North East Divert Policy. The flight deck will support capacity and demand modelling and divert activity to alternative
hospitals during periods of surge based on intelligence. The NEAS emergency demand predictor tool gives a forward view
of demand which maybe faced. The prodictor also details contingency arrangements in place for escalation purposes. The
tool is shared across all health and social care provider organisations.
KPIs (which trust will be monitored against)
FT bed base (580)
Reduce length of stay within the FT - LOS
against peer (Baseline 4.54)
Bed occupancy (Baseline 87.8)
Consistently achieve the 95% A&E target
Reduce delayed discharges (Baseline 10)
Ambulance handover (NEAS Baseline 10,760)
and turnaround delays (13/14 Baseline 25 for
30-60mins, 3 for over 60mins)
Readmissions (Baseline 0.96 ratio(100 is avg)
NEEP Levels
Daily attendance in A&E (Baseline 189 (type 1)
Daily attend ambulatory care (Baseline 18)
Daily average discharges (Baseline 253)
Daily unplanned admissions (Baseline 85)
Annual unplanned admissions (Baseline
30,890, Plan 30,375)
Daily WiC activity (Hartlepool OneLife Baseline
81, Stockton Baseline 110)
Cancelled OPs over the previous 24hrs
(Baseline 74 (over 21 week winter monitoring
period)
Elective activity plan during winter monitoring
period (Baseline 47,975, Plan 47,987 tbc- re
RTT activity)
BCF metrics
Primary care dashboard
Underpinning the capacity and demand planning across the system are the BCFs which are focused on keeping people at
home longer.
Currently across Tees (South Tees CCG and Hartlepool and Stockton CCG) a GP paramedic support services OOHs has been
commissioned and shows to reduce accident and emergency attendances and to some extent non-elective admission,
creating additional capacity within NTHFT.
Additional national money has provided the opportunity to reduce 18 week waits to 16 weeks by undertaking additional
activity during summer months to reduce the likelihood of clashes between non-elective and elective care during the
winter months.
Work underway to map demand/capacity and identify gaps, undertaken by the Crisis Concordat is intended to improve
pathways for assessment across a wider system, including the Police.
The Directory of Service captures all service pathways and a regular assessment of dispositions ensures services are
meeting the needs of patients. Any gaps in provision are identified and discussed within the SRG. The NHS 111 Clinical
Governance Group is in place and a directory of service action plan has been developed and implemented. Any issues for
escalation are identified for the regional group to take action. In addition prior to any holiday period the directory is
reviewed and updated to ensure services are up to date.
A communication plan has been developed and will be implemented ahead of winter with the intention of encouraging the
public to use the NHS 111 service. The campaign 'talk before you walk' will encourage the public to use NHS 111 before
choosing to attend another health services. This will be a local campaign but further work is being conducted to see if this
could be rolled out across the North East. Key to this is ensuring the NHS 111 service is able to manage the additional
demand which the campaign is likely to generate. The SRG has identified a number of development areas in relation to 111,
as follows:
- Access to general practice and WiC slots navigated by 111
- Access to a seasonal ailment scheme navigated by 111
- Acute dental pain is the highest reason for the public calling NHS 111. Therefore there is a need to undertake an
assessment of service provision, linking with the Area Team to establish additional provision if required. Northern Doctors
Urgent Care to utilise OOH provision more by slotting people into appointments via NHS 111.
Monitoring of PTL
Weekly monitoring template submitted to AT
re: compliance
Target Outcomes
Reduce length of stay.
Comply with national recommended
average for bed occupancy of 85%.
Reduce the numbers of delayed
transfers of care.
Reduce the number of ambulance
hand over delays.
Plans and dashboards to
be completed by the end
of September.
We will comply with the
NHS constitution KPIs and
monitor all matrix to
ensure we will manage all
demand and capacity in
the winter period,
maintain quality and
financial balance.
Reduce the number of readmissions.
Reduce the number of A&E
attendances.
Reduce the number of unplanned
admissions.
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Lead Accountable Officer
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
Name:Jill Harrison
Email:
[email protected]
Job Title: Assistant director, Adult
services
Organisation: Hartlepool Local
Authority
Name: Sean McEneany
Email:
[email protected]
Job Title: Head of Adult services
Organisation: Stockton
Local Authority
Reduce WiC activity.
Reduce the number of cancelled
operations within the previous 24hrs.
Achieve the reduction of the 18 weeks
to 16 weeks via returns to area team
and monitoring of PTL.
Name: Douglas McDougal
Email:
Job Title: Team Leader for Tees
Organisation: NEAS
Estimated Costs
in 2014/15
£731,130
2
Working with NHS 111 providers to identify the Please also refer to section one for details on capacity and demand for NHS 111.
service that is best able to meet patients’ urgent
care needs
In order to increase the usage of the NHS 111 service the SRG has agreed to fund a communications campaign. See sectioin
1 for further details.
Work is underway to update mental health services within the directory of service. This will mean increased referrals into
the most appropropriate services for mental health and improve quality of care and patient experience.
Prior to schemes going live, the directory of services will be updated to incorporporate and ensure appropraite streaming
of patients is taking place.
3
Additional capacity for primary care
The SRG has committed funding for the following schemes:
A primary care scheme which is currently under development. Scheme to improve access to general practitioners.
Public communications campaign: Flu, GP/ Pharmacy opening and closing hours over bank holidays, patient leaflets etc. including bus shelters and leaflet drops.
Seasonal Ailment Scheme to work with 100 hour pharmacies and will assess and treat seasonal ailments, such as coughs
and colds. This will be a drop in service after 5pm and an appointment service in hours.
Total number of calls engaged
Total number of calls abandoned
No. of calls answered within 30 seconds
No. of calls answered within 60 seconds at the
end of the introductory message
No. of calls referred to Ambulance Service
within 3 minutes which are life threatening
Provision of interpretation service/
appropriate provision where required within
15 minutes of initial contact
Frontline staff and Advisors training in
recognition of safeguarding issues for adults
and children to an appropriate level
Percentage of answered calls triaged
Percentage of answered calls transferred to
999
Percentage of patients advised to attend
Accident and Emergency Department
Warm Transferred to NHS 111 service Clinician
where required
Maximum Warm Transfer Time (30 seconds)
Time taken for call back <10 minutes
Provision of all consultations (including
appropriate clinical information) to the
practice the patient is registered with by 8am
the next working day.
Percentage of frequent users (who call 111
more than 4 times a month) whose use is
immediately highlighted to their registered GP
An increase in use of 111 will provide a
seamless approach to primary urgent
care for service users. This will result in
patients receiving right care, in the
right place, at the right time.
We will see an increase in use of
pharmacies as part of the Seasonal
Ailment Scheme.
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Working towards KPI's for these schemes
• Increase capacity within General
Practice;
• Increase case management and
personalised care planning;;
• Increase internal practice review;
• Reducing avoidable unplanned
admissions
• Reducing re-admissions
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Reduce WIC/MIU attendances
Reduce Emergency Admissions
The following scheme will compliment the above but is not part of the SRG funding:
Reduce A&E attendances
The following scheme will be implemented from beginning of October:
Monitor access for 48hr GP appointments
1. Improved access and capacity for elderly and complex patients- increasing provide longer GP appointments (20mins) to Reduction in high intensity users
patients aged over 75 and patients with complex needs that equate to 2% of their practice list. Patients in the top 2%
Increase number of 20 minute appts
should be offered a 20 min appointment every three months. Patients over the age of 75 who aren’t identified in the top Increase number of patients that have a
2% should be offered an annual 20 minute appointment.
personal care plan
2. Proactive management of patients in nursing and residential care homes:
Increase number of care homes visited by a GP
This scheme requires practices to make a weekly care home visit where patients on the practice list are ordinarily resident. weekly
During this visit, GPs would be required to provide general care and provide intensive support to their acutely ill registered Increase the number of patients in a care
patients. In addition they will offer all eligible residents who are registered patients a pneumococcal/flu vaccination and
home with a care plan
develop relationships with care home staff and relevant education to the staff regarding patient care.
Increase the number of patients receiving a
It is also a requirement that all registered patients in care homes would have a personalised care plan
vaccination - flu and pneumococcal
3. Promoting integration and providing proactive care for patients with mental health conditions - to improve the quality of Increase the number of patient with mental
primary care for people with mental health problems, in line with the strategic direction of achieving parity of esteem
health condition with a care plan
between physical and mental health and to support the implementation of the Better Care Fund in 2015-16.
4
Improve services to provide more responsive
Points 4 and 6 both set out plans for 7 day working.
and patient-centred delivery seven days a week
NEAS will continue to provide 24/7 services
Mental Health - LD community service enhancement will provide a 7 day week service. Crisis for Younger Peoples Service
liaison (under 16s) 7 days per week.
BCF plans include:
- Stockton on Tees Borough Council : BCF schemes for HAST CCG: Scheme 1 Multidisciplinary Teams/ Scheme 2 Improving
Pathways and care for Dementia/ Scheme 3 7 Day Working/ Scheme 4 Joint Assessments/ Scheme 5 Digital Health Care/
Scheme 6 Narrowing Health Inequalities/ Scheme 7 ICT Systems and Data Sharing
- Hartlepool Borough Council: BCG schemes for HAST CCG: community - momentum programme/ integrated care
Reduce Emergency Admissions
Reduce A&E attendances
Monitor access for same day appointments
(face to face and telephone)
Reduction in high intensity users
Name: Emma Gordon
Email: [email protected]
Job Title: Senior Commissioning
Support Officer - Directory of
Services
Organisation: North of England
Commissioning Support Unit
This will reduce A&E and WIC
attendances.
Name: Carl Parker
Email:
Job Title:
Organisation:
Name: Deborah Bowden
Email:[email protected]
Job Title: Commissioning manager
Organisation: North of England
Commissioning Support Unit
Name: Paul Whittingham
Email:[email protected]
Job Title: Commissioning Manager
Organisation: North of England
Commissioning Support Unit
This will reduce patients length of stay
by providing 7 day working through all
services and offering a seamless
process from admission to discharge.
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Name:Jill Harrison
Email:
[email protected]
Job Title: Assistant director, Adult
services
Organisation: Hartlepool Local
Authority
Name: Sean McEneany
Email:
[email protected]
Job Title: Head of Adult services
Organisation: Stockton
Local Authority
£7,500
£238,037
5
SRGs should serve to link Better Care Fund (BCF) The BCF plans are being updated based on national requirements. Hartlepool area is undergoing an assessment of current increase in nursing home beds
principles in with the wider planning agenda
nursing care provision and development of a longer term plan for step up and step down services. Detailed modelling is
• admissions to residential and care homes;
underway to inform future commissioning intentions.
• effectiveness of reablement;
• delayed transfers of care;
Multi Disciplinary Team (MDT) approach in Stockton working with community matrons, Teams Around the Practice (TAPS) • patient / service user experience; and
and Community Integrated Assessment Team (CIAT) to enhance services.
• a locally defined metric – Dementia for
SBC/HBC
Voluntary Sector organisations have been commissioned for a range of schemes to deliver BCF outcomes. Some specifically • avoidable hospital admissions (See below)
to support timely discharge, provide support to people throughout their hospital journey and then at home. Working with
patients where practices have identified them as high risk using the risk profiling tool. Pro-actively working with people to
improve their health and well being.
This will help in the implementation of End October/ beginning of
the BCF and support admission
November 2014
avoidance, delayed transfer of care
and length of stay in hospital.
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
This will reduce patients length of stay
by providing 7 day working through all
services and offering a seamless
process from admission to discharge.
Name: Sally Thompson
mail: [email protected]
Job Title: Associate Director of
Operations (Emergency and
Anaesthetic Care Services)
Organisation: North Tees &
Hartlepool NHS Foundation Trust
NTHFT involved in the BCF Unit of planning to develop the plans for integrated service delivery that will contribute to
reducing hospital admissions
Hartlepool LA BCF Plan demonstrates the investment in 2014/15 for additional social work capacity.
Stockton on Tees BC BCF Plan outlined principles linked with the wider planning agenda. There is a shared system vision
and commitment to reduce emergency hospital admissions, reduce admissions into long term care , improve discharge and
reduce readmissions through reablement. It should be noted that the BCF plan will have a limited impact during 14/15 as
the plans will be geared at delivery during 15/16.
6
Seven day working arrangements
The SRG has agreed to fund:
- Extended pharmacy and phlebotomy services
- NEAS to provide patient transport for end of life and mental health patients - 10.00 - 20.00, 7 days a week
- NEAS to provide a discharge tranport service 7 day a week
- NTHFT 7 day working in Ambulatory Care, Pediatric Day Unit (PDU) and pharmacy as well as diagnostic working including
ultrasounds and phlebotomy services. NTHFT Community Integrated Assessment Team (CIAT) service have extended its
working day.
Reduce Length of stay
Timely discharges
Reduce hospital admissions
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Seamless end to end process
Mental Health: Action Mental Health (AMH) and Mental Health Services for Older People (MHSOP) already provide services
7 days a week (crisis, liaison, psychiatrist on call) .
Name: Sean McEneany
Email:
[email protected]
Job Title: Head of Adult services
Organisation: Stockton
Local Authority
Within NTHFT there will continue to have 7 day working of ward rounds and board rounds, and having access to 7 day
diagnostics and senior decision makers in A&E/EAU. There will be a 7 day on call manager rota in place to manage flow 7
days a week.
BCF plans - see section 5 above.
7
Expand, adapt and improve established
pathways for highest intensity users within
emergency departments. Organisations will
want to review the pathways for the group(s)
most relevant to them (e.g. frail/elderly
pathways, minors pathways, and mental health
crisis presentations) and there must be
evidence of sign-up to local Mental Health Crisis
Care Concordat arrangements.
The SRG has funded NTHFT to increase opening times of Ambulatory Care. By increasing access to senior decision makers
the likelyhood of patients being seen and treated without leading to an admission increases.
£142,032
Name: Liz Hanley
Email:
[email protected]
Job Title:
Organisation: Stockton LA
Identify high intensity users
Reduction in the High intensity users.
GP variation data support monitoring
High intensity users are managed by a
senior decisions maker.
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
General Practitioners will have the ability to discuss the medical needs of their patients with a secondary care physician to
ensure their patient is placed on the most appropriate care pathways for their condition. This will iimprove the use of
existing service and reduce non-elective admissions. The SRG and NTHFT work in collaberation to review pathways, as part
of a rolling programme.
The unplanned admission DES will support GP practices in the identification and management of high intensity users to
avoid admission.
Ongoing
Name: Sally Thompson
mail: [email protected]
Job Title: Associate Director of
Operations (Emergency and
Anaesthetic Care Services)
Organisation: North Tees &
Hartlepool NHS Foundation Trust
£150,000
£60,000
Complete
8
Have consultant-led rapid assessment and
treatment systems (or similar models) within
emergency departments and acute medical
units during hours of peak demand
The SRG has funded NTHFT to provide a front of house streaming nurse, who will assess then navigate patients to the most Comply with the 95% A&E target
appropriate alternative health care providers.
(Internal quality metric i.e. 20 A&E notes from
During winter NTHFT will have a senior decision maker at times of surge within A&E/PDU/Ambulatory Care to maintain
the streaming nurse fortnightly)
patient flow.
This service will reduce hospital
admissions and increase patient
satisfaction with senior decisions being
made early.
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Name: Sally Thompson
mail: [email protected]
Job Title: Associate Director of
Operations (Emergency and
Anaesthetic Care Services)
Organisation: North Tees &
Hartlepool NHS Foundation Trust
9
All parts of the system should work towards
ensuring patients’ medicines are optimised
prior to discharge
NTHFT will continue to provide medicines optimisation to ensure accurate prescribing of patients medicines on admission. Reduced LOS.
During the patients stay their medication charts will be reviewed and monitored daily by a pharmacist and discussed where Reduce delayed discharges
necessary with prescriber to effect changes to ensure each medication is optimised in relation to therapeutic outcome and Quality control
side effects. Medicines will be reconciled at discharge by pharmacy to ensure that communication includes an accurate list
of medicines at discharge and any changes that have been made while patients were inpatients.
This will support medicines
reconciliation for increased numbers
presenting
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
Name: Sally Thompson
mail: [email protected]
Job Title: Associate Director of
Operations (Emergency and
Anaesthetic Care Services)
Organisation: North Tees &
Hartlepool NHS Foundation Trust
10
Processes to minimise delayed discharge and
good practice on discharge
The system plan details the planning and operational management of discharges across Hartlepool and Stockton. schemes Reduced LOS.
currently in place to avoid admissions are: GP Paramedic support, access to primary care within the same day, additional
Reduce delayed discharges ( zero tolerance)
support for CIAT, including TAPS. The plans are to improve and build upon existing services for discharge.
Reduce admissions to the acute
Reduce readmissions
The SRG is to fund the following:
Reduce ambulance handover delays
- NTHFT - extention of the therapy led discharge team
Reduce admissions to Nursing home
- NTHFT - audit on patient flow and discsharge processes - MEDWORXX
Improve patient flow
- NTHFT - additional rapid response nurse
- The SRG has agreed to funding for increasing capacity within the SBC Intermediate Care/Reablement team to meet the
demands of client discharges at weekends.
- The SRG has agreed to fund additional capacity in indepentant home care for SBC, this will enable care packages to be put
in place within 2 hours to support client discharges at weekends (new packages/ restart packages).
- The SRG has agreed to fund HLA to support care home providers to have care staff a\and co-orddinators available over
the weekend period in order to facilitate discharges.
A streamlined process to reduce LOS
as well as supporting the zero
tolerance to delayed discharges.
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
£379,980
Name: Sally Thompson
mail: [email protected]
Job Title: Associate Director of
Operations (Emergency and
Anaesthetic Care Services)
Organisation: North Tees &
Hartlepool NHS Foundation Trust
The SRG has agreed to fund 10 time to think beds (4 in Hartlepool and 6 in Stockton), allowing the implementation of the
discharge to assess process which has be identified as an area of good practice. This will increase capacity in primary care
which will improve patient flow and reduce delayed discharges.
NTHFT, SBC and HLA are working in partnership to revise the current policy for discharge/patient choice. See point 1 for
further details.
As part of Clinical Quality and Improvement (CQUIN) work has been undertaken to revise the discharge letter.
Improvements mean that a more timely production of the patients discharge letter is sent to their GP, incorporating
concise information to support ongoing care.
11
Plans should aim to deliver a considerable
reduction in permanent admissions of older
people to residential and nursing care homes
The unplanned admission DES will support GP practices in the identification and management of high intensity users to
avoid admissions. This additional funding will support rapid response within the community which will support admission
avoidance.
The SRG has funded an extension on the working day for CIAT with NTHFT.
For preventing admissions to care homes Mental Health Services for Older people have integrated mental health services
with social care (with the exception of Hartlepool who have developed close working links with social care teams) who
have a focus on promoting independence and supporting people at home, in addition to this ICLS can provide intensive
support to people in their home. In Hartlepool there are specialist Mental Health regalement service to help facilitate and
support people to go home from a hospital setting.
12
Cross system patient risk stratification systems
are in place, and being used effectively
Practices are completing an assessment of high risk patients. Unplanned admission DES is being implemented and care
plans will be in place. A schedule of review meetings is in place within practices.
People at home 31 days after discharge
• People only having to tell their story once.
• Faster response times and more integrated
support to both individuals and their
carers/families.
• Positive feedback and customer satisfaction
reports.
• A reduction in the number of
residents being admitted to nursing
and residential care homes, from both
acute and community settings.
• The effectiveness of the Regalement
service in keeping people in their own
homes after discharge from hospital.
• A decrease in the number of delayed
discharges and lost bed days from
acute settings for those patients
medically fit for discharge.
• A decrease in emergency avoidable
admissions.
• Increase in the estimated diagnosis
rate of dementia.
Reduce readmissions
Support discharge
Reduce attendance to A&E
Reduce readmissions and support
discharge
All scheme to be
implemented by mid
September to mid
October, detailed action
plan to be developed.
Name:
Email:
Job Title:
Organisation:
The planned outcome is to ensure
more patients can be cared for in their
home environment, and supported to
self-care or to remain within the
primary and community care
pathways.
The scheme is planned to
run over the whole winter
period. Commencing 1st
November 2014, and
ceasing 31st March 2015.
Name: Paul Liversidge
Email:
[email protected]
Job Title: Chief Operating Officer
Organisation: NEAS NHS FT
Capacity of community matrons has been assessed and practices have been given a approx. number of patients they can
refer to community matrons to ensure there is support across practices.
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
£70,134
Referral to alternative services will take place, voluntay care services (VCS) will increasingly be offered as an alternative to
core services as the schemes become embedded.
Work is underway to explore the use of risk stratification within the ward area (LACE).
Work is ongoing with 111 to add special patient notes for improving communication between agencies in and out of hours.
The BCF plan will enhance the use of risk stratification in 2015/16. Opportunities are being explored to include measures
that would more effectively identify those patients where an early intervention/ preventative approach would be most
beneficial. Combining a 'Frailty Index' score with the RAIDR score is one possible method of achieving this.
The creation of a GP support telephony service to our operational Paramedic Staff, working from the ambulance HQ
Increased See & Treat rate.
control room. The purpose of this service is to allow Paramedics access to a significant clinical and medical skill-set for the Reduced admissions to ED.
improved triage and care of patients in the home environment, or at the scene of an incident. The service would operate
4pm-2am Monday -Friday (10 hrs. per day), and 8am-2am Saturday and Sunday and Bank Holidays (18 hrs. per day)
13
The use of real time system-wide data
See section 1 regarding development of dashboard and evaluation of schemes.
Feedback on the winter website established for Winter 2013/14 was extremely positive. The website has been further
enhanced and will be in place for winter 2014/15. The website improves communication and acts as a single storage point
for plans and other documentation required to operationally manage winter across the system.
reduce LOS, reduced delays, better patient
flow throughout the system. Implementation
of QlikView to monitor A&E Performance
Name: Julie Gillon
Email: [email protected]
Job Title: Chief Operating Officer
Organisation: North Tees &
Hartlepool NHS Foundation Trust
The development of a regional 'Flight Deck', capacity management system. This includes the development of a regional
divert system, incorporating a sensitive algorithm for planning diverts.
The service would be in place 24/7.
For the winter period, the plan would be an Officer to continuously liaise with the local acute hospitals to ensure an
ongoing update of capacity is understood. This will be within the over-arching Flight Deck Project, led by NECS.
For this winter only, NECS will provide an online system for Acute providers to be able to update their capacity in terms of
their beds. NEAS will provide a 24/7 Band 5 role in Emergency Contact Centre who will liaise with the Acute providers &
provide a situation report to the Duty Manager & CCGs to support divert decision making in the real-time environment.
This is an additional service to the on-line system as, in addition to the production of situational reports, this intelligence
will be utilised by the band 5 role to support live divert decisions.
This scheme links to the initiative to support further PTS discharge vehicles. The discharge vehicles will support the timely
discharge of patients, maintaining patient flow throughout the hospital, which will be reflected in situation reports
regarding bed capacity. This intelligence can then be used to support real-time decisions regarding patient
admissions/conveyances matched to bed capacity at sites across the patch. This bid is for the NEAS aspect only.
Reduction in handover times where hoospitals For those patients who are diverted a
are experiencing problems clinically accepting faster response time to decide the
patients
divert and theregfore a reduced time
to receive care
Improved understanding of bed capacity over
the region and therefore improved divert
Better planning of patient destinations
management
with communications across all acute
providers, NECS are NEAS
The scheme is planned to
commence over the whole
winter period.
Commencing 1st
November 2014, and NEAS
will look to fund this from
1st April 2015.
Name: Paul Liversidge
Email:
[email protected]
Job Title: Chief Operating Officer
Organisation: NEAS NHS FT
The implementation of intelligent dispatching of vehicles through the creation of additional planning desks, to more
effectively allocate and utilise operational resources. This is to become more integrated and more responsive to changing
demand on an intra-day and real-time basis. Creating a single cohesive allocation of emergency, urgent and scheduled
vehicle and crew resources.
Improved allocation of vehicle types to clinical The outcome is proposed to be
need. Improved operational productivity.
improved vehicle allocation over the
whole range of NEAS resources, from
DCA, RRV, Intermediate Care, PTS, Car
services and Volunteers.
The scheme is planned to
commence over the whole
winter period.
Commencing 1st
November 2014, and NEAS
will look to fund this from
1st April 2015.
Name: Paul Liversidge
Email:
[email protected]
Job Title: Chief Operating Officer
Organisation: NEAS NHS FT
Total costs of all minimum requirement
schemes:
£1,778,813
Section 3: Local Plans for Innovation. Plans over and above the minimum requirements to meet local patient needs. If there is any funding gap between the total emergency care support funding and the total costs of the minimum plan requirements, SRGs must present plans to close such gaps such that the minimum
requirements are deliverable
Ref
Local Requirements
Organisation
14
Supported rapid discharge service
Hartlepool Hospice
15
Discharge support service: community support
service
16
HAST CCG Contribution to NEAS schemes
Summary of plan to achieve requirement
KPIs
Lead Accountable Officer
To provide a rapid supported discharge service Reduce delayed discharges
from hospital into the community from Friday Reduce emergency admissions
until Monday to facilitate acute bed utilisation
and patients preference to care closest to
home. Non stretch service users will be
collected in a disabled ambulance by a driver
and carer and provided with a supportive care
package over the weekend until a care
package is in place
Optimise bed utilisation in
the acute trust and
provide high quality care
in the community
Improve choice
Prevent delays
Increase access
Care closer to home
Retain independence
Name: Tracy Woodall
Email:
[email protected]
k
Job Title: Chief Executive
Organisation: Hartlepool Hospice
£85,020
Butterwick Hospice
Service would provide specialist support to
Reduce number of readmissions
patients and their carers following discharge Minimises delays in discharges
from the hospice and those with palliative
care needs who are attending the hospice day
care service. Aim is to enable patients to stay
home and manage their conditions as well as
possible and prevent readmission to the
acute trust. Provide support over 7 days.
Provide additional support
to patients with palliative
and supportive needs and
their carers in their own
homes and in nursing and
residential care homes.
Name: Paula Wood
Email:
[email protected]
Job Title:
Organisation: Butterwick Hospice
£73,473
NEAS
Awaiting finalisation of schemes to be
supported across the region. The HAST CCG
local contribution is included in these plans.
£56,980
Total costs of local plans
£215,473
Total proposed
Section 4: Local Stakeholder Engagement. Please describe how you have considered each of the elements listed below and how you have included them in your resilience plans (as appropriate)
Independent Sector non-acute bed capacity
(intermediate care, nursing homes, etc.)
Capacity and demand modelling is being undertaken for the general and EMI nursing beds within care homes. A business case is being developed to develop a step
up and step down model of care in Hartlepool due to the shortage of nursing home places.
Access to rehabilitation and assessment beds in Stockton and Hartlepool. Negotiation of spot purchased beds in nursing homes.
NTHFT
As part of the Flight Deck proposal, we would look to have oversight of the 'step-up' and 'step-down' care beds over the region, therefore integrating intermediate
care into the overall capacity management approach.
A
NEAS
HLA
SLA
Other Independent Sector capacity (e.g. healthcare
at home etc.)
NTHFT
B
NEAS
HLA
SLA
Voluntary Sector capacity and expertise
Current occupancy levels for nursing beds and an increase in out of area nursing placements are a cause of significant concern. Shortfalls in nursing provision have
been highlighted with health commissioners and a group has been established to identify options to best address this situation.
pressure points in bed capacity continues to be monitored especially regarding availability of dementia nursing and general nursing beds.
Identifying alternative service providers, particularly in Hartlepool due shortage in places . Intermediate Care Group established to co-ordinate solutions
N/A
Our Schemes for the GP in the Contact Centre and the increased provision of Enhanced Care Paramedics are specifically designed to support patient care in the home
environment.
No issues with independent domiciliary care providers.
capacity / quality issues with independent domiciliary care providers are being addressed.
VCS projects have been commissioned by the HAST CCG and in Stockton jointly with the LA. These projects are in place to support delivery of the HAST CCG priorities
(reducing emergency admission, reducing delayed discharges). Additional voluntary sector staff working within A&E and wards would be useful to increase capacity.
Volunteers could transport patients to provide timely discharges.
C
NTHFT
HLA
SLA
Flu vaccination of healthcare workers
NTHFT
NEAS
Hospital volunteers and volunteer drivers utilised
HBC commissions low level services from the voluntary sector to help maintain people independently at home - see BCF plan.
SBC continues to commissions low level services from the voluntary sector to help maintain people independently at home - we will focus upon prevention / early
flu plans in place and targets within FTs
Robust flu vaccination plan and implementation
programme. Utilisation of ward vaccinators.
N/a - We have an internal Flu Vaccination scheme led by our in-house Occupational Health team.
HLA
D
SLA
TEWV
7-day a week commencement of new care packages
(including over holiday periods)
E
F
G
NTHFT
NEAS
Trust wide project commenced to implement the Keogh recommendations for 7 day working
The dedicated PTS, MH & EoL discharge vehicles will support 7-day wraparound care packages.
HLA
See section 2, ref 6.
SLA
See section 6
24/7 crisis liaison team in place/RAID team provided by TEWV Mental Health FT
TEWV
worked with both acute hospitals in developing the enhanced liaison service 24 hours a days, 7 days a week DB
Paediatric pathways to be assessed, appropriateness of direct to PDU, Paediatric autonomous Nurse Practitioners in A&E
NTHFT
HLA
TEWV
Engagement with patient representative groups
NTHFT
H
SBC encourage / facilitate the take up for eligible social care staff of flu vaccinations through a funded voucher service or direct contact with GP for those with
medical needs.
The TEWV Staff Flu Vaccination Plan 2014/15 has been agreed by their Executive Management Team. All staff shall be entitled to be vaccinated against flu including
high risk staff who may choose to be vaccinated at work rather than by their GP. Bank workers, student nurses on placement with the Trust and local authority
employees who work with Trust colleagues as members of integrated teams and agency workers will be offered the vaccination subject to the agreement of their
HEI/employer/agency respectively. Volunteers and Governors will also be offered the vaccination.
Capacity and demand modelling is being undertaken for the general and EMI nursing beds within care homes. A business case is being developed to develop a step
up and step down model of care in Hartlepool due to the shortage of nursing home places.
Improvement in access to psychiatric liaison service
teams in A&E
Collaboration with and development of Children's
services
Estimated Costs in
2014/15
Target Outcomes
HLA
HAST CCG led strategy development involved broad involvement from a range of stakeholders (of which TEWV were one)
Healthwatch work closely with HAST CCGs to highlight issues from the patients perspective. Healthwatch involved in HAST CCG locality meetings. A Patient rep will
be identified and will attend 4 SRGs a year.
Hospital Users Group, Healthwatch, Governors and Members
HBC engages with Hartlepool Healthwatch on a range of issues, including a recent investigation regarding domiciliary care and the current investigation regarding
hospital discharge arrangements.
SLA
SBC engages with Stockton Healthwatch on a range of issues., including the current work regarding hospital discharge arrangements.
TEWV
For HAST CCG completion
£1,994,286
Section 5: Key Partner Organisation Sign-Off. By signing this document you are stating both that you have been fully involved in developing this plan and that you will commit to attending all SRG meetings (or sending an appropriate deputy when unavailable).
Representative of:*
Organisation
Name
Email
Job Title
SRG (Chair)
HAST CCG
Dr Carl Parker
[email protected]
Clinical Lead Urgent Care
Lead Acute Trust
NTHFT
Julie Gillon
[email protected]
Chief Operating Officer /
Deputy Chief Executive
[email protected]
Chief Operating Officer /
Deputy Chief Executive
Electronic Signature
’signed October 2014’
’signed October 2014’
Lead Community Care Provider
NTHFT
Julie Gillon
’signed October 2014’
Stockton LA
Liz Hanley
[email protected]
Assistant Director Stockton
LA
’signed October 2014’
Local Authority
Hartlepool LA
Jill Harrison
[email protected]
Assistant Director Hartlepool
LA
[email protected]
Director of Operations for
Tees
[email protected]
Associate Director of
Strategy, Contracting
and Performance
’signed October 2014’
Lead Mental Health Provider
Ambulance Service
TEWV
NEAS
David Brown
Nichola Fairless
’signed October 2014’
’signed October 2014’
*please add rows as appropriate
Section 6: CCGs and Trust Finance Directors sign off that the plans are affordable, and will delivered whilst maintaining or improving their financial position
Representative of:*
Organisation
Name
Email
Job Title
CCG representative
HAST CCG
Graeme Niven
[email protected]
Chief Finance Officer
Electronic Signature
’signed October 2014’
Director of Finance,
Information and Technology
Acute Trust Representative
NT&HFT
Lynne Hodgson
[email protected]
Lead Community Care Provider
NT&HFT
Lynne Hodgson
[email protected]
Julie Danks
[email protected]
Hartlepool LA
Chris Little
[email protected]
Chief Finance Officer
Lead Mental Health Provider
TEWV
Colin Martin
[email protected]
Director of Finance
Ambulance Service
NEAS
Roger French
[email protected]
Director of Finance and
Performance
Stockton LA
’signed October 2014’
Director of Finance,
Information and Technology ’signed October 2014’
Director of Finance
Local Authority
*please add rows as appropriate
’signed October 2014’
’signed October 2014’
’signed October 2014’
’signed October 2014’