dorset health authority

Transcription

PAN-DORSET
INTEGRATED SEASONAL
ESCALATION PLAN AND
PANDEMIC INFLUENZA PLAN
2012/13
BOURNEMOUTH AND POOLE AND DORSET PCT CLUSTER
& SHADOW DORSET CCG
DOCUMENT CONTROL SHEET
TITLE OF DOCUMENT: INTEGRATED SEASONAL ESCALATION AND
PANDEMIC INFLUENZA PLAN 2012/3
VERSION
NO
DATE
AUTHOR
STATUS
REASONS FOR
CHANGES
V1.0
01-08-2012
Lou Crockett
Draft
Updated for 2012-13
V2.0
12-10-2012
Lou Crockett
Draft
Feedback from SHA
included
V3.0
19-10-2012
Lou Crockett
Draft
Final feedback included
V4.0
7-11-2012
Lou Crockett
Draft
Ready for sign off by
PCT/Shadow CCG
2
NHS BOURNEMOUTH AND POOLE AND DORSET PCT CLUSTER
& SHADOW DORSET CCG
INTEGRATED SEASONAL ESCALATION AND PANDEMIC INFLUENZA PLAN
2012/13
TABLE OF CONTENTS
EXECUTIVE SUMMARY
Page No:
1.
INTRODUCTION ................................................................................................5
2.
CONTEXT ..........................................................................................................6
3.
FLU PREPAREDNESS ....................................................................................13
4.
LESSONS LEARNT .........................................................................................16
5.
COMMUNICATION ..........................................................................................22
6.
SERVICE AREAS ............................................................................................24
7.
END OF LIFE ...................................................................................................53
8.
CROSS CUTTING THEMES ............................................................................54
9.
INFORMATION AND REPORTING .................................................................61
10. LOGISTICS AND WAREHOUSING ..............................................................63
11. WEATHER AND FUEL ....................................................................................64
12. EXCESS DEATHS ...........................................................................................68
13. ESCALATION MANAGEMENT .......................................................................68
14. RISK MANAGEMENT & EIA………………………………………………………..71
15. ORGANISATIONAL RESPONSIBILITY ..........................................................73
APPENDICES
APPENDIX 1
APPENDIX 4
APPENDIX 2
SPRIG OPERATIONAL
POLICY
ACTION CARD
APPENDIX 3
RISK ASSESSMENT
APPENDIX 6
3
APPENDIX 5
COMMUNICATION
ACTION CARDS
ACUTE TRUST
ACTION CARDS
WINTER COMMS
PLAN
& SHADOW DORSET CCG
2012/13
EXECUTIVE SUMMARY
Each Primary Care Trust (PCT) cluster is required to produce an integrated seasonal
escalation and pandemic influenza plan for 2012/13 to ensure a consistent approach
across the health and social care community in terms of escalation and major
incident co-ordination. The Dorset Clinical Commissioning Group (CCG) takes over
commissioning from the PCT cluster from April 2013 and is in shadow form this year.
The CCG is coterminous with the PCT cluster and plans to directly employ PCT staff
to provide its commissioning support. Leadership within the PCT is moving gradually
to the Shadow CCG and this plan has therefore been developed and approved by
both the PCT & Shadow CCG.
Winter planning has always been performed Pan-Dorset and in 2011 the PCT
Cluster took the opportunity to fully review the plans to ensure the planning and
escalation processes in place are fit for purpose if the need to escalate in any area of
the Pan-Dorset Health and Social Care Community occurs.
All partners within the Pan-Dorset Health and Social Care System have been
involved in the development and sign-off of this plan through the Seasonal Planning
Resource Implementation Group (SPRIG).
The learning from previous years has also been incorporated within this plan along
with key service developments.
Escalation is a key element of this plan; during 2010/11 the Bournemouth, Poole and
Dorset PCT (the Cluster) implemented the Capacity Management System (CMS) as
the tool to measure and monitor demand and capacity. The actions cards which
determine the triggers for escalation and required actions by each organisation have
been reviewed during the 2012/13 winter planning process and embedded into our
local escalation process.
The autumn of 2012 has seen a significant rise in urgent and emergency activity in
Dorset across all health care sectors – ambulance, out-of-hours services, emergency
departments and in the community through admission avoidance cases. In addition
the acuity of emergency admission cases has increased, leading to some increases
in length of stay. The provider Chief Executives are meeting with commissioners
during November 2012 to agree the most effective use of resources to ensure that
capacity is available throughout the winter and to enable the health community to
manage should these high levels continue. Additional resource will be made
available should it be required to areas of greatest need, whether this be within
acute, community or independent sectors to ensure the most effective utilisation of
the services. Unfortunately these arrangements are not sufficiently well progressed
to include detailed information within this plan.
4
& SHADOW DORSET CCG
2012/13
1.0
INTRODUCTION
1.1
We have reviewed the learning from previous years in order to produce a
Pan-Dorset plan for 2012/13. As part of the development process we have
reviewed the plans held by partner organisations within Dorset and have
embedded the key escalation triggers and actions to ensure a joint response
can be achieved if the need to escalate occurs.
1.2
Dorset hosted part of the Olympics in Weymouth & Portland this summer
(2012) and as a result a huge amount of preparation for potential escalation or
major incident events took place to ensure capacity to manage effectively
should such events occur. As a result the Major Incident Plan has been
updated and much of the learning will assist in managing escalations over the
winter period.
1.3
The plan sets out the actions being taken to ensure that essential services are
maintained, including the delivery of elective workload, achievement of
primary care access targets and appropriate staff cover of services over the
peak demand periods (i.e. Bank Holidays). The plan also acknowledges that
in the event of Pandemic Influenza all organisations will need to be prepared
to escalate within a short period of time (possibly 24 hours) if needs require.
1.4
Bournemouth, Poole and Dorset PCT (the cluster) have worked with South
Western Ambulance Service NHS Foundation Trust (SWAST) to ensure that
the Capacity Management System (CMS) is kept updated. CMS enables
providers to share information on the overall hospital activity and capacity and
provides a full Directory of Skills and Service (DOSS) for the local area.
1.5
Brief statements regarding contingency plans for each section/service can be
found within the highlighted boxes throughout the paper.
1.6
The plan is all inclusive in that it has been developed in partnership with key
stakeholders and to emphasise this it has been written to follow the natural
flow of patients through the health and social care system. Figure 1 provides
a diagrammatical view of this flow.
Figure 1:
5
Flow of Patient Activity Escalation
2.
CONTEXT
2.0
The Primary Care Trust Cluster is responsible for protecting the health of its
population and is a category 1 responder as stated in the Civil Contingencies
Act 2004. During a surge in demand over potentially a sustained period of
time such as Pandemic ‘Influenza, the Primary Care Trust has a responsibility
to:
•
lead the local NHS response;
•
co-ordinate primary care support on behalf of the Shadow Dorset CCG;
•
provide public health, NHS or other specialist advice for the Local
Resilience Forum in liaison with the Health Protection Unit.
2.1
Bournemouth, Poole and Dorset PCT Cluster can confirm that Jane Pike is the
full time Director level lead with responsibility for winter planning and
assurance for the Bournemouth, Poole and Dorset Cluster and Shadow CCG.
2.2
Bournemouth, Poole and Dorset PCT Cluster can confirm that Adrian Dawson
is the full time Director level lead with responsibility for winter planning and
assurance for the Bournemouth, Poole and Dorset PCT Cluster.
2.3
Alison Clegg, Deputy Director of Service Improvement and Sue Underhill,
Urgent and Emergency Care Commissioning Manager support Jane Pike on
this agenda.
2.4
Table 1 shows the details of the accountable Chief Officers / Flu Directors in
each organisation within the local health economy.
Table 1:
6
Accountable Chief Officers
Organisation
Title
Contact details
NHS Bournemouth
and Poole, NHS
Dorset PCT Cluster
& Shadow Dorset
CCG
NHS Bournemouth
and Poole, NHS
Dorset PCT Cluster
Royal Bournemouth
and Christchurch
Hospital NHS
Foundation Trust
Dorset County
Hospital NHS
Foundation Trust
Director Acute and
Primary Care
Commissioning
[email protected]
Dorset Healthcare
NHS Foundation
Director of
Community Health
Director or Public
Health
Chief Operating
Officer
01305 2135333
[email protected]
01202 541488
[email protected]
01202 704998
Director of
Operations
[email protected]
01305 251150 ext. 4272
[email protected]
01202 541470
Trust
Poole Hospital NHS
Foundation Trust
South Western
Ambulance Service
NHS Trust
Urgent Care
Out-of-Hours service
Bournemouth
Borough Council
Social Services
Borough of Poole
Social Services
Dorset County
Council Social
Services
NHS Direct
Services
Chief Operating
Officer
Executive Director
of Delivery (Flu
Director)
Executive Director
of Delivery (Flu
Director)
Service Director
Community Care
Services
Strategic Director
of Adult Social
Services
Head of Adult
Services
Director Lead
(South West &
West Midlands)
[email protected]
01202 442547
[email protected]
01392 261637
[email protected]
01392 261637
[email protected]
01202 458719
[email protected]
01202 633633
[email protected]
01305 251414
[email protected]
01384 473815
07824 820192
Co-ordination Networks
2.5
Development of the Integrated Seasonal Escalation and Pandemic Flu Plan
has been co-ordinated through the Seasonal Planning and Resource
Implementation Group (SPRIG), which is a sub group of the Unscheduled
Care Service Delivery Group. SPRIG takes on a strategic planning role for
part of the year and a monitoring and operational roll during the winter and
other periods.
2.6
An Operational Plan, which outlines the role of SPRIG and the responsibility
of its members has been developed and signed off by the Unscheduled Care
Service Delivery Group. The document is included within Appendix 1 and
includes a diagram demonstrating the relationship between the key groups.
2.7
A single email account has been established [email protected].
The purpose of this email is to accept information / alerts which can then be
cascaded to the health and social care community as appropriate Pan-Dorset.
The email account is managed from 09.00 – 16.00 Monday to Friday.
All providers are aware that they should use this as the first point of contact
with the PCT to advise of demand and capacity issues. Out of hours the oncall Director for the PCT is responsible for co-ordinating if escalation is
required. During normal business hours the resilience alert is not available to
the Director on-call but for Bank Holiday weekend periods this facility is
provided.
7
2.8
SPRIG partners are asked to schedule in weekly winter teleconferences to
commence from October 2012 until the last week in March the following year
or as determined by seasonal pressures.
2.9
The calls are facilitated by the PCT and are stood down if not required. There
is a requirement for all partners to dial in. Relationship with Other Key
Documents
2.10
This Seasonal Escalation Plan and Pandemic Influenza Plan 2012/13 should
be used in conjunction with a number of other key documents which will be
noted throughout the text. These documents include:
8
•
Cold Weather Plan for England 2012;
•
The Strategic Health Authority Emergency Services Review;
•
Department of Health: Seasonal Flu Plan 2012/13;
•
NHS Winter Self Assessment Checklist (The Department of Health);
•
Mass Vaccination Plan (NHS Bournemouth and Poole and NHS
Dorset);
•
Joint Major Incident Plan (NHS Bournemouth and Poole and NHS
Dorset);
•
NHS Bournemouth and Poole Strategy for Organisational Resilience
2012-2013;
•
NHS Bournemouth and Poole Business Continuity Plan 2010-2012;
•
Local Resilience Forum – Management of Excess Deaths Plan;
•
National Ambulance Services Winter / Pandemic Flu Planning
Framework 2009/10;
•
Learning the lessons from the H1N1 vaccination campaign for
healthcare workers (The Department of Health;
•
Report of the Swine Flu Critical Care Clinical Group and Key Learning
Points for Future Surge Planning (The Department of Health);
•
NHS South of England Escalation Framework August 2012.
Activity Trends Data
PHFT
ED Activity
Conveyance Data
9
RBCH
ED Activity
Conveyance Data
10
DCH
ED Activity
Conveyance Data
11
SWAST Activations - 4 Year Trend
12
3.0
FLU PREPARENESS
3.1
Flu preparedness this year increases focus on seasonal influenza, not just a
Pandemic as learning from previous years has been that Flu in general can
be significant.
3.2
However the plan acknowledges that additional plans, over and above those
for seasonal influenza, are needed for pandemic influenza to:
•
Ensure that we are able to detect the emergence of a new virus and its
arrival in the UK as quickly as possible and to determine the severity of
illness, age groups and populations most affected and how transmissible
it is likely to be.
•
Take account of the much greater number of people who will become ill
with influenza and / or experience more severe symptoms and of the
resulting potential impact on both the health system and the wider
economy.
•
Prepare for an influenza pandemic that may have a high impact on the
health system and wider society.
3.2
Whilst influenza pandemics have been relatively infrequent over the past
century, a new pandemic could emerge at any time. Plans for response to
any influenza pandemic build on and enhance normal business continuity
planning for more routine pressures such as bad weather and winter illness.
Pandemic preparedness is therefore an integral part of wider emergency
response and preparedness.
3.3
The UK has been preparing for an influenza pandemic for some years. These
preparations were tested by the H1N1 (2009) influenza pandemic although, in
comparison with previous influenza pandemics, the H1N1 (2009) influenza
pandemic was very mild.
3.4
The Department of Health launched the ‘UK Influenza Pandemic
Preparedness Strategy 2011’. The document describes proposals for an
updated, UK-wide strategic approach to planning for and responding to the
demands of an influenza pandemic. It builds on, but supersedes, the
approach set out in the 2007 National framework for responding to an
influenza pandemic (and the Scottish equivalent), taking account of the
experience and lessons learned in the H1N1 (2009) influenza pandemic and
the latest scientific evidence.
Strategic Objectives
3.5
13
Any new influenza pandemic can be expected to have a significant effect on
individual members of the population, the NHS and society at large. The
overall objectives of the UK’s approach to planning and preparing for an
influenza pandemic are therefore to:
Minimise the potential health impact of a future influenza pandemic by:
•
Supporting international efforts to detect its emergence, and early
assessment of the virus by sharing scientific information
•
Promoting individual responsibility and action to reduce the spread of
infection through good hygiene practices and uptake of seasonal
influenza vaccination in high-risk groups
•
Ensuring the health and social care systems are ready to provide
treatment and support for the large numbers likely to suffer from
influenza or its complications whilst maintaining other essential care.
Minimise the potential impact of a pandemic on society and the
economy by:
•
Supporting the continuity of essential services, including the supply of
medicines, and protect critical national infrastructure as far as possible;
•
Supporting the continuation of everyday activities as far as practicable;
•
Upholding the rule of law and the democratic process;
•
Preparing to cope with the possibility of significant numbers of
additional deaths;
•
Promoting a return to normality and the restoration of disrupted
services at the earliest opportunity.
Instil and maintain trust and confidence by:
14
•
Ensuring that health professionals, the public and the media are
engaged and well informed in advance of and throughout the pandemic
period and that health professionals receive information and guidance
in a timely way so they can respond to the public appropriately.
•
Given the uncertainty about the scale, severity and pattern of
development of any future pandemic, three key principles should
underpin all pandemic preparedness and response activity:
•
Precautionary: the response to any new virus should take into
account the risk that it could be severe in nature. Plans must therefore
be in place for an influenza pandemic with the potential to cause
severe symptoms in individuals and widespread disruption to society.
•
Proportionality: the response to a pandemic should be no more and
no less than that necessary in relation to the known risks. Plans
therefore need to be in place not only for high impact pandemics, but
also for milder scenarios, with the ability to adapt them as new
evidence emerges.
•
3.6
Flexibility: there should be a consistent, UK-wide approach to the
response to a new pandemic but with local flexibility and agility in the
timing of transition from one phase of response to another to take
account of local patterns of spread of infection and the different
healthcare systems in the four countries.
The cluster will review the Pandemic Preparedness strategy once it is
published and will update this plan as required.
Planning assumptions for a future influenza pandemic
3.7
Influenza pandemic planning in the UK has been based on an assessment of
the “reasonable worst case”. This is derived from the experience and a
mathematical analysis of influenza pandemics and seasonal influenza in the
20th century. This suggests that, given known patterns of spread of infection,
up to 50% of the population could experience symptoms of pandemic
influenza during a single pandemic wave lasting 15 weeks, although the
nature and severity of the symptoms would vary from person to person.
3.8
For deaths, the analysis of previous influenza pandemics suggests that we
should plan for a situation in which up to 2.5% of those with symptoms would
die as a result of influenza, assuming no effective treatment was available.
3.9
However, it is important to note that:
15
•
These “reasonable worst case” planning assumptions take no account
of the potential effect of response measures such as practising good
respiratory and hand hygiene, the use of antiviral medicines and
antibiotics, and modern hospital care for those with severe illness.
Such measures should reduce the number of patients needing
hospital care or dying, even in a widespread and severe pandemic,
although the extent cannot be known in advance.
•
Planning assumptions are not a prediction of what could happen. A
lesson learned from the H1N1 (2009) influenza pandemic was that
calling the planning assumptions ‘reasonable’ was not well
understood. Many people wrongly thought that it meant this was the
likely scenario.
•
Planning assumptions can be informed by evidence from the past and
analytical work but there will inevitably be an element of judgement.
There is no ‘right answer’ and even experts may disagree on the
‘reasonable’ levels for planning.
•
Influenza pandemics are intrinsically unpredictable. Plans for
responding to a future pandemic should therefore be flexible and
adaptable for a wide range of scenarios, not just the “reasonable worst
case”. During a pandemic, the assumptions on which to base the
response will be updated in the light of emerging evidence about the
range of likely scenarios at the time.
•
Even influenza pandemics with only mild or moderate impact are likely
to put considerable pressure on services and the experience in local
hotspot areas could be much more severe.
•
In an influenza pandemic that has a higher impact on society, services
and businesses would be under extreme pressure and may be unable
to continue to meet all demands, even with the best of preparations.
Step changes, including national contingency measures, could be
necessary in such circumstances.
Infectivity, mode of spread and numbers affected
3.10 Influenza spreads by droplets of infected respiratory secretions which are
produced when an infected person talks, coughs or sneezes. It may also be
spread by hand-to-face contact after a person or surface contaminated with
infectious droplets has been touched.
3.11 The incubation period will be in the range of one to four days (typically two to
three). Adults are infectious for up to five days from the onset of symptoms.
Longer periods have been found, particularly in those who are
immunosuppressed. Children may be infectious for up to seven days. Some
people can be infected, develop immunity, and have minimal or no symptoms
but may still be able to pass on the virus.
3.12 Regardless of the nature of the virus, it is likely that members of the population
will exhibit a wide spectrum of illness, ranging from minor symptoms to
pneumonia and death. Most people will return to normal activity within 7 - 10
days.
3.13 All ages are likely to be affected but those with certain underlying medical
conditions, children and otherwise fit younger adults could be at relatively
greater risk as older people may have some residual immunity from previous
exposure to a similar virus earlier in their lifetime. The exact pattern will only
become apparent as the pandemic progresses.
3.14 Between 1% and 4% of symptomatic patients will require hospital care,
depending on how severe the illness caused by the virus is.
3.15 It is impossible to give precise figures of the number of deaths that can be
expected. However, on a precautionary basis, local planners should prepare to
cope locally with up to 200,000 additional deaths across the UK over a 15
week period. In a less widespread and lower impact influenza pandemic, the
number of additional deaths would be lower.
4.0
LESSONS LEARNT
4.1
Over the years there have been several lessons learnt nationally, across the
South West and locally which have been considered to ensure the seasonal
plan is progressive and current.
16
Local Lessons
4.4
The significant issues were captured and used as the basis of an action plan
delivered during 2010/11. The key areas within the plan included:
•
Development of a mutual aid plan across the health and social care
community;
•
Importance of using the Capacity Management System;
•
Promotion / communication around winter including encouraging early
uptake of the flu vaccine.
4.5
An assurance exercise took place at the beginning of December 2011 with all
health and social care providers to ascertain the level of cover they would
have in place prior to, during and immediately following the Christmas and
New Year period in order to identify any gaps in provision.
4.6
A winter tabletop exercise was also held with Director level input from all
health and social care organisations to test out the resilience and escalation
plans of all organisations.
Service Developments
4.7 Service developments that have been taken forward as a result of the lessons
learnt include:
17
•
Improved CHC assessment process;
•
Two hour fast track CHC application process;
•
Funding out of hospital agreement in conjunction with the local authorities
in Bournemouth & Poole;
•
Proactive discharges over a 7 day a week period;
•
DTOC targets for the local authorities pan-Dorset as part of the 256
agreements;
•
Specific DTOC targets for Dorset Healthcare as part of the contract for
2012/2013;
•
Specific teleconferences to focus on DTOC when required;
•
Self-funding pilot which provides support to patients and their families in
understanding the options available to them in order to reduce self-funder
delays. This pilot is in place until the end of March 2013.
Health and Social Care Community Wide
Everyone involved in health and social care in Dorset has signed up to the
Local Resilience Forum Mutual Aid Policy.
Acute Trusts
•
Development of a fracture liaison service at DCHFT, PHFT & Yeovil
District Hospital to improve the service and outcomes for individuals who
have experience a trauma fracture and reduce length of stay;
•
The pilot of a GP service in RBHFT Emergency Department (Minors) for
patients who attend the Emergency Department with a primary care
complaint continues to run successfully. The patients are managed and
encouraged to attend their GP Practice in the future or referred directly
back to them. The service is operational Monday to Friday 08.00 – 20.00
and 16.00 – 20.00 Saturday and Sunday. On Monday 5 November 2012
the pilot will extend to the Majors section of the ED for an initial 6 month
period.
•
The Nurse Practitioner pilot continues to run in PHFT Emergency
Department (Minors). Run by SWAST the pilot operates 13.00 – 19.00
Monday & Friday and 10.00-22.00 Saturday & Sunday. This pilot is
producing great results with up to 24% of Minors patients being seen by
SWAST during their working hours.
•
NHS Dorset funded a member of staff to work with DCHFT Discharge
Team to work with the wards to ensure that discharge planning
commences within 24 hours of admission and delayed discharges do not
occur because of poor hospital planning.
•
An ambulance divert policy is in place, agreed between all three acute
trusts, SWAST and the PCT Cluster.
•
A project is in place to provide a care management service at weekends
at Royal Bournemouth hospital and Poole hospital to facilitate unplanned
discharge from Emergency Departments and short term assessment
wards. This is a shared response between the three local authorities
through joint funding and it is hoped to establish this service ahead of the
Christmas holiday period. The project seeks to cover weekends but there
will be ring fenced funding for Bank Holiday cover which will be provided
as usual by volunteers from existing teams.
The project aims to have a worker available on both RBH and PHFT
acute sites between 10am and 3:30pm, the last 30 minutes of which will
be used to ensure all paperwork is completed and handed over. The
resource is for unplanned discharges within the emergency department
and short term assessment units.
Safeguarding will sit outside of the service, remaining the responsibility of
the existing social care out-of-hours service.
18
An agreed minimal standard of paperwork based on the out-of-hours
service paperwork will be completed for hand over.
Primary Care
•
The vast majority of practices are now offering some extended opening
hours which includes the option of book on the day. Boscombe Health
Centre offers a walk in service on a Saturday and Sunday 0800 - 2000
hours 52 weeks of the year;
•
Weymouth Community Health Clinic offer walk in services 7 days a week;
•
A Practice Based Commissioning Local Enhanced Service (LES) has
been agreed for 2012/2013. There a number of components to the LES,
including:
• Develop a register of patients at risk of avoidable unplanned admissions
to release resources to re-invest in further developments of community
based and preventive care set up internal processes to monitor and
proactively manage information on daily admissions and discharges.
Production of practice business continuity plans, including buddy
arrangements between practices;
• Production of the Primary Care Pandemic Flu Escalation Strategy.
• Primary care based DVT service in West and North Dorset and
Weymouth and Portland;
• Development/extensions of various schemes that are aimed at identifying
and proactively managing patients who are most vulnerable to admission
including virtual ward scheme in North Dorset, Tracker scheme in East
Dorset, vulnerable elderly scheme in Christchurch;
• Community Paramedic / ECP scheme in Purbeck;
• The pulmonary rehabilitation service rolled out across Pan Dorset from
the end of 2011 and is now available in 19 locations throughout Dorset.
Referrals can be made by Community staff, GPs and the acute hospitals
for patients with MRC3 or above level of COPD;
• Development of integrated health and social care in Weymouth and
Portland and Christchurch;
• Use of HealthNumerics RISC tool in primary and community services to
identify patients at high risk of future unplanned admissions: 34 practices
in Bournemouth and Poole; 12 practices currently in Dorset, 30
anticipated by 31 December 2012:

19
Use of RISC in MDTs to review patients at high risk of
future unplanned admissions;

Pilot continuing with Bournemouth Borough Council to
add social care data;

Bournemouth University undertaking evaluation of RISC
and its effect on Community Matron caseload. Initial
baseline data collected and interviews plus focus group
undertaken with 6 Community Matrons from Dorset.
• NHS Bournemouth and Poole and NHS Dorset secured funding in 2011
for 100 telehealth equipment units which will be provided on a mediumterm basis to patients who would benefit from remote monitoring of their
vital signs by their GP. By October 2012 the number of units has grown
to 500 in total with 172 referrals received on top of the initial roll out.
Community Services
• Significant investment has been made by the PCT Cluster to increase the
capacity and hours of service of the intermediate care and locality
community care teams, with the intention of providing care close to home
and preventing unnecessary admission to long term care and hospitals.
• Working towards the development of integrated health and social care
locality teams is a specific objective of the Transforming Community
Services. The Transforming Community Services Board is working
towards these teams being in place by 1st April 2012.
Social Care
• The SOURCE database was launched across Bournemouth, Poole and
Dorset in Spring 2011. The database which is moderated by Help and
Care provides comprehensive information on a wide range of voluntary
sector services which promote health and wellbeing activities including
those for older people.
• A new Care at Home contract has been awarded by Poole Social
Services, the service is now available seven-days a week and providers
have a contractual obligation to reduce the number of unplanned hospital
admissions through the provision of good quality preventative and proactive domiciliary support.
• Patients admitted to the RACE Unit in PHFT have their packages of care
held open for 48 hours by Poole Social Services to facilitate discharge.
Work is underway with Bournemouth and Dorset Social Services to
enable them to offer the same provision.
• Borough of Poole Hospital Discharge Team have employed a Lead
Practitioner (37 hours a week) to support the team with day to day
management and to attend Trust meetings with regards to daily delays as
BOP representative. The post supports daily Management availability to
the team and contact for the Trust.
20
• 2 year seconded post within the Hospital Discharge Team role is to
enhance the Borough of Poole Hospital Discharge Team service to
Borough of Poole clients admitted to Hospital with a no delay discharge
process.
• Borough of Poole brokerage have extended their services to support no
delay in discharge by providing a brokerage officer to Mon-Fri to arrange
to meet relatives or friends of Borough of Poole Clients admitted to
hospital pending a 24 hour care placement.
• It was identified by Borough of Poole that clients pending 24 hour care
placement was often delayed due to family not having information
available to meet at the Civic Centre. Finance have allocated a Finance
Officer to work a daily duty rota to cover PHFT. The Hospital Discharge
Team can refer a client for a financial assessment and Finance Officer
will meet with client and or family within a 24 hour period, discuss how to
obtain documents and work with the client and family to gain verification
of finances with a view to non delay of discharge process.
• Borough of Poole working in partnership with NHS colleagues tendered
for the provision of a Reablement Service in late 2011 and the service
became operational in March 2012 delivered by an independent sector
provider. The service is designed to increase Reablement capacity in
the Borough to deliver up to 600 hours per week once it has been fully
rolled out. Unfortunately in September 2012 following a number of Adult
Safeguarding referrals a block was made on further placements into the
service pending completion of the safeguarding investigation and any
subsequent action required by the Provider; as at 30th October that
block is still in place.
•
Total Place Pilot: Borough of Poole is working with Dorset County
Council in piloting the delivery of a night care service following receipt of
funding from the Total Place Pilot. The project will help to assess how
many people could be supported successfully at home through the
provision of night time support (where necessary in addition to day time
home care). The objectives of the project are to enable people to be
supported at home for longer and discharged home where the provision
of night time care will enable this to happen.
• Dorset County Council are currently in the process of negotiating with
Bournemouth and Poole Boroughs for a shared worker to be at both RBH
and Poole at weekends to respond to urgent discharges between 10 and
3 on Saturday and Sundays They are hoping to have this in place before
the Christmas 2012 period but will update when the plans are further
ahead.
21
• All 3 councils (Dorset, Bournemouth & Poole) are all included in the
heater loan project run by Dorset Fire & Rescue Service (DFRS). DFRS
have purchased 20 free standing oil filled radiators to be distributed via
their Community Safety Task Team. Circumstances in which the heaters
can be provided include; sudden/recent loss of domestic gas or oil fire
heating system or medically diagnosed health condition (including recent
hospital discharge) requiring temporary additional heating (including for
babies and small children). Relevant agency must refer the patient this
cannot be applied for by them themselves. Heaters can be loaned for 5
days to 2 weeks at a time though this may be extended in some
circumstances.
5 COMMUNICATION
5.7
Good communication is essential for smooth and effective management of all
services particularly at times when services are stretched due to increasing
demands or where services are reduced over the holiday period.
5.8
The Cluster prepares an annual heat wave plan which outlines how
information will be cascaded in the event of a heat wave. However as the real
and more immediate risk to the health system is winter, excess deaths and
unnecessary admissions to hospital, more emphasis is give to communication
over the winter period.
5.9
The Cluster develops an annual winter communications plan with partner
agencies to ensure well planned communication messages and information
can be shared with staff, patients, carers, the public and healthcare
professionals in a timely manner.
5.10 The Cluster is committed to ensuring that people have the information they
need to make sensible choices about their health and wellbeing.
Communication escalation processes
5.11
The cluster’s communication lead deals with routine issues and keeps NHS
South of England informed of issues that may be of major significance,
reporting incidents that could potentially attract national media attention and
taking appropriate advice where help is required regarding media handling.
5.12
The 2012/13 Annual Winter Communication Plan was finalised in October
2012 (see appendix 6).
5.13
Specific communication action cards have been developed and circulated to
communication colleagues (see appendix 4). All partner organisations have
an Emergency Care Network Directory with contact details of who and how to
contact. The Major Incident Plan provides a directory of all relevant
personnel whom it will need to contact in the event of an emergency. Out of
hours media issues will be dealt with by the relevant on-call Senior
Manager/Director.
5.14
In addition to this the Dorset LRF warning and informing group have contacts
of communication staff across the county and are well placed to prepare
22
information in anticipation of bad weather or pressures on the system in their
informing role.
5.15
Primary care providers are informed of current situations through an existing
internal communication network, which in most cases would be via e-mail or
fax. Providers will be informed of any upsurges in emergency pressures and
also advised when the pressure has abated. GP practices are encouraged to
feedback information about any emerging trend or upsurge in emergencies
that would impact on other organisations.
5.16
In the event of a Major Incident being declared the Dorset Police will, under
most circumstances, take control of the incident and will assume
responsibility for communications involving leads from other organisations as
necessary, implementing the major incident plan and using the principles laid
out by the local warning and informing group.
Communication channels
5.17
Trusted and recognised communication channels will be used to target
groups directly. This will be in addition to information on the PCT’s web sites.
The channels that will be used are as follows:
•
•
•
•
•
•
•
•
•
•
•
Health websites
Local media
Articles in council magazines
Church and faith newsletters and magazines
Partner newsletters
Email bulletins and information
Keep warm, keep well newsletters
Thermometer cards for elderly patients
Posters in GP surgeries, pharmacies and other public places
Source web site
Face to face communication through events
5.18
Following its implementation in 2011/12, the use of Twitter will be important to
keep people informed about key health issues over the winter and directing
people to the right information resource.
5.19
The seasonal vaccination promotional activity begins in early October.
Cascading messages to the public and staff regarding vaccination will be coordinated to ensure a wide spread group of people are reached. Further
information on vaccination plans is provided in section 8. The following steps
will be taken:
23
•
Early circulation of information regarding the seasonal influenza
vaccination programme;
•
Development / circulation of posters and leaflets;
•
Letters to staff to advise them that the vaccination programmes will
begin;
•
Targeted information to groups who would benefit from the
vaccination.
Contingency Plan
•
Any immediate, urgent messages will be transmitted via the local
broadcast media in their warning and informing role. Urgent
messages to GP practices will be sent by email. Twitter will be
used to provide real time updates and information
•
A network of partners, voluntary organisations and community
workers has been developed to cascade information
•
Resilience email will be used to receive and cascade immediate
information to professionals.
6 SERVICE AREAS
Assurance has been sought from all service leads to ensure they have
considered whether they have sufficient cover in place and ability to flex
services over the winter, including Christmas and New Year. During the
autumn 2012 urgent and emergency activity has been significantly increase
with higher activity leading to pressures across all sectors of the health care
community. A meeting of the Chief Executives of the providers, with
commissioners is to take place during November 2012 to agree what
additional resources are needed to ensure capacity during the winter should
these high levels continue.
PHARMACY / NHS DIRECT
6.1
The use of pharmacies and other self-help facilities such as NHS Direct have
increased over the past year as both have raised their profile with the public
as health support services. On 19 March 2013 NHS Direct will be replaced by
111.
6.2
Both these services also have key roles in the preparation for and
management of pandemic influenza across Bournemouth, Poole and Dorset
as well as nationally.
NHS Direct
6.3
24
NHS Direct routinely prepares for peak-pressure periods as part of an
ongoing, rolling programme of forecasting and capacity planning. This may
include seasonal or event specific elements where appropriate. However,
prior to key public holidays such as Christmas Day and Boxing Day, there is
always an intensified period of preparation which is integral to their usual
forecasting and capacity-planning.
6.4
NHS Direct have tried and tested arrangements for prioritising demand for
their service, optimising call centre capacity and ensuring clinical pathways
dovetail with those of both regional and local NHS partners.
6.5
NHS Direct will continue to work in partnership with SWAST to ensure agreed
transfer of appropriate Category C calls.
6.6
NHS Direct will maintain a knowledge management system of local services
available to ensure appropriate referral to other providers. Local information
will need to be up to date and provided to NHS Direct.
111
111 will go live in Dorset and replace NHS Direct on 19 March 2013 so will
not impact on this year’s winter planning to any significant extent. However
Hampshire went live during October 2012 and borders the east of Dorset.
This may have some limited impact, although Dorset patients calling
111 will be informed this is not yet in place with the following message:
“NHS 111 is not currently available in the area you are calling from. If it is an
emergency please hang up and call 999; otherwise call NHS Direct on 0845 4647 or
contact your GP”
Pharmacy
6.7
Community Pharmacies have a key role in providing the public with a range
of services, including:
• Essential service delivery (dispensing and medicines supply);
• Self-care advice and treatments for a variety of conditions;
• Maintaining care of people with long term conditions/vulnerable elderly;
• Switching therapeutic groups;
• Co-ordinating logistics in medicines supplies;
• Services where pharmacists may be utilised such as patient screening and
education of the public with approved messages and materials.
6.8
They have the ability to provide a range of enhanced services (in some
cases directing pressure away from general practice).
6.9
Geographically accessible to local communities with long opening hours,
community pharmacies provide an accessible, trusted and high quality
service in the community.
25
6.10
Community pharmacies were successfully used as antiviral collection points
(ACPs) during the 2009 flu pandemic. It is not clear that this model of supply
would be used in the future as it is dependent on national systems. However
the process and systems could be repeated if appropriate.
6.11
Community pharmacies have developed Business Continuity Plans to ensure
they have identified ‘buddy’ pharmacies and considered their business
continuity in the event of an influenza outbreak or other crisis.
Medicines Management Teams
6.12
The Medicines Management Teams in the cluster have a key role in providing
specialist advice to NHS staff who are in face to face prescribing roles with
the public. This would include keeping abreast of changing national guidance
and emergency legislation including potential distribution systems for
antivirals and advice for GP Practices on switching medications if stocks are
running low.
Contingency Plan
•
Use of Pharmacies as anti-viral points;
•
Pharmacies have produced business continuity plans which include
their ‘buddy’ arrangements.
PRIMARY AND URGENT CARE SERVICES
6.13
Primary Care Services play a large part in keeping patients out of hospital
and away from the Emergency Departments allowing these services to be
used more appropriately and potentially creating more available capacity in
times of greater need.
General Practice
6.14
General Practice plays a key role in keeping people out of hospital and for
many is the first point of contact when they become ill. Therefore activity is
often escalated during the winter period.
6.15
Currently within Bournemouth and Poole there are 44 General Practices and
59 in Dorset all providing core, additional and enhanced medical services to
the local population. In addition to their contracted hours, all practices in
Bournemouth and Poole and all except one in Dorset are also offering
extended opening hours as part of enhanced services agreements agreed
with their respective PCT.
6.16
As part of the services outlined above, all practices offer their registered
patients routine and urgent care. Unregistered patients are also able to
register as a ‘temporary resident’ should they need medical care, and anyone
26
in the practice area can seek immediate necessary treatment from any GP
practice.
6.17
Late September, early October also sees a significant number of students
arriving in the Bournemouth and Poole area to begin University and college
courses and these people also tend to register with a local GP at this time.
6.18
The development of the Primary Care Pandemic Flu Escalation Strategy has
provided the Primary Care Trust with the tools to support frontline general
practice services during the peak period of an influenza pandemic.
The strategy is based on five levels of escalation as follows:
•
Level 1
normal activity;
•
Level 2
increased activity due to vaccination programme;
•
Level 3
suspension of non-core activities;
•
Level 4
managed suspension of clinical services;
•
Level 5
full suspension of services; and
•
De-escalation appropriately between levels as needed.
Contingency Plan
•
Individual Practices have produced business continuity plans which
encompass buddy arrangements;
•
Development of a Primary Care Pandemic Flu Escalation Strategy based
on the Department of health guidance document ‘Pandemic Flu: Planning
and Responding to Primary Care Capacity Challenges’;
• Escalation plan that triggers suspension of non-core activities through to
full suspension of services if required in place.
Out-of-Hours (OOH)
6.19
The South Western Ambulance Service NHS Trust manages the Out-ofHours Urgent Care Service for Dorset, and deploys a multi-disciplined
response to requests for general practitioners in the out-of-hours period. The
South Western Ambulance Service NHS Trust has a Service Agreement with
NHS Direct to pass them non-life threatening, non-serious emergency calls
categorised as category C.
6.20
The Out-of-Hours Urgent Care Service has a pandemic influenza plan, which
outlines three levels of escalation:
27
•
Level 1
Suspension of non-core activity;
•
Level 2
Suspension of core activity;
•
Level 3
Significant capacity lost or reduced
Contingency Plan
•
Increase in call handlers and clinicians over peak holiday periods to meet
predicted demand;
•
Patient group directives in place to enable nurses to dispense certain
medications;
•
Use of a wide skill-mix within the service i.e. GPs, Nurse Practitioners and
Emergency Care practitioners.
•
Exploring the potential to increase OOH capacity over the winter months,
by offering a walk-in service.
Dental Services
6.21
28
Primary Care Dental Services, other than those NHS services provided by
‘high street’ dental practices in contract with the PCT during normal surgery
hours, are provided across Dorset by the Salaried Dental Service (the PCTs
hold contracts for the salaried services with both Dorset County Hospital –
West Dorset - and Dorset Healthcare – East Dorset):
•
Community Dental Service (CDS) – comprehensive treatment service
for children and adults who have special needs and are not suitable for
treatment in ‘high street’ practices (Dorset County Hospital and 3 sites
in Poole);
•
Primary Care Dental Service (PCDS) – limited day time access for
patients, not ‘registered’ with a high street practice, requiring urgent
relief of dental pain and also routine dental care;
•
Intermediate Minor Oral Surgery Service (IMOSS) – provides minor
oral surgery in community based clinics (Poole only); and
•
Urgent Care Dental Service (UCDS) – Pan-Dorset service providing
any member of the public or temporary resident in Dorset with urgent
relief of dental pain/trauma via clinics both during normal surgery
hours, on some evenings, every weekend and every public holiday.
The service includes telephone triage, advice and guidance every
evening out of hours.
6.22
The Urgent Care Dental Service is contacted on 01202 854443 (9 am to 5 pm
weekdays) or 0845 701 0401 out of these days/hours. The 0845 701 0401
contact number is linked to the SWAST call centre in St. Leonards.
6.23
The East Dorset Community Dental Service have available a mobile dental
unit, which primarily provides a dental service to the homeless, which can be
used to maintain access to dental services across Dorset if general system
capacity is reduced.
6.24
The PCT holds NHS dental contracts for services provided at circa 120
locations across Dorset. This capacity at separate locations provides strong
resilience making total system failure, in terms of access to basic urgent
dental care, a remote possibility in a season.
Contingency Plan
•
All dental practices holding contracts with the PCTs in Dorset are
requested to have documented contingency plans including ‘buddy
arrangements’;
•
Mobile dental unit can be sited at any suitable location in Dorset to
treat patients with flu like symptoms separate to other patients (subject
to resilience to infection rates in the available dental workforce);
•
The potential exists to redirect dental contracts to engage inoculated
or symptom free dental staff in the provision of domiciliary dental care
subject to workforce capacity.
SINGLE POINT OF ACCESS (SPOA)
6.25
NHS Bournemouth and Poole commissioned South Western Ambulance
Service NHS Foundation Trust (SWAST) in December 2010 to deliver a
Single Point of Access (SPoA). The pilot was extended to cover NHS Dorset
from April 2011.
6.26
SPoA provides a telephone triage and referral service to community services
for health and social care practitioners.
6.27
The pilot will run until March 2013 when it will merge into the new NHS 111
service but with a separate number for health professionals.
DORSET HEALTHCARE UNIVERSITY NHS FOUNDATION TRUST
Dorset Healthcare University NHS Foundation Trust is the provider of
community health services and mental health services from July 2011.
Admission avoidance is vital during the winter to ensure business continuity of
Acute Trusts and also to ensure capacity for patients who urgently need
secondary care input. Currently there are a number of rapid response teams
including:
29
Bournemouth & Poole Locality Intermediate Care Teams. This service
provides a locality integrated health and social care multi-professional
Intermediate Care Service to home service for all adults over the age of 18
who are registered with a Bournemouth and Poole GP, which will undertake
acute assessment and diagnosis, crisis and rapid support, intensive
rehabilitation / reablement and treatments for adults and older people. These
services are available 7 days per week from 0700-2200.
The provision of enhanced integrated services delivered in partnership with
the Borough of Poole and Bournemouth Borough Council, means that
unnecessary hospital admissions are prevented and effective rehabilitation
services can be provided to enable early discharge from hospital and reduce
the need for premature or unnecessary admission to long term residential
care.
Intermediate Care can be provided in a person’s own home, residential and
residential with nursing home, and in a “step up/step down” inpatient
community beds which are currently on Jersey Ward, Guernsey Ward,
Tresillian Nursing Home and Broadwaters.
Bournemouth & Poole Locality Long Term Conditions Teams. This service
will identify people with long term conditions and provides them with access
to a range of services which are personalised to meet their needs. They are
supported by services which promote self management, health and well
being, independence, reduce the exacerbation of their long term condition,
and prevent unnecessary use of hospital or specialist services, and
supporting timely effective transfer from hospitals to community services.
People who have complex long terms conditions and are very high intensity
users of hospital and specialist services will be supported by this service
through a process of systematic case finding using agreed case finding tools
and a process of case management by Community Matrons and other
professionals within the team.
6.28
Dorset has strengthened capacity in its intermediate care teams for physical
and mental health services. Many teams are integrated and have health and
social care teams providing services as part of the Connecting Health and
Social care implementation programme. These services are available 7 days
a week from 0800-2200.
6.29
Dorset has enhanced community nursing services to provide evening and
night cover. Night nursing cover 10pm to 7am in Dorset has been finalised for
a consistent model across Dorset.
6.30
Community Matrons are in post across provider services, providing care for
patients with long term conditions and managing more care out of hospital for
this group of patients.
6.31
Dorset has arrangements in place for community hospital staff to sleep over if
they cannot travel home due to bad weather.
6.32
Where bad weather conditions are anticipated staff plan and deliver whatever
support is possible for patients prior to the weather arriving, including
30
telephone support and earlier and more frequent routine visits. In addition,
where patients circumstances necessitate home visits then staff living in
close proximity are allocated to those patients.
Community Hospitals
6.33
There is one community hospital within the NHS Bournemouth and Poole
geographical area, Alderney Hospital which has 48 beds.
There are 11 community hospitals across the NHS Dorset geographical area.
Table 2: Community Hospital Beds
Community Hospital
Alderney Hospital, Jersey and Guernsey wards
Blandford Community Hospital
Bridport Community Hospital
24
Betty Highwood
14
Langdon Ward
22
Ryeberry Ward
22
Portland Community Hospital – Castletown Ward
16
St Leonards Hospital
22
Victoria Community Hospital,
Wimborne
6.35
48
Tarrant Ward
Fayrewood Ward
Swanage Hospital – Stanley Purser Ward
6.34
Number of Beds
15
Cuthbury
15
Hanham
7
Wareham Hospital
16
Westhaven Community Hospital – Radipole Ward,
Weymouth
34
Westminster Memorial Hospital, Shaftesbury
20
Weymouth Community Hospital – Chalbury
16
Yeatman Hospital, Sherborne
34
Occupancy of the community hospitals has increased and the length of stay
decreased over recent years, enabling them to be a real asset in planning
intermediate care.
There are weekly teleconferences to discuss DTOC within Community
Hospitals.
Older People’s Mental Health
6.36
31
To work more effectively with the beds that the OPMHS at Kings Park have,
they are working towards identified Social Workers have being nominated in
each local authority to facilitate discharge of patients. There is daily
monitoring to oversee the bed occupancy in the service and work with the
wards and social services on discharges.
6.37
The Crisis Home Treatment Team continue to support OPMHS patients who
run a 24 hour service.
6.38
In the event of the beds being full at Kings Park, there is access to mental
health beds at Chalbury Unit in Weymouth and Betty Highwood Unit in
Blandford.
6.39
The Intermediate Care Service for Dementia (ICDS) is planned to be in place
from 1st April 2013, the role of this team will be to provide intensive
assessment and support for people in the community / in their place of
residence with a primary diagnosis of dementia. The team will provide a
similar function to the existing Crisis and Home Treatment Team; the
difference being this team will specialise in assessing and supporting people
with organic mental illness; the service will run seven days a week 8am 8pm. The pathway into the ICSD will be through the Community Mental
Health Team, or the Crisis and Home Treatment Team outside the
operational hours of the CMHT. The ICSD will act as a bed management
service; all admissions to organic inpatient beds in the East of the service will
be arranged via this team. When waiting for package of care to be put in
place / reviewed, ICSD staff will assess whether the patient requires
intermediate care and if so contact relevant care providers to spot purchase
social care.
6.40
Alderney Older Peoples Mental Health beds are temporarily moving to KPH
in August/September. Then all Older Peoples Mental Health beds will move
back to the restructured Alderney site in March 2013. Currently 68 beds in
total this will reduce to 46 - two ITU wards and two assessment and treatment
from March 2013. There will be increased service provision in the community
seven days a week for older peoples mental health. These developments are
in line with the dementia strategy.
Mental Health Services
6.41
32
Demand for care in mental health services does not tend to peak in the same
way as other services over the winter months. Services continue to be
available to avoid/ minimise emergency hospital admissions. Dorset
Healthcare have put a number of initiatives in place, to enable them to
manage during seasonal pressures:
•
A mental health telephone help line, which could also provide
guidance on managing flu symptoms at home;
•
All vulnerable patients will have an agreed management plan and
contact is available to attend to the person in a crisis;
6.42
•
Access to a crisis home treatment service for service users and
carers, which is open 24 hours a day and covers people from 16
years;
•
A weekend out of hours service for Poole Hospital for under 16 year
olds;
•
An early intervention team and crisis resolution service, both of
which aim to reduce the need for admission to hospital.
Additionally normal emergency admission procedures will continue over the
holiday periods and Consultant Psychiatrists will be on call and available to
all professional staff who need to refer to mental health services, including
Social Services, Commissioning Units of local and unitary authorities, the
Police service, minor injuries units and Accident and Emergency
departments. This service includes alcohol and substance miuse by mental
health patients.
Vulnerable Groups
6.43
Health and social care have identified within their caseloads vulnerable
individuals who may require additional support at specific times i.e. severe
weather. Vulnerable groups include those with a suppressed immunity
system; long-term condition and those who live on their own and are unable
to get out.
6.44
People who are homeless or in temporary accommodation have also been
included within the planning process and arrangements to ensure they have
access to the flu vaccine has been commissioned as appropriate within
primary and community settings.
Home Oxygen Service
The home oxygen service is provided by Air Liquide; the service has a
contingency plan in place, which outlines the Indicative order of priority for
homecare operational activity in an emergency or critical situation where
resources become overstretched due to unforeseen events or an abnormal
demand epidemic or pandemic situation.
Contingency Plan
33
•
Business Continuity Plans in place for each service area and overseen by
the Community Health Service Management Team (all plans are held on
an encrypted memory stick and held by all managers).
•
Staff are being encouraged to have seasonal flu vaccination.
•
Ability to use staff 4x4 vehicles in severe weather or link in with the LRF
Snow Desk (more information included within the weather section 11).
SECONDARY CARE SERVICES
6.45
6.46
Within the PCT Cluster area there are three acute NHS Trusts;
•
The Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust; and
•
Poole Hospital NHS Foundation Trust;
•
Dorset County Hospital NHS Foundation Trust.
A number of actions have been taken to support capacity management
including:
PHFT
Modelling has been undertaken to identify the number of beds and flow
required to deal with expected demand;
Inpatient elective admission will reduce during Christmas and New Year and
will increase incrementally after the holiday period;
At quarter 4 2011/12 there were 398 beds, this has been reduced to 384 beds
in quarter 3 2012/13 (excluding maternity, assessment units and Forest
Holme). Resilience planning includes 20 inpatient beds that can be opened
flexibly across all specialties and 11 additional assessment beds. The
reduction in beds has only been achievable due to the improvements made
within the trust:
34
•
Increase in Medical Investigation Unit Capacity to reduce length
of stay and reduce admissions
•
A reduction in average adult LOS of 7.88%. Reduction in bed
capacity has been supported by improvements to inpatient
pathways with a significant reduction in LOS, further work is
planned to improve internal processes and build on pathway
redesign.
•
Monthly readmission audits undertaken by specialty teams
•
4.6% increase in day surgery rates
•
British Red Cross assisted discharge scheme to support ED and
RACE Unit
•
7 Day working in pharmacy, therapies and consultant
assessment;
•
Introduction of older peoples nurse practitioners to review
patients in ED and Trauma specialties to aid discharge where
possible
•
Reconfiguration plans are in place from January 2013, action
plans in place based on further redesign of pathways to achieve
shorter LOS e.g. Increased capacity in the Discharge lounge and
increased access to the Medical Investigation Unit. Contingency
plans in place to provide escalation capacity during times of peak
demand.
•
Positive work with partner agencies has significantly reduced
formal delays across the Trust with further improvements
planned for Q3 & Q4.
RBHFT
in quarter 3 2012/13.Resilience planning includes 34 inpatient beds that can be
opened flexibly across all specialties.
The Trust’s Winter Plan sets out a range of actions and initiatives being put in
place to ensure that essential services are maintained including safe
management of emergency admissions, the delivery of elective workload and
achievement of all performance targets over the winter period.
The Trust has been building on the lessons learnt each year to ensure that the
Winter Plan is progressive and current. Our experience demonstrates that
emergency activity increases, patients are sicker with more complex needs and
the health economy as a whole is not always able to respond to the demands
made upon it during this period.
There is significant evidence to date this year that shows emergency
admissions are growing and creating capacity concerns prior to the official
winter period starting.
The key focus of this year’s Plan is to open twenty-eight general medical beds
The ward will be made available for medical patients for a period yet to be
confirmed but likely to be before Christmas to cope with the high level of
emergency admissions. Learning from last year this will be designated at a
medical ward but is likely to specifically meet the needs of acutely unwell elderly
patients and increased respiratory admissions from November.
In addition the opening of a Treatment and Investigation Unit will prove a vital
adjunct to the Winter Plan as this will free up inpatient capacity across a range
of specialities.
Alongside these projects there will be a greater focus on improving the
discharge process and reducing re-admissions. Many of the initiatives proposed
are to enhance and speed up the discharge process and prevent all avoidable
delays in the patients’ pathway. These initiatives will be given clear objectives
and will closely monitored to assess their impact and value these are outlined
below.
35
Other initiatives include
Increased Staffing into Discharge Coordination Team
With specific targets and objectives in relation to:•
•
•
•
•
Provision of 7 Day Service
Eradicating delays in CHC process
Continue to closely monitor and reduce formal delay
Reduction in all patients with a length of stay over 30 days
Consistent Daily Discharge Metrics
Increase support into Clinical Site Team
An additional fulltime Band 6 Nurse will be incorporated into the Clinical Site
Team over the winter period. This is a specific post to enhance the resilience
of the Clinical Site Team and to ensure the availability of H@N Bleep over the
entire weekend. This will also support junior Doctors with their workload.
Discharge Lounge
Appointment of ‘packer uppers’ to ensure patients are pulled through to the
Discharge Lounge in timely manner.
Medical Support
Extra medical support will be appointed to support the care of medical outliers
as well as manage the high levels of emergency activity. In addition this will
be used to provide input into the care of elderly patients on the orthopaedic
and surgical wards.
Discharge Planner for AMU
AMU currently provides this service on a part-time basis. Additional funding to
provide this 7 days a week will improve flow through the unit.
Housekeeping ‘SWAT’ Team
A designated team to deal with deep and terminal cleans in a timely manner is
currently being developed by Housekeeping. This will definitely improve
patient flow specifically in ED and AMU.
Additional Portering
This porter will work specifically between ED and x-ray to ensure efficient flow
of patients between the two departments. This porter can also be designated
to support AAU when the new emergency patient pathways come to fruition.
Initiatives being carried out by various directorates will further support the
Trust’s ability to manage over the forthcoming winter period. These include
• Dementia Nurse Specialist
• Pharmacy support into AMU
• Inpatient Angio Nurse to coordinate patients to achieve timely intervention
• Additional therapy staff to support outliers
• Extension to Liver Nurse secondment in order to sustain a reduction in
admissions and support timely discharges
36
DCHFT
in quarter 3 2012/13.Resilience planning includes 14 inpatient beds that can
be opened flexibly across all specialties.
Modelling has been undertaken to identify periods of high demand and
capacity required. A nursing pool has been employed to staff 14 winter
escalation beds with comprehensive plans agreed for the opening of these
beds;
New bed management policy in place supported by physician and surgeon of
the day models to ensure clear clinical responsibilities during periods of high
demand;
Acute physician in place to lead Emergency Medical Assessment unit and
ambulatory care service introduced to support admission avoidance
pathways. Surgical emergency assessment will be incorporated into this
facility from December 2012;
Decrease in inpatient elective activity over Christmas and New Year periods
with an increase in day surgery during this time;
•
A member of staff from the PCT cluster attends the weekly Trust
capacity planning meeting.
•
A further reduction of half a day has been achieved since April
2012 in non elective length of stay. However emergency
admissions have increased by 10% compared to 2011/12 and as
a result additional bed capacity has been opened on an adhoc
basis since August 2012
•
Consultant led ward rounds take place in the morning to facilitate
‘home for lunch’
•
7 day working in therapies in key areas.
Contingency Plan
37
•
Business Continuity Plans are in place;
•
The acute trusts have developed their escalation plans in partnership so
they are similar and take a 5 level approach;
•
Discussions have taken place between the Acute Trusts and a joint
approach has been agreed (mutual aid plans).
Emergency Department
6.47
During periods of reported high demand at an emergency department, the
South Western Ambulance Service NHS Foundation Trust may dispatch a
manager or practitioner to assist with patient triage and ambulance handover
arrangements. The South Western Ambulance Service NHS Foundation
Trust representative will work closely with colleagues in the management
team of the acute Trust to ensure patients are admitted, transferred or
discharged in a timely manner.
Contingency Plan
•
Trust wide Business continuity plan developed;
•
Work with SWAST to re-direct admissions where appropriate and agreed;
• Utilise additional capacity (resources and areas) within the hospitals for
times of increased demand.
Same Sex Accommodation
6.48
Compliance with same sex accommodation is a key priority for the PCT,
particularly in light of the bed pressures which may be faced over the winter
period.
6.49
The PCT undertake regular visits to provider organisations to monitor
compliance, and utilise the performance meetings as a mechanism by which
to address any non-compliance issues and seek assurance as to how
compliance will be achieved over the winter months.
Paediatrics
6.50
The Acute Trusts have drafted a Policy around Paediatric Management in a
Pandemic, which includes three levels of escalation. The policy outlines the
actions which would be taken for each identified level of escalation.
6.51
The key principles across the three acute trusts include:
38
•
PHFT would facilitate the expansion of the paediatric ward / HDU and ICU
facilities if capacity increases;
•
DCH would open 7 additional paediatric beds;
•
Trusts would contact one another if further support is required after all
additional beds have been opened;
•
PHFT provides critical care in partnership with Southampton University
Hospital based on a hub and spoke model; there are clear plans regarding
the transfer of paediatrics between the two hospitals;
•
RBHFT would take adult emergency admissions in order to enable PHFT
to accommodate more paediatric patients in adult beds;
•
There is agreement between PHFT and RBHFT that all paediatric
patients, including those requiring critical care should be accommodated
within PHFT rather than across two hospital sites where possible; this will
be reliant on the ability to transfer patients to RBHFT.
CRITICAL CARE
6.52
All three Acute Trusts provide critical care capacity for the health economy.
6.53
The Acute Trusts currently have critical care capacity of:
Table 3: Critical Care Capacity
NHS Trust
The Royal Bournemouth and
Christchurch Hospitals NHS
Foundation Trust
Poole Hospital NHS Foundation
Trust
Dorset County Hospitals NHS
Foundation Trust
6.54
Critical Care Beds
4 ITU Beds
6 HDU Beds
10 Coronary Care Beds
11 Critical Care Beds (x5 L3 and x6 L2)
8 CCU beds;
4 HDU paediatric beds
4 neonatal ITU beds
6 neonatal HDU beds
4 ITU Beds
4 HDU Beds
4 Coronary Care Beds
In the event of a pandemic, acute trusts can escalate as follows:

PHFT - can escalate from 11 to 26 (Level 2 and level 3), a 136%
increase, although some services would have to be suspended in
order to facilitate this;

RBHFT – adult critical care can be trebled;

DCHFT – adult critical care can be doubled;

Paediatric care capacity can be increased by 100% with escalation
measures in place between the acute trusts;

There is no capacity to increase current neonatal critical care beds.
6.55
Further detailed information is available in the acute trusts ‘Capacity planning
for level 3 & 2 activity– Swine Flu planning’ documents.
6.56
The SHA South West critical care plan makes it clear that hospitals in this
region will be liaising with Southampton for support.
39
In complying with the requirements of HSC 2000/17 acute Trusts have
established local critical care transfer networks which can be seen in table 4.
6.57
Should patients need to be transferred outside of the critical care network
then the decision to consider mutual aid will be made; figure 2 defines the
escalation process.
Table 4:
6.58
40
Critical Care Transfer Network
NHS Trust
NHS Trust in agreed Critical Care Transfer
Network
The Royal Bournemouth
and Christchurch Hospitals
NHS Foundation Trust
Poole Hospital NHS Foundation Trust
Dorset County Hospitals NHS Foundation
Trusts
Salisbury Health Care NHS Trust
Poole Hospital NHS
Foundation Trust
The Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust
Dorset County Hospitals NHS Foundation
Trusts
Salisbury Health Care NHS Trust
Southampton University Hospital –
PICU/NICU
Dorset County Hospitals
NHS Foundation Trusts
Poole Hospital NHS Foundation Trust
The Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust
East Somerset NHS Trust
By way of ‘mutual aid’ in the event that a pandemic or major incident effect
one area of the county, provision has been made to escalate patient transfer
initially through local networks and then Primary Care Trusts culminating in
the Strategic Health Authority co-ordinating across the county to find
available critical care beds.
Figure 2: Critical Care Escalation
GOLD
SILVER
Southampton
University
Hospitals NHS
Trust
(PICU / NICU)
WIDER NETWORK
SHA
NHS Bournemouth,
Poole and Dorset
Salisbury
Health
Care NHS
Trust
The Royal
Bournemouth and
Christchurch
Hospitals NHS
Foundation Trust
East
Somerset
NHS Trust
Dorset County
Hospitals NHS
Foundation
Trust
BRONZE
Poole Hospital
NHS
Foundation
Trust
LOCAL
SHA
6.59
As highlighted earlier in the plan Poole Hospital provides paediatric critical
care in partnership with Southampton University Hospital based on a hub and
spoke model and there are clear plans in place regarding the transfer of
paediatric patients between the two hospitals.
6.60
More detail on the management of paediatrics can be found in section 6.50.
6.61
There will be a need to maintain compassionate and dignified care for the
remainder of life for those patients who have not responded to therapy in
intensive care and for whom intensive care is not continued or available.
There is an expectation that there will be guidance from the Department of
Health regarding ventilation criteria during a pandemic.
6.62
It is noted by all trusts involved that if the pandemic influenza takes hold it is
unlikely within the critical care networks that any organisation will be able to
provide much in the way of additional capacity for their partners.
41
INTERNAL /NETWORK TRIAGE
SHA
PCT
SHA
Contingency Plan
•
Agreed plans between the Acute Trusts regarding management of
paediatrics; and
•
Preparation for staffing additional beds taking place, including identifying
retired, bank staff who are already trained or can be trained to support the
specialist nurses.
Stroke
The provision of Early Supported Discharge for patients admitted to DCHFT,
RBHFT and PHFT who meet the ESD criteria will support the availability of
inpatient beds for stroke patients throughout the winter months. This will
enable Stroke units to maintain the national targets of 90% of patients
admitted directly to the stroke unit within 4 hours and 90% of patients
spending 90% of their time on the stroke unit.
The skills of staff delivering ESD in the community will enable other patients to
be discharged following a stroke in a more timely fashion thereby maintaining
the patient flow through the stroke units.
TERTIARY CARE SERVICES
6.63
The main tertiary care provider for Dorset is Southampton University Hospital
NHS Foundation Trust.
6.64
Assurances have been obtained regarding capacity to sustain services during
the winter and in the event of a pandemic flu.
6.65
Contracts are in place with the independent sector for cardiac surgery and
these centres have an ICU. The centres will be able to take non-elective
cardiac surgery in order to free up capacity.
6.66
The key area of concern for the Primary Care Trust is in terms of paediatric
critical care which has been discussed in section 6.53 of this paper. Planning
between the Acute Trusts has provided assurance that in the event that
paediatrics cannot be transferred to Southampton University Hospital
capacity can be found locally to care for the patient with telephone/video
conference support from the PICU.
6.67
Additionally plans are in place to defer some cancer treatments if a flu
pandemic takes hold, this will include the transfer of some cases out of
county. These will be considered on a case by case basis.
42
Contingency Plan
•
Business continuity plans produced and reviewed as part of the
contracting process.
SOCIAL CARE SERVICES
6.68
Dorset is covered by three Local Authorities Social Care teams (Dorset,
Bournemouth and Poole) and each has a vital role to play in seasonal
planning and in the preparation for pandemic flu.
6.69
At times of pressure on beds within the acute hospitals, the Social Work
teams, in acute settings, will aim to do the following:
43
•
Regularly consult with hospital discharge staff regarding bed state.
•
Identify with the discharge liaison staff those Dorset patients who require
social work input and are nearing discharge or those whose discharges
could potentially be brought forward.
•
The Locality Manager / Team Leaders / Social Care Discharge Manager
will prioritise the above cases with allocated workloads and, if necessary,
put current less urgent work on hold whilst the priorities are dealt with.
•
Managers with staff on more than one site will consider staff moving
between sites to areas of greatest pressure.
•
The Brokerage service will be alerted to bed state and request higher
priority to identifying placements and packages of care for hospital
discharge.
•
Intermediate care services and reablement will be approached regarding
any availability and any additional capacity.
•
All staff will review those service users who are ready for discharge and
awaiting placements or large packages of care, and decide if needs could
be met by interim/short term placements to be followed up by community
teams;
•
All staff will focus on quickly achievable discharges
•
will notify appropriate service managers of bed state and any actions that
they may propose to implement to assist the discharge process.
•
will notify Local Offices of implications for discharges and seek potential
assistance from local teams.
•
Ten unallocated cases held by a social work team in an Acute Trust will
trigger the possibility of overtime hours to be agreed by Community
Service Manager. Dorset County Council has agreed that if there are 5
unallocated cases at either RBH or Poole hospital who are medically fit for
assessment, payment of overtime will be agreed by the Adult Service
Manager to enable staff able to work additional hours to catch up.
•
The Managers will document cases identified and maintain a log of cases
prioritised so that information can be obtained quickly and efficiently.
•
Administration staff will filter telephone calls and take messages. Team
members will check for messages on hourly basis (minimum).
•
At times of pressure within the Social Work team the locality Manager /
Team Leader / Social Care Discharge Manager will ensure that the
relevant hospital management and staff in acute hospital bases are aware
of the pressure and cause - for example, unforeseen high level of
sickness, planned essential training, risk caused by IT problems, high level
of Safeguarding Adults referrals. The relevant team will also ensure CMS
is updated to reflect their position.
•
Relevant staff will include discharge team and leaving hospital support
staff as appropriate.
6.70
A key principle to be achieved is the recognition that communication should
initially take place at an operational level and escalated to higher levels only if
no response / action is taken forward.
6.71
Contingency Plan
•
Arrangements between the three Local Authorities to enable joint
working;
•
Liaise with all Directors and help ensure adequate staffing levels and
relief staff by offering temporary contracts or additional hours;
•
Prioritisation of cases;
•
Increased work with acute hospitals to facilitate discharges;
•
Consideration of other options to be taken to all Senior Management
Teams.
AMBULANCE SERVICE
6.72
44
The purpose of this section of the Winter Plan is to describe the
arrangements put in place by the South Western Ambulance Service NHS
Foundation Trust for winter 2012/13 to inform the integrated planning
processes for health and social care partners.
Ambulance Services
6.73
As an integral part of its winter planning arrangements, the South Western
Ambulance Service NHS Foundation Trust will:
•
Agree with NHS and Social Care partners robust local protocols to
ensure patients are referred to the most appropriate care with a
minimum of delay
•
Provide efficient handling of 999 calls to include and address: fast
activation, effective resourcing, demand matching, dynamic as
opposed to station-based cover, adequate relief levels
•
Ensure the safe and timely transfer of patients between facilities,
based upon the Accident and Emergency Service Level Agreement
of moving patients from a lower to high care facility:
*
6.74
if exceptionally, a transfer of a critically ill patient takes place
outside an agreed transfer group, this must have been agreed
by the responsible consultants for both NHS Trusts and the
respective NHS Trust Chief Executives or Duty Directors must
be informed. The NHS Trust from which the transfer took place
must ensure that the Chief Executive of the relevant local
commissioning body (Primary Care Trust) is informed within
two working days
•
Work with primary care colleagues to ensure that general practitioner
generated HCP medical priority dispatch calls (formerly urgent) are
managed in such a way to optimise patient flows at times of
exceptional demand. The PCT cluster is identifying current
arrangements for home visits for all GP practices to investigate
whether these arrangements need reviewing in order to achieve a
better spread of GP ambulance admissions throughout the day.
•
Ensure that the scheduling and planning of ambulance staff will be
carried out up to three weeks in advance and known absences
covered by relief or overtime staff
•
Ensure that the Patient Transport Services Planning Department
continues to plan adequate resources in advance to meet predicted
demand according to contractual requirements.
Rostering for Christmas and New Year will take place as in previous years.
The South Western Ambulance Service NHS Foundation Trust will be unable
to accept leave applications from any operational employee group (other than
substantive relief staff who are wholly employed externally to rotas) during
the Christmas/New Year period on the following dates:
•
45
Tuesday, 25 December 2012
•
•
•
.
6.75
In exceptional circumstances leave applications may be considered. Staff
who wish to apply have to do so through their Operations Locality Manager
for authorisation by the respective Head of Operations. Alternatively, stations
may apply as a group to the Head of Operations for authority to manage their
shifts autonomously for the duration of the holiday period of 2012/13. This
should cover the following weeks:
•
•
6.76
Wednesday, 26 December 2012
Thursday 27 December 2012
Tuesday, 1 January 2013
Sunday
Sunday
23 December 2012
30 December 2012
Proposals for self-management should be submitted through the respective
Locality Manager and must cover the following issues:
•
The proposal must be agreed and signed by all members of the
station making the application
•
The proposal must meet all the principles set out in South Western
Ambulance Service NHS Foundation Trust policies including equity
and working hours policies.
6.77
Any existing individual flexible working agreements must be honoured unless
the individual concerned has agreed to suspend the existing agreements.
6.78
The station will guarantee that all shifts during the period are covered without
support from other stations, including all short notice absences.
6.79
The station will undertake to manage the plan and manage duties without
additional support from area administrators.
6.80
Applications should reach the appropriate Head of Operations no later than 1
October 2012.
Fleet Provision
6.81
The accident and emergency fleet/logistics department will be requested to
provide the maximum number of fully equipped ambulances and response
cars at all times during the winter period to meet both the proactive and
reactive requirements placed on the Trust.
6.82
Servicing and safety checks on ambulance vehicles will meet the agreed
internal quality and performance standards.
6.83
A skeleton internal workshop service will be maintained throughout the festive
period to ensure ambulance availability. External workshop suppliers will be
engaged on an on-call basis throughout the festive period.
46
6.84
Existing roadside rescue/recovery arrangements will be consolidated with
external contractors to ensure that disruption to the availability of ambulance
resources is minimised.
SWAST Escalation Procedures
6.85
It is the intention of the Trust to maintain a high level of patient care service to
the communities of Cornwall and Isles of Scilly, Devon, Dorset and Somerset
when experiencing capacity pressures. This is critical to maintain public
confidence in the service and the good reputation of the Trust.
6.86
The NHS now accepts that ‘over capacity’ can occur at any time of the year
and has introduced the philosophy of ‘Whole System Capacity Planning’.
The response by South Western Ambulance Service NHS Foundation Trust
has been to produce, in line with nationally guidance, a Resource Escalatory
Action Plan. This action plan triggers specific measures when the Service is
operating over capacity.
6.87
During periods of high pressure, South Western Ambulance Service NHS
Foundation Trust will consider a variety of tactical options that are considered
most suitable to deal with over capacity situation.
6.88
Resource Escalatory Action Plan is designed to increase operational
resourcing in line with demand, to cope with periods of high pressure and
maintain the highest possible quality of patient care.
6.89
Resource Escalatory Action Plan is in operation at all times. In normal
circumstances it will operate at Resource Escalatory Action Plan level one,
when the service is at a steady state. There are varying levels reflecting
increasing pressure on the service, up to level six, where there is the
potential of service failure.
6.90
The Resource Escalatory Action Plan levels are:
47
REAP Level 6
Potential Service Failure
REAP Level 5
Critical
REAP Level 4
Severe Pressure
REAP Level 3
Moderate Pressure
REAP Level 2
Concern
REAP Level 1
Normal service
6.91
Each level is triggered by intelligence from both inside the Service or from the
external environment. It is based on many different factors including,
performance targets, increased activity, sickness, accident and emergency
capacity, weather conditions and system failures.
6.92
The REAP plan and the REAP levels apply to the whole organisation. The
current level will be widely publicised and are currently reviewed on a monthly
basis. Every manager has a responsibility to know the current state. It is
expected that all staff will have an understanding of the REAP levels and
know what is required of them.
6.93
During the winter reporting period the REAP level will be reviewed, if
necessary, on a weekly/daily basis. Each operational manager and head of
department has a responsibility to understand the REAP level and to have a
corresponding implementation plan for their area of operation.
6.94
All areas of the Service are required to take meaningful action, with the
appropriate urgency, as the plan escalates.
6.95
The Resourcing Escalation Action Plan is aimed at protecting patient care.
Consequently actions taken under the plan should be considered to have
been taken with the delegated authority of the Chief Executive.
6.96
The nationally agreed triggers for implementation of a REAP level based on
factors affecting performance are shown in Table 5 on page 49:
48
Table 5 – Resource Escalatory Action Plan – Nationally Agreed Triggers for Implementation of a REAP Level based on factors
affecting performance
REAP
Level
Factors Affecting Performance
Performance
Cat A < 60%
6
Cat B < 65%
Cat A 65% - 60%
5
Cat B < 70%
Cat A 73%-65%
4
Cat B 90% - 70%
Cat A 76% - 73%
3
Cat B 95% - 90%
Cat A 79% - 76%
2
Cat B 97% - 95%
Cat A 79% +
1
Cat B 97%+
49
Demand
Operations
Abstractions
Activations
> 15% above
normal
contracted
level
Abstractions within
Operations have
increased by > 15%
over normal seasonal
levels.
Activations
10% -15%
above normal
contracted
level
Abstractions within
Operations have
increased by 10%15% over normal
seasonal levels.
Activations
8% -10%
above norm
Abstractions within
Operations have
increased by 8-10%
levels.
Activations
5% - 8%
above normal
contracted
level
Abstractions within
Operations have
increased by 5%-8%
levels.
Activations
2%-5%
above normal
contracted
level
Abstractions within
Operations have
increased by 2%-5%
levels.
Activations
< 2% above
normal
contracted
level
Abstractions within
Operations are within
normal seasonal
levels.
Clinical Hub Issues
External Influences
NHS / Internal Influences
Abstractions within Clinical Hub
have increased by >20% over
normal seasonal levels.
Call abandoned rate > 40%
50% calls answered within 5
seconds
have increased by 15% over
Call abandoned rate > 30%
seconds
Call abandoned rate 10 - 30%
seconds
Abstractions within Clinical Hubs
Call abandoned rate 5% - 10 %
seconds
normal seasonal levels
Call abandoned rate 2%– 5 %
seconds
Supply chain difficulties
are not manageable
Events are having a wide
spread impact Trust wide
Hospital turnaround times extended by average 10
minutes
Major critical infrastructure issues have been experienced
for a period of up to 24hours and are expected to continue
for a specified time of no more than 24 hours.
are manageable
Events are having a wide
spread impact in a area
Hospital turnaround times extended by average 5 minutes
Critical infrastructure issues have been experienced for a
period of 12hours and are expected to continue for a
specified time of no more than 6 hours.
are short lived.
Events are having a
limited local impact on
activity.
Hospital turnaround times Trust wide extended by average
3 minutes
Critical infrastructure issues have been experienced for a
period of 6 hours and are not expected to reoccur.
are within normal seasonal levels.
Call abandoned rate < 2%
seconds
No reported supply chain
difficulties
No events are a threat to
activity
Hospital turnaround times are <28 minutes on average
No critical infrastructure issues
mean trust supplies are at
a critical level
mean trust supplies are at
a critical level
minutes
for a period of 24hours and are expected to continue for an
unspecified time.
minutes
for a period of 24hours and are expected to continue for an
unspecified time.
Handovers
‘Emergency Care, New Service Standards, Reflecting the True Patient
Experience’ asserts that NHS Chief Executives should ensure that
ambulance borne patients wait for no more than 15 minutes on arrival at the
emergency department before their care is transferred to a clinically qualified
member of staff. The standard of 15 minutes for handover of patients from
ambulances is to address the issue of delays to ambulance borne patients
waiting outside of the emergency department when it is busy.
6.97
Local health partners, including South Western Ambulance Service NHS
Trust, will work together closely to draw up contingency arrangements to
ensure the NHS can cope efficiently with increased demand.
6.98
In the event of ambulance vehicles becoming delayed in excess of 30
minutes due to the inability to handover their patients, the receiving
emergency department must make every effort to free up vehicles for
immediate use by the South Western Ambulance Service NHS Trust.
6.99
As of July 2012 the cluster now have to report on a weekly basis to the SHA
in regard to any 1 hour delay and/or where 15% or more ambulance
handovers in one week take in excess of 30 minutes as reported in the
weekly NHS Ambulance Trust SITREP. A letter is sent by the Cluster after
SWAST provide the detail.
6.100 The cluster work closely on a day-to-day basis with the emergency
department to try to resolve any issues.
6.101 A bi-monthly meeting takes place with RBHFT/PHFT/SWAST and the PCT in
order to discuss any specific issues/concerns and review the cause of any
delays over 1 hour.
Non-Emergency Patient Transport Services (PTS)
6.102 Throughout winter, ensuring a timely discharge from hospital for patients is
paramount. The South Western Ambulance Service NHS Trust is, where
possible providing Patient Transport Services to support discharges and to
facilitate timely, simple discharge from hospital.
6.103 The strategic commissioning of community transport services across the
health and social services is being reviewed in Devon, Cornwall, Somerset
and Dorset. Following a procurement process last year to increase the range
and capacity of patient transport services due to not all of these being
available from the current South Western Ambulance Service NHS Trust
contract, further independent sector providers have been commissioned to
work within the health community for 5 types of transport (timed response,
long distance transfers and repatriations, bariatric, short notice). This will help
to provide appropriate and effective discharge over the winter period and
acute Trusts regularly engage the independent sector to facilitate their
requirements.
50
6.104 The current levels of patient transport ambulances commissioned from the
South Western Ambulance Service NHS Trust do not provide the resilience
required in the event of a significant escalation and a high level of
dependency on the independent sector would be required which is now
commissioned as highlighted above.
SWAST Useful contacts
Clinical Hub (24 hours) (Somerset, Devon
and Cornwall)
01392 261621
Clinical Hub (24 hours) (Dorset)
08456 047 089
Urgent Care Service (24 hours) (Dorset)
0845 6001013
Urgent Care Service (24 hours) Somerset
0845 4088000
Contingency Plan
•
Business continuity plan for ambulance services produced;
•
Human Resources policy for pandemic influenza produced;
•
Escalation processes include arrangements to spread demand between
hospitals;
•
Improved planning for and management of escalation to ensure early
communication to SWAST and other partner organisations.
Mental Health Services
6.105 Demand for care in mental health services does not tend to peak in the same
way as other services over the winter months. Services continue to be
available to avoid/ minimise emergency hospital admissions and there is an
increased emphasis on business continuity this year because of the predicted
pandemic flu virus.
6.106 Dorset Healthcare have put a number of initiatives in place, to enable them to
manage during seasonal pressures:
•
A mental health telephone help line, which could also provide
guidance on managing flu symptoms at home;
•
All vulnerable patients will have an agreed management plan and
contact is available to attend to the person in a crisis;
51
•
Access to a crisis home treatment service for service users and
carers, which is open 24 hours a day and covers people from 16
years;
•
A weekend out of hours service for Poole Hospital for under 16 year
olds;
•
An early intervention team and crisis resolution service, both of
which aim to reduce the need for admission to hospital.
6.107 Additionally normal emergency admission procedures will continue over the
holiday periods and Consultant Psychiatrists will be on call and available to
all professional staff who need to refer to mental health services, including
Social Services, Commissioning Units of local and unitary authorities, the
Police service, minor injuries units and Accident and Emergency
departments. This service includes alcohol and substance miuse by mental
health patients.
Learning disabilities
6.108 A number of initiatives are in place to support patients who have a learning
disability if they need to access healthcare, including the following;
•
In all three acute trusts there is an agreed assessment in order to
identify additional needs and advise on the best way to support the
individual;
•
RBHFT have an Admissions Policy for people with LD and DCHFT has
a Policy for Supporting People with a Learning Disability;
•
The Yellow Health Book (health action plan) has been rolled out PanDorset to people with a learning disability. This book can be taken with
the individual when the attend any health appointment and contains
information for health staff to help them to support the person;
•
All of these documents will contain information on how to support the
person if they present a particular challenge to health services because
of their behaviour in unfamiliar environments or under difficult
circumstances, or due to communication needs;
•
Support is available from the Intensive Support Team, who have staff
based in both the east and the west of the county and are available
seven days a week, from 8am -8pm. There are named Link Nurses
from the IST for acute hospitals;
•
Community Learning Disability Teams also have nurses who are
available to support colleagues in the acute hospital sector by giving
advice, training/awareness of the needs of people with a learning
disability or attendance at multi-disciplinary meetings to develop
individual support plans, including discharge plans;
52
•
All three of the acute hospitals have recently taken part in the South
West Acute Hospital Learning Disability Peer Review and have
developed action plans based on the review findings.
7.0
END OF LIFE
7.1
The Community Generalist Palliative Care Service provides general palliative
care for all patients in Bournemouth and Poole who are aged 18 or over
suffering a life threatening illness, cancer or non cancer and wish to die in their
home environment.
7.2
The provision is available seven days a week between 0830 hours and 2100
hours with night cover when required. It offers a comprehensive service to
patients by working in close partnership with Twilight services, Marie Curie,
Social Care, Specialist Palliative Care consultants, Acute Hospitals,
Continuing Health Care team and Out of Hours services.
Contingency Plan
•
Business Continuity Plans in place and overseen by the Community
Health Service Management Team (all plans are held on an encrypted
memory stick and held by all managers).
Deaths in the Community
7.3
Death in the community is managed as part of general practice core business,
and generally (and over the winter) there is capacity in the system to provide
certification of death by GPs.
7.4
During an influenza pandemic there could be an increase in deaths in the
community which could in light of other increases in activity in general practice
mean we struggle to find people to certify death. This would be addressed
through the training of nurses to provide verification of death.
Contingency Plan
•
Training of additional nurses to perform verification of death in the
community has taken place;
•
Implementation of excess deaths plan.
53
Mortuary Capacity
7.5
7.6
The mortuary capacity within the Acute Trusts is:
•
The Royal Bournemouth Hospital – 48 places available (+ 3 places for
obese and 2 paediatric places). Capacity to firstly double up + 50. Second
stage to use adjoining rooms with chillers + 40 – total 90;
•
Christchurch Hospital – 12 places available with capacity to double up;
•
Poole Hospital – 50 places available (including 3 deep freeze units and 5
places for obese individuals.
•
Dorset County Hospital – 32 places (+3 deep freeze units)
The Acute Trusts have the ability to increase capacity if urgently required
during a pandemic flu outbreak as part of the partnership working with the
local authorities and third sector providers.
Contingency Plan
•
Acute Trusts have identified the ability to increase capacity if urgently
needed;
•
Links with Bournemouth Borough Councils Mortuary and co-operative
mortuary if needed; and
•
Contingency plans in place to support excess deaths through the Local
Resilience Forum.
Management of Excess Deaths
7.7 The management of excess deaths is addressed through the Local Resilience
Forum (LRF) and the Local Authorities, a plan for which is held centrally and
was signed-off by the LRF in February 2010.
8.0
CROSS CUTTING THEMES
8.1 As well as there being a number of key provider organisations there are also a
number of cross cutting organisations that have an impact on acute, community
primary care and social care provision across the health economy.
8.2 These services have all developed business continuity plans and have been
engaged in the Seasonal Planning Resource and Implementation Group.
VACCINATION PLANS
8.3 The objective of the seasonal flu programme is to minimise the health impact of
seasonal flu through effective monitoring, prevention and treatment including:
54
•
Vaccinating at least 75% of those at greatest risk with the seasonal flu
vaccine before the virus starts to circulate;
•
Monitoring flu activity, severity of the disease in risk groups, vaccine
uptake and impact the NHS;
•
Offering antiviral medicines to patients in at-risk groups for the
treatment of flu in line with NICE guidance;
•
Ensuring the NHS is well prepared.
8.4
Local planning has enabled the identification of triggers and an awareness of
when escalation systems need to be activated outlined within the local action
cards in Appendix 2.
8.5
Section 5.16 of this plan provides an overview of the communication plan for
staff and patient immunisation.
Seasonal Influenza – General Public
Data from ImmForm returns shows that
8.6
In 2011/12 NHS Bournemouth and Poole achieved an uptake of:
• 72.9% in the over 65 year olds;
• 48.9% in the 16 – 64 years ‘at risk’ age group;
• 44.6% of at-risk pregnancy women.
8.7
In 2011/12 NHS Dorset achieved an uptake of:
• 73.7% in the over 65 year olds;
• 50.4% in the 16 – 64 years ‘at risk’ age group;
• 51.0% of at-risk pregnancy women.
8.8
The number of staff that received the H1N1 vaccine from NHS Bournemouth
and Poole in 2011/12 was 328 and in NHS Dorset it was 899 (including PCT
and community staff).
8.9
The priorities for 2012/13 are to:
•
Meet / exceed the 2011/12 target of 75% in those aged 65 years and
over;
•
Increase the influenza vaccine take-up rates in clinical risk groups
under 65 years;
55
•
Increase the influenza vaccine take-up rates in pregnant women to
70% or more
•
Ensure all general practices provide data on vaccine uptake in
2012/13
Priority Groups
8.10
The priority groups eligible for seasonal flu vaccine for 2012/13 are as follows:
•
People aged 65 or over
•
All pregnant women
•
People with a serious medical condition such as:

chronic (long-term) respiratory disease, such as severe asthma,
chronic obstructive pulmonary disease (COPD) or bronchitis;
chronic heart disease, such as heart failure;
chronic kidney disease at stage 3, 4 or 5;
chronic liver disease;
chronic neurological disease, such as Parkinson's disease or
motor neurone disease;
diabetes; or
weakened immune system due to disease (such as HIV/AIDS)
or treatment (such as cancer treatment).
•
People living in long-stay residential care homes or other long-stay care
facilities where rapid spread is likely to follow introduction of infection
and cause high morbidity and mortality. This does not include, for
instance, prisons, young offender institutions, or university halls of
residence.
•
People who are in receipt of a carer’s allowance, or those who are the
main carer of an older or disabled person whose welfare may be at risk
if the carer falls ill.
8.11
The list above is not exhaustive and decisions should be based on a
practitioner’s clinical judgement. Consideration should also be given to the
vaccination of household contacts of immunocompromised individuals, i.e.
individuals who expect to share living accommodation on most days over the
winter and therefore for whom continuing close contact is unavoidable.
8.12
The ‘Directly Enhanced Service (DES) for Influenza and Pneumococcal
Immunisation for those for those in the 65 and over and other At-Risk Groups’
issued in April 2012 states that these vulnerable patients will be vaccinated
with both the influenza and pneumococcal vaccinations as a matter of
routine.
56
8.13
Dorset Healthcare will provide the vaccination service for house bound
patients for both the seasonal and pandemic influenza vaccines if necessary.
Health and Social Care Staff Vaccination
8.14
The updated Code of practice on the prevention and control of infections and
related guidance reminds both NHS and social care bodies of their
responsibilities. These are to ensure, so far as is reasonably practicable, that
health and social care workers are free of, and are protected from exposure
to infections that can be caught at work. All staff should be suitably educated
in the prevention and control of infections. The Code includes ensuring that
occupational health policies and procedures in relation to the prevention and
management of communicable diseases in healthcare workers, including
immunisation, are in place.
8.15
This message has been communicated to all providers through the
contracting route and assurance sought that they have a plan in place for the
vaccination of their staff.
8.15
Dorset Healthcare have arranged a series of vaccination clinics running
during October & November 2012 in various locations including the two head
offices of the PCT cluster.
Contingency Plan
•
Each general practice has a contingency plan that includes ‘buddy’
arrangements which provide support if staffing capacity is reduced;
•
Bank staff would be identified that could provide vaccination support
across the health community as required (short term requirement);
•
Identification of Primary Care Trust staff (nurses still on the register) that
could be trained to deliver vaccination;
•
Local pharmacists have been trained to deliver vaccinations and could be
incorporated into mass vaccination plans as vaccinators, if required.
WORKFORCE
8.16 As leaders of the local health community the cluster PCT has a key role to
play in workforce assurance across the health system. Provider
organisations remain responsible for the employment, deployment and
management of their staff; however the two PCTs within the cluster as
commissioners of services must be assured that the providers have the
workforce capacity and capable to deliver high quality services in line with
commissioning intentions and contract monitoring arrangements. This is
particularly critical during times of seasonal pressures and arrangements are
57
in place through the contract monitoring framework with Human Resources
Directors to review and monitor workforce information and associated quality
issues and seek the necessary assurance that adequate staffing levels are in
place.
8.17 The PCT cluster must also ensure that it remains ‘fit for purpose’ and able to
deliver its statutory functions and priorities during the transition period. All
Directorates have business continuity plans in place which identify critical
functions, and where necessary reciprocal arrangements have been identified
in the event that staff are not able to either attend work or access specific
information systems from their normal place of work. An ‘Adverse Weather
Policy’ is in place and provides a framework for staff in the event that they are
not able to attend or access their normal place of work.
8.18 If there was a pandemic the Department of Health predict that up to 50% of
the workforce may require time off at some stage over the entire period of the
pandemic. In a widespread and severe pandemic, affecting 35%- 50% of the
population, this could be even higher as some with caring responsibilities will
need additional time off.
8.19 Staff absence should follow the pandemic profile. In a widespread and severe
pandemic, affecting 50% of the population, between 15% and 20% of staff
may be absent on any given day. These levels would be expected to remain
similar for one to three weeks and then decline.
8.20 Additional staff absences are likely to result from other illnesses, taking time
off to provide care for dependants, to look after children in the event of
schools nurseries closing.
Contingency Plan
•
Business continuity plans developed;
•
Critical functions identified for each Directorate;
•
Bank and recently retired staff approached regarding support in the event
of increased staff absence caused by a pandemic;
•
Staff skills audit complete.
INFECTION CONTROL
8.21 The Dorset Infection Prevention and Control Team is in place to monitor and
manage infection control in collaboration with the Infection Prevention and
Control Teams of the three local acute NHS Trusts, General Practitioners,
Dorset Health Protection Unit, Public Health Directorate and Dorset
Healthcare University Foundation Trust to create a seamless approach to the
management of incidents and outbreaks of infection.
58
8.22 The cluster receives assurance from all NHS providers that high quality
systems exist to prevent cross infection and reduce healthcare associated
infection rates. This includes ensuring that staff are competent and trained to
identify patients at risk and manage their care appropriately. Audits are
reviewed to ensure compliance with cleaning standards and hand washing.
The PCT also conducts unannounced visits on a quarterly basis to carry out
spot-checks in relation to environmental cleanliness.
8.23
Systems include:
• A Patient assessment algorithm for potentially infectious patients used
by South Western Ambulance Service NHS Foundation Trust
(SWASFT) to ensure appropriate management of potential infections in
the Emergency Department or other admitting area;
• A Patient Assessment in the Emergency Departments following an
agreed algorithm;
• Side room assessment tool to enable patient isolation and movement if
required;
• Adherence to Outbreak Policy (reference to Norovirus toolkit);
• Outbreak reviews at daily capacity meetings with agreed plans of action;
• Cleaning plans agreed to enable increased cleaning during outbreaks
and deep clean following end of outbreak to ensure prompt re-opening
of a closed area;
• Reporting of outbreaks through HPA reporting system;
• Escalation within the trusts as per escalation policy;
• Notification to PCT of infection outbreak through IT system;
• Pressures identified through CMS reporting.
8.24
An outbreak is defined as:
• An incident affecting two or more people thought to have a common
exposure to a potential source, in which they experience similar illness or
proven infection;
• A rate of infection or illness above the expected rate for that place and
time, where spread is occurring through cross infection, or person-toperson;
• Norovirus infection leading to the closure of 2 or more wards in acute
setting and 2 or more cases in other inpatient settings (e.g. ITU, HDU,
CCU) or in community based hospitals and care homes.
59
8.25
Work has been undertaken to:
• Ensure consistency in approach via organisations’ outbreak
management policies relating to periods of isolation, cleaning regimes
and responsibilities, incubation and stand down times and advice to the
general public;
• Establish an alert system of email notification to all infection control staff
of outbreaks in the county;
• Develop a trigger tool for appropriate level involvement during outbreak
management.
8.26 The relevant Infection Control Team are contacted immediately in the event
of a suspected outbreak and an outbreak control meeting will be convened as
necessary with PCT attendance as required.
8.27 Actions will be agreed to limit the outbreak, provide information to the
public, ensure safe staffing levels, and liaise with other local Trusts and
independent sector care homes regarding movement of patients.
8.28 All transfers and discharges to community hospitals and care homes would
be assessed to minimise the risk of further spread.
8.29 During out-of-hours and at weekends/bank holidays the nurse in charge of
the respective ward/hospital will contact the on-call manager for their Trust if
an outbreak is suspected. Action will include liaising with the Director on-call
and specialist advice may be sought from the microbiologist on-call.
8.30 The Infection Control Teams have developed a full set of infection control
policies which are available via the organisations intranet.
8.31 Standard elements of the policies include guidance on cohort/isolation
nursing of infected patients, restricted movements between departments of
symptomatic patients, enhanced infection control and cleaning schedules and
outbreak control procedures. Policy implementation is supported by
mandatory infection control training for all staff.
8.32 Primary care staff receive training and education in relation to Norovirus to
enable the management of their clients in their own homes. Staff give advice
on symptom management and avoiding visiting of family members. Services
to clients with Norovirus would be assessed and continue if required.
8.33 HPA notify IPC teams within Dorset of Norovirus outbreaks in schools, hotels
and care homes.
8.34 Root cause analysis is undertaken to review outbreaks and identify learning
that can be disseminated across the health community. All outbreaks
affecting more than 2 wards or relating to a unique area of the hospital such
as ITU, HDU or CCU are declared as Serious Untoward Incidents. All root
60
cause analysis reports are reviewed and quality assured by the multi-agency
Infection Control Root Cause Analysis Group.
8.35
An Annual Review of outbreaks during 2010/2011 led to:
• Robust reporting system where all acute and community hospitals report
though the HPA voluntary surveillance system;
• Pan-Dorset Policy review led by the Dorset IPC Forum;
• Review of cleaning and environment assessments;
• SWASFT assessment algorithm;
• Improved management of cases and outbreak of infection in care homes
through education and training;
• A campaign for all health care providers on hand hygiene and
preventing the spread of infections (October 2011).
The experience from 2011/2012 was as follows:
• Due to effective infection control measures, norovirus was not as
prevalent both within the acute trusts and community hospitals as in
previous years.
• When it did occur, all three hospitals effectively managed outbreaks,
which included quickly restricting visiting in order to prevent further
spreading.
• The local media supported this work by positively advertising why wards
had to be closed and providing contact numbers for those wishing to
visit.
8.36 The PCT will monitor outbreaks through information available from the HPA
surveillance system, daily reports from acute Trusts, CMS and HPA weekly
report on Norovirus outbreaks within Dorset including schools, hotels and
care homes. Information will be shared with the RCA group to assess any
actions required to reduce spread.
8.37
Awareness messages regarding norovirus will be sent to the public and
partners from the cluster. Planned activities for this year include: a media
release, website information and twitter messages. An e-shot will be
circulated through the local healthcare community, local stakeholders and
networks.
9.0
INFORMATION AND REPORTING
9.1
Each year there is additional information/monitoring requirements at each
level of the health economy. This information is submitted, primarily by Acute
61
Providers and Community Hospital Providers. This information is submitted
via UNIFY2 through to the Department of Health. The PCT Performance and
Information Team co-ordinate submissions as required.
9.2
9.3
Acute and Community Providers are expected to report a daily SITREP to the
Department of Health running from 1 November 2012 until at least 28
February 2013. The information contained in this report will highlight
operational concerns across elective and emergency areas. Information
included this report is shown below:
•
Emergency Department Closures or Diverts;
•
Ambulance Handover delay in excess of 30 minutes;
•
Cancelled Elective and Urgent Operations;
•
Bed Availability including reporting against D&V/Norovirus like
symptoms and Delayed Transfer of Care;
•
Critical Care/Intensive Care Bed (cots) information relating to patients
with flu or suspected flu.
In addition to normal winter reporting there are a number of additional reports
which cover pandemic flu. Areas which each Provider must report on, from
October 2012 include:
•
Admissions to hospital for patients with laboratory confirmed influenza
by flu type and by age cohort;
•
Deaths in hospital for patients with laboratory confirmed influenza by flu
type and by age cohort;
9.4
The reporting is managed in partnership by the Emergency Planning Lead and
the Primary Care Trust Information Team.
9.5
Each year there is additional information/monitoring requirements at each level
of the health economy from provider services, through Primary Care to
Department of Health.
9.6
In addition to normal winter reporting there are a number of additional reports
which cover pandemic flu. These change as changes occur in the state of the
pandemic flu. The reporting is managed in partnership by the Emergency
Planning Lead and the Trust Information Team.
9.7
The Primary Care Trust is also responsible for the delivery of information on:

Deaths in the community due to/or suspected of being caused
pandemic flu;

Flu cases within the Acute Trusts;

Sickness/absence monitoring due to pandemic flu symptoms.
62
10.0
LOGISTICS AND WAREHOUSING
10.1 In the case of a Pandemic in order to provide and support the local health
community with adequate stocks of personal protective equipment, antiviral
drugs and vaccine consumables, such as needles, syringes and sharps bins, a
robust storage, distribution, stock control and stock management systems is
now in place.
10.2 In order to maintain a robust and resilient logistics process for all stock
expected to arrive at the Primary Care Trust, the PCT has established and
commissioned a secure and robust service that acts as a logistical single point
of contact for the receipt and storage of all Personal Protective Equipment and
antivirals for the conurbation. The company nominated to maintain this
function is Wyvern Cargo Ltd:
Wyvern Cargo Ltd
Broom Road
Poole, Dorset
BH12 4 NR
Tel No: 01202 307500
10.3 Wyvern Cargo has the necessary capacity and capability to run a secure
storage, distribution, stock control and stock management system with robust
business continuity arrangements in place. They also had the capability to run
a service on a 24 hour 7 day per week basis with the ability to respond at short
notice to changing requirements.
10.4 Wyvern Cargo was commissioned to provide storage facilities and a delivery
service for:

Personal protective equipment;

Antiviral drugs; and

Vaccine consumables, such as needles, syringes and sharps
bins.
10.5 As part of the contract agreement, Wyvern Cargo continues to hold a small
amount of antiviral drugs and are commissioned to ‘stand up’ the service
within a 24 hour timeframe when required with the potential to function on a
24/7 basis.
Cold Chain Delivery and Storage
10.6 Integral to the safe delivery of vaccine to General Practices, is a Cold Chain
method of delivery and storage.
10.7 The national Swine Flu epidemic and its effect in NHS Bournemouth and
Poole and NHS Dorset has brought logistical challenges of distribution of
antiviral medicines and vaccines. Bath ASU as a major specialist
pharmaceutical supplier and manufacturer has been sourced as a provider
63
with the resource and expertise to overcome the logistical challenges of future
pandemics.
10.8 Bath ASU will receive and store securely the Cluster’s allocation of vaccines
for any future Department of Health instigated pandemic response. The cold
storage facilities at Bath ASU will be used to store the vaccines in line with the
manufacturer’s standards.
10.9 Bath ASU will process orders for vaccines from NHS Bournemouth and Poole
and NHS Dorset for delivery to approved addresses throughout NHS
Bournemouth and Poole’s area of responsibility and any such sites as directed
by the PCT as might be required. Orders will be prepared and checked,
records of stock kept and delivered according to standard operating
procedures set out in this document.
10.10 The Department of Health will determine which vaccines are to be distributed
and will set out how the distribution to Bath ASU will take place. Bath ASU will
if required breakdown vials for onward distribution if required and will distribute
vaccine throughout NHS Bournemouth and Poole and Dorset area.
10.11 The operational procedures that must be carried out for the activation of the
service between NHS Bournemouth and Poole and NHS Dorset and Bath ASU
have been agreed and are available from the Head of Emergency Planning
within the PCT.
11.0
WEATHER AND FUEL
11.1 Severe weather conditions can have a major impact on health, particularly
cardiovascular and respiratory conditions.
11.2 In the event of bad weather local media will be utilised in order to inform the
public and the appropriate steps to take if healthcare is required or planned.
11.3 The Met Office Predictor Tool is used to predict adverse weather conditions.
11.4 The South Western Ambulance Service has an Adverse Weather Policy which
facilitates key staff attending their shifts.
11.5 Four wheel drive capacity exists within the South Western Ambulance Service
NHS Foundation Trust and are strategically placed throughout the operating
area. Given extreme weather the South Western Ambulance Service NHS
Foundation Trust will work with its colleagues in other blue light services, local
authorities and the military to enhance its mobility.
11.6 Given appropriate warning of inclement weather additional four wheel drive
vehicles are hired in from 4x4, a voluntary provider. The police (LRF Snow
Desk) have agreed to act as the coordinator for requests and distribution of
4x4 vehicles if required.
11.7 Relationships exist with the local authorities to ensure access to and egress
from ambulance stations through snow clearing or the provision of salt.
64
11.8 The South Western Ambulance Service NHS Trust has four dedicated air
ambulances available during daylight hours in the winter if weather conditions
permit flying. Additional helicopter support may be available from the local
constabulary and the military during exceptional circumstances.
11.9 Community Services Team utilise the 4x4 capacity within the staff group or
walk to appointments if feasible. If required they would contact the LRF Snow
Desk.
Fuel
11.10 NHS organisations in Dorset, like most organisations rely to some extent on
fuel. The availability of fuel within the UK is generally very good, however our
reliance on fuel to maintain essential services cannot be taken for granted,
particularly as any fuel shortages may also affect public transport.
11.11 There have been several examples in recent years of brief disruptions to fuel
supplies, both on a regional and national basis. Disruption/shortages of fuel
supplies could be caused by a number of factors:
•
•
•
•
•
•
international reduction in availability;
unforeseen event at a Refinery or Terminal resulting in shortage of
supplies
organised fuel protests resulting in disruption to supplies;
industrial action resulting in disruption to supplies;
pandemic flu outbreak resulting in reduced workforce impacting on
supplies; and
all of the above could be exacerbated by increased public demand
(panic buying).
11.12 Any disruption/shortage of fuel supplies in the short term would require a
scaled implementation of our Business Continuity planning arrangements to
prioritise essential work and ensure key services are maintained. It should be
remembered that fuel shortages will affect everyone and could severely
reduce the ability of suppliers to maintain routine deliveries.
11.13 The NHS in Dorset Fuel Resilience Plan 2012 provides a framework for the
response of all Dorset NHS organisations in the event of a disruption /
shortage of fuel supplies.
11.14 The plan should also be considered alongside existing NHS organisations
Business Continuity Plans and the Bournemouth, Dorset and Poole Local
Resilience Forum (LRF) Fuel Plan.
11.15 This plan outlines the options available to obtain fuel and the action required
by NHS organisations in Dorset to enable essential users to access fuel when
restrictions are imposed due to disruption/shortage of fuel supplies. The plan
will be activated on notification from the Bournemouth, Dorset and Poole
Local Resilience Forum and / or the Department of Health of any potential for
fuel disruption/supply. The level of response will be determined by the severity
of the disruption and advice from the NHS South of England and the
Bournemouth, Dorset and Poole Local Resilience Forum.
65
11.16 The local response for NHS organisations in Dorset will be managed
strategically by the Bournemouth, Dorset and Poole Local Resilience Forum
(LRF), tactically by NHS Bournemouth, Dorset and Poole PCT Cluster and
operationally by each organisations individual Incident Management Teams.
Links with partners will be in accordance with the established command and
control arrangements set out in organisations Major Incident Plan and the
Bournemouth, Dorset and Poole LRF Initial Responders Major Incident Plan.
11.17 In the initial stages of any potential disruption/shortage of fuel supplies one of
the obvious steps to minimise dependency on road fuel is to use less. On
advice of any potential fuel disruption/shortage NHS organisations in Dorset
should consider using the measures to conserve fuel outlined below:
•
•
•
•
•
•
•
•
only make essential journeys;
encourage staff to car share or use public transport;
home working where appropriate;
temporary relocation to workplaces nearer the home;
flexible extended daily hours to reduce the working week;
cancel or reschedule non-essential meetings;
cancel or reducing non-essential activity in line with Business
Continuity Plans; and
responsible fuel purchasing, avoid panic buying.
11.18 In the event of a fuel disruption, the first method that will be implemented to
allocate fuel to those key health workers is through the Temporary Logo
Scheme (TLS). In line with the NHS in Dorset Fuel Resilience Plan 2012this
will be introduced for those identified health workers to enable the essential
health, social care and critical life saving services provided by NHS
organisations in Dorset to continue.
11.19 The numbers of Temporary Logos issued by each NHS organisations will be
dictated by the overall severity of the fuel shortage. Therefore the list of
potential authorised users is maintained in strict priority order. The Incident
Management Teams for each NHS organisation can then start the issue from
the top of the list and stop at the given cut off point and thereby ensure those
in most need receive a Temporary Logo.
11.20 This process should be carried out in consultation with NHS Bournemouth,
Dorset and Poole to ensure consistency is applied across the Dorset health
organisations. NHS Bournemouth, Dorset and Poole would also engage with
the Local Resilience Forum (LRF) Bournemouth, Dorset and Poole Strategic
Co-ordinating Group (SCG) and NHS South of England to ensure a consistent
and proportionate use of the TLS is applied across all partner agencies.
11.21 Whilst the National Emergency Plan -Fuel 2009 does state that TLS is not
generally to be used to obtain fuel for travelling to and from work, the
Department of Health (DH) has issued guidance in 2012 advising that those
staff delivering critical care services within the Acute Trusts, including A and
E key personnel should now be included.
66
11.22 But it is recognised that certain staff, such as GPs, Community Nurses and
social workers respond to calls directly from their homes so more flexibility
has to exist. It is also recognised that for shift workers and those living in rural
areas, public transport may not always be available to allow these staff to get
to work to provide their essential service.
11.23 Therefore, in line with the DH guidance, the following service areas / staff
groups within the healthcare sector are considered appropriate to receive
TFLs:
Level one –
(Priority to apply for a TFL; within 2 hours of invocation of NEPF)
•
•
•
•
•
•
•
Critical care services
A and E Key Personnel
Neonatal care
Provision of emergency surgery (Inc theatre & resuscitation)
Acute Maternity services
Community/Practice/Mental Health nurses carrying out life critical
services
Doctors/Consultants/GPs carrying out home visits and life critical
services
Level two –
(Priority to apply for TFL; within 12 hours of invocation of NEPF)
•
•
Acute Admissions Unit
Non acute maternity services such as scanning, and high risk
pregnancy clinics
•
Emergency Inpatient Admissions
•
Dialysis
•
Community pharmacists carrying out urgent home medication deliveries
•
Members of the major incident response teams and those attending
SCGs
The following services / staff groups may be considered to receive logos in a
protracted incident in discussion with the Local Resilience For a (LRF) and SCG:
Level three –
(Up to seven days (if possible and with SHA/LRFguidance)
•
•
•
Endoscopy
Cardiac catheterisation ,including PCI (primary angioplasty)
Cancer treatments and surgery
Level four –
(After 7 days of invocation of NEPF)
•
Planned and elective care (non-critical) and by clinical prioritisation
67
12.0
EXCESS DEATHS
12.1
The graph in figure shows the number of households in fuel poverty in
England and also the excess winter deaths in Bournemouth and Poole, which
identifies a possible link between the two.
Figure 3: Fuel poverty and excess deaths.
500
450
400
350
300
250
200
150
100
50
0
4.5
4
households
3.5
3
2.5
2
1.5
1
0.5
0
excess deaths
Households in fuel poverty (England)
Excess winter deaths Bournemouth & Poole
sources DECC 2011. PH mortality file.
12.2
There is escalating concern around fuel poverty and winter deaths as
domestic fuel prices are expected to be high throughout this winter. A feature
of the communication plan is focussed about keeping homes warm and
ensuring those eligible are claiming grants.
13.0
ESCALATION MANAGEMENT
13.1
The Dorset Health Community will comply with the NHS South of England
Escalation Framework (August 2012) where the Local Health Community
experiences pressure such that despite all actions by the whole system to
reduce the pressure external assistance is needed.
13.2
Development of an effective escalation management across the Pan-Dorset
Health and Social Care system has been a key priority for SPRIG with the
Local Health Community.
13.2
Each health and social care organisation has produced an internal escalation
plan for winter with an increased emphasis on the effect pandemic flu may
have on business continuity.
13.3
These plans have been taken into consideration when developing the
community wide escalation plan, which has been aligned to SWAST REAP
levels, with level 6 being full stage major incident as shown in figure 4.
68
13.4
The first two levels highlight a reduction in capacity which may be due to an
increase in pandemic flu attendances within general practice or emergency
departments.
13.5
Level three is looking at reduced capacity but also an inability to discharge
patients out of hospital, increase in staff absence in the community with no
ability to replace staff and reduced beds to admit to within health or social
care.
13.6
Level four and five extend from level three due to the predicted continuation
of the situation and ultimately the inability to function due to staff absence,
lack of capacity across the health community or due to a major incident.
Figure 4: Escalation Levels
LEVEL 5
LEVEL 4
LEVEL 3
LEVEL 2
LEVEL 1
(Normal Flow)
Acute Trusts
capacity matching
demand
Community Health
Care Services
Capacity Matching
Demand
Primary Care/OOH
Capacity Matching
Demand
Social Care
Capacity Matching
Demand
Infection Control
No outbreaks
Acute Trusts
Reduced capacity in
some areas of the
Trust
Community Health
Care Services
Increase in patients
attending
Primary Care/OOH
Increase in patients
attending
Social Care
Increase in demand
Acute Trusts
Reduced capacity
Predicted discharges
less than predicted
admissions
Community Health
Care Services
Significant increase in
patients attending
Primary Care/OOH
patients attending
Social Services
Increasing levels of
unallocated work
Reduced capacity in
Residential and / or
Nursing homes
Infection Control
1 ward closed
Infection Control
2 or more wards
closed due to an
infection outbreak
Pandemic Flu
Pandemic Flu
Pandemic Flu
No outbreaks
Acute Hospitals
Demand is greater
than bed capacity
Red state is predicted
to continue
Escalation beds in
use
Community Health
Care Service
patients attending
Primary Care/OOH
GP Practices closed
with no plans to reopen
patients attending
Social Services
High level of
unallocated work
High level of ongoing
adult protection work
No capacity within
Residential and / or
Nursing Homes
Infection Control –
prolonged ward
closures in line with
EL4 for each trust
Acute Hospitals
CDU full with no
planned transfers or
discharges
Expected CDU
emergencies via GP
and 999
Routine elective work is
being cancelled
Community Health
Care Services
patients attending
Primary Care/OOH
GP Practices closed
with no plans to reopen
Social Services
High level of
unallocated work
High level of ongoing
adult core services
Infection Control –
Severe infection
outbreak causing
prolonged ward
closures in line with
EL5 for each Trust
Pandemic Flu
Pandemic Flu
Action Cards
13.7
Action cards have been developed for each of the main service areas:
•
•
•
•
•
Primary Care
Acute Trusts
SWAST
Urgent Care
Community Services
69
•
•
•
•
Mental Health
Single Point of Contact
Primary Care Trust
Communication
13.4
The action cards are aligned to SWAST REAP levels and offer an overview of
the triggers for escalation and the actions required of all service areas to
support if need be. An example action card is provided in Appendix 2.
13.5
As part of the winter planning we have worked with all providers to review the
action cards to ensure they are fit for purpose. The PCT intend to embed use
of the cards as a contractual requirement from 2012/13.
Capacity Management System
The Capacity Management System (CMS) went live in 2010/11 and is used
Pan-Dorset as a method by which to monitor demand and capacity.
13.6
CMS replaced a local escalation matrix which had previously been in place.
13.7
CMS is a web based application which can be viewed on almost any internet
connection and over NHS net. It has password protection, but does not
contain any patient identifiable information; it is more a resource mapping
facility arranged as a structured database of what services are available in a
locality and when they are available.
13.8
Currently a proportion of 999 calls are directed to alternative providers rather
than to the ambulance crews, for example NHS Direct. However, it has been
realised for some time that if the information on other providers were
available to PCTs and to 999 call takers a higher proportion of patients could
be signposted to alternative care providers. For example GP surgeries, Outof-Hours services, NHS Direct, community nursing teams, Minor Injury Units,
Walk-in-Centres, Social Services, alcohol and drug teams and mental health
teams.
13.9
CMS has several modules, the largest is the Directory of Services and Skills,
which is a database of what services and importantly what skills they have
available for example whether they have catheter changing skills,
physiotherapy, general nursing, cancer support, or paediatric care etc. Also
included are their opening hours and their availability, which can be flagged
red for full, amber for busy and green for normal service.
13.10 Other modules include the Overall Hospital Activity (OHA) Module, which
presents the pressure status and bed states for acute hospitals, including
their A&E and ITU beds, and similarly the bed status and admissions and
discharges for Community Hospital direct access wards. Social Services also
update CMS if they have capacity issues although not as a routine daily
update. In addition GP practices, pharmacies, palliative care services,
intermediate care services and MIUs are all shown on the CMS. Currently the
70
habit of daily updating of CMS is variable across these services though
improving. NHS Direct do not use CMS.
13.11 Each acute provider updates their bed status several times a day and are
currently in top five acute trusts in terms of frequency of update.
13.12 We are working with the CMS team to ensure the tool is fit for purpose
locally.
De-escalation
13.13 The learning from previous years shows that de-escalation needs to be well
planned and managed.
13.14 De-escalation should comprise of the following elements:

Reduction to appropriate escalation level as laid out in the
escalation cards in Appendix 3;

Audit the backlog of assessments;

Agree time-frame to meet any performance targets not currently
being met;

Complete a risk-assessment against recovery time-frame;

Plan for additional resourcing and agree if necessary through
appropriate internal Governance arrangements.
Command and Control
13.15 It is important to acknowledge that in the event that of an influenza pandemic
escalating, the Local Resilience Forum will increase its involvement and there
may be a need to open the major incident room in order to co-ordinate across
a wider region.
13.16 The initiation of the Local Resilience Forum in turn triggers the setting up of
the Command and Control structure as used by all UK responding agencies.
This can be seen in Table 7. At this point the Primary Care Trust would be
operating from the Major Incident Plan.
71
Table 7: Local Resilience Forum Command and Control Structure
Command and Control Structure
Role
Function
Membership
• Strategic Management and liaison with
NHS Dorset,
Bournemouth
and Poole
GOLD
•
Strategic •
Co•
ordinating •
other agencies
Activating the plan
Policy implementation
Control of overall resources
Elected member liaison
-Chief Executive or
designate
Group
(SCG)
• The main Dorset LRF Control Centre will be established at the Dorset
Police Headquarters, Winfrith.
• This location will accommodate GOLD Command as well as the Joint
Intelligence Group (JIG).
Role
SILVER
Function
Membership
• Providing an internal communication for
NHS Dorset,
Bournemouth
and Poole
staff, members and managers
• Providing an external service to members
Tactical
of the public
co• Support and resources to the BRONZE
ordinating
service units
Group
• Information and updates to GOLD
(TCG)
•
•
-Flu Director
-Major Incident
Room
-PCT Flu Control
Team
SILVER Command will be held at the NHS Bournemouth and Poole or
NHS Dorset Major Incident Room.
This Command will be used to control internal situation monitoring,
response and data collection and the collation of and submission of the
relevant contributions to the nationally required SITREP.
Role
Function
Membership
BRONZE
• Maintaining critical functions
• Advising SILVER of service
Pandemic contacts in
each Service Unit
status, problems and risk
Operational
In the event of a Major Incident being health related, such as Pandemic flu the
LRF Chairmanship will be provided by the Chief Executive of the PCT Cluster.
72
During the Olympic period in summer 2012 the Major Incident Room was
manned from 8am – 8pm daily and across the area the multi-organisational
Gold/Silver/Bronze command was in place. This enabled a very effective test
of the process and plans set up for Major Incidents and significant learning
took place in this period.
14.0
RISK MANAGEMENT / EQUALITY IMPACT ASSESSMENT
14.1 A risk assessment of the Integrated Seasonal Escalation and Pandemic
Influenza plan has been completed. The current risk assessment can be found
in Appendix 3.
14.2 An Equality Impact Assessment has been completed against the Seasonal
Escalation and Pandemic Influenza Plan.
15.0
ORGANISATIONAL RESPONSIBILITY
15.1 Ensuring capacity is maintained during the winter months and additionally
during this year’s Influenza Pandemic is the responsibility of the whole health
and social care community. Details of organisational responsibilities can be
found in Table 8.
ORGANISATION
RESPONSIBITY
Strategic Health
Authority
•
•
Ensure effective co-ordinated local plans
Provide public information, media handling and
provision of monitoring information
•
•
•
•
•
•
Provide leadership
Production of seasonal escalation plan
Gaining agreement of key triggers
Production of pathways within escalation plan
Setting of key outcomes measures and RAG system
Ensure all health and social care partners are
involved
•
Contingency arrangements for surge in capacity,
increase demands for beds, help and support
maintaining plans
General Practice
and Primary Care
•
•
•
Production of organisational escalation plan
influenza vaccination process
Development of organisational escalation plans
Community
Health Care
•
Social Care
•
NHS Direct
•
Advice and information for the public
Primary Care
Trusts
Hospital Trusts
73
APPENDIX ONE
SPRIG OPERATIONAL POLICY
74
SPRIG OPERATIONAL POLICY
AUGUST 2011
1.0
INTRODUCTION
1.1
This policy will outline the roles and responsibilities of the System Planning,
Resource Implementation group (SPRIG) and its members.
1.2
The aims of SPRIG are:
•
•
•
•
1.3
To facilitate effective management of the Dorset health and social care
system;
Maximise effective system response to seasonal and other pressures
through robust operational management;
Plan and deploy available resources in line with prioritised need;
Inform and implement strategy developed by the Local Resilience
Forum with clearly defined pathways in terms of business continuity,
resilience and major incident planning/delivery.
The policy will outline the following:
•
SPRIG objectives;
•
SPRIG meeting format;
•
Membership;
•
Method of information sharing;
•
The role of members.
2.0
SPRIG OBJECTIVES
2.1
The objectives of SPRIG are as follows:
•
To lead the development and implementation of a collaborative PanDorset plan across the health and social care community in order to
reduce avoidable attendances, admissions and deaths; prevent delays
and ensure an effective health and social care system is in place;
•
To plan for surges in demand for services i.e. winter, heatwave and
ensure the triggers and required actions have been identified;
•
To identify gaps and areas of risk within the current plans and identify
solutions;
75
•
To ensure an effective robust agreed escalation process is in place and
is being used by all partners;
•
To address any issues with escalation methods and processes;
•
To co-ordinate communication messages in line with seasonal
pressures.
•
Monitoring effectiveness of plan
3.0
SPRIG MEETING FORMAT
3.1
Reporting structure
SPRIG will report up to the Unscheduled Care Service Delivery Group and will
receive updates / actions to disseminate to members as required.
Diagram shows how the Unscheduled Care Service Delivery Group is represented
as the hub of a wheel connected to the seven Clinical Commissioning Groups.
SPRIG is represented as the outer ‘tyre’ which exists to keep the system moving.
Diagram 1 Structure
There is also reporting line to the Delayed Transfer of Care group and vice versa to
ensure no duplication.
76
3.2
Chair and deputy
Jane Pike (Director of Acute and Primary Care Commissioning) will chair the group;
Ali Clegg (Deputy Director of Service Improvement) will fulfil the role of Deputy Chair.
3.3
Frequency
SPRIG will meet on a bi-monthly basis as a face-to-face group; the opportunity for
video conferencing will be explored.
The meetings will rotate between Canford House and Vespasian House.
3.4
Membership
Each organisation listed within this section is signed up to this policy.
Each organisation is required to ensure a representative attends the bi-monthly
SPRIG meetings and dials into the weekly teleconferences:
4.0
•
Bournemouth, Poole and Dorset PCT Cluster:
- Primary Care Commissioning Lead
- Urgent and Emergency Care Commissioning Lead
- Communication Lead
- Resilience Lead
•
Poole Hospital NHS Foundation Trust;
•
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust;
•
Dorset County Hospital NHS Foundation Trust;
•
Poole Social Services;
•
Bournemouth Social Services;
•
Dorset Social Services;
•
South Western Ambulance Service NHS Foundation Trust;
•
Dorset Healthcare University NHS Foundation Trust.
TELECONFERENCE
Organisations should plan for weekly winter teleconferences to commence in
the last week of November and will run until the last week in March the
following year. [NB Due to the high levels of emergency admissions during
September 2012 the health community agreed to commence weekly winter
teleconferences at the beginning of October 2012.]
77
The calls will only go ahead if required based on overall demand and capacity
across Dorset and / or specific issues raised by Providers otherwise they will
be stood down by the PCT on the morning of the call.
Weekly and daily calls can be called at other times throughout the year as
required.
SPRIG members are required to ensure that a representative dials into the
calls and has up-to-date information on the demand and capacity within their
own organisation and predicted position for the next 24 hours.
Members joining the call will adhere to the Teleconference Protocol in
Appendix 1.
Prior to the call Providers should ensure their current status is updated on the
Capacity Management System (detailed in section 5.0) so all members can
view this and update themselves of the current situation prior to the call.
Exception reporting and agreement of any required actions will be the focus of
the calls.
5.0
INFORMATION SHARING
The Capacity Management System should be utilised by all partners across
the health and social care community as a method by which to share and
ascertain the current levels of demand and capacity. The PCT monitors CMS
at regular intervals Monday to Friday 9.00 – 16.00.
SPRIG members should be familiar with CMS and ensure there organisation
has s a robust plan in place to ensure the system is updated on a daily basis
at regular intervals.
6.0
ROLE OF MEMBERS
•
To actively participate in the SPRIG meetings and teleconferences;
•
To take back key messages / actions and disseminate in a timely
manner throughout their organisation;
•
To alert the SPRIG group to any potential demand and capacity issues;
•
To provide information from their organisation as required enabling a
deep dive into specific areas / concerns;
•
To ensure their organisation has a robust way of ensuring the Capacity
Management System (CMS) is updated as agreed.
Policy Review Date – August 2012
78
Appendix 1
BT MeetMe Teleconferencing Procedure and Protocol
Participants
Dial In Number: 0800 032 8069 or number allocated
Participant Code: 75856492 then # or number allocated
When prompted please state your Full Name and Service Unit
When you are listening in to the conference please mute your handset to cut out
background noise (especially useful in busy offices or when calling in on a mobile)
Participant controls
DTMF
Control
*4
Function
Operation
Adjust Line Volume
Allows Participant to equalise the volume
of their phone line
This option will silence the Participant’s
line, but they will still be able to hear
everyone else.
On line menu listing features available to
the Participant.
*6
Self Mute
#0
Conference Help
Menu
The Chairperson may decide to record the teleconference, although confirmation of
this will be made prior to commencement of the recording.
The Chair will move through the agenda if you have no contribution to an item you
do not need to verbally acknowledge this. Silence will be used as the
acknowledgement that there is no comment on the matter.
If you wish to make a contribution please confirm your name before speaking.
All participants will be expected to attend the call briefed on the current demand and
capacity within their organisation and any actions required by partner organisations.
SPRIG (May 2011)
79
APPENDIX TWO
EXAMPLE – ACTION CARD
80
PAN-DORSET
AMBULANCE SERVICE ESCALATION PLAN
LEVEL 1 – TRIGGERS
•
•
•
•
•
•
•
•
Normal mode of operation
Meeting all operational targets
Demand profile normal
Operational staffing lower than 5% of establishment
Clinical hub staffing less than 5% of establishment
Less than 20% of hospital turnaround times are above 15 minutes
Staff sickness and absence < 5%
Consequence score on Trust risk matrix at level 1 negotiable
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
LEVEL 1 – HEALTH COMMUNITY ACTIONS
ACTION
• Continue to monitor
N/A
N/A
• Ensure CMS is updated online daily (intermediate care teams and
community beds)
N/A
• Consider alternatives to 999
LEVEL 1 – MONITORING AND REPORTING ARRANGEMENTS
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Daily
•
LEVEL 1 – TRIGGERS FOR FURTHER ESCALATION OR DE-ESCALATION
TRIGGER
RESULT
Escalation
to
level
2
Level 2 triggers evident
81
•
•
•
•
•
•
•
1-3% minus on CAT A8 (4 week average)
2-5.99% demand increase (4 week average)
Operational staffing shortages greater than 5% of establishment
Clinical hub staffing greater than 5% of establishment
More than 20% of hospital turnaround times are above 15 minutes
Staff sickness and absence < 5%
Consequence score on Trust risk matrix at level 2 low
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
• Advise all health & social care partners, including GP Practices
who may be impacted upon if escalation increases
• Continue to monitor every 6 hours
N/A
• Assist SWAST with efficient handovers where possible through
the facilitation of timely admissions / discharges
community beds)
• Continue to monitor and alert NHS B&P if escalation to level 3 is
predicted
• Reduce conveyance by utilising alternative services where
possible
REPORT
FREQUENCY
SITREP Report
Daily
CMSS
Daily
TRIGGER
RESULT
Position resolved
De-escalation; return to Level 1 and inform
PCTs who will notify the SHA and local
health economy
Escalation to level 3
• Level 3 triggers evident
82
•
•
•
•
•
•
•
•
3-4.99% minus on CAT A8 (4 week average)
6-9.99% demand increase (4 week average)
Hospital diverts in place at three or more hospitals or for prolonged periods
Staff sickness and absence between 5-10%
Consequence score on Trust risk matrix at level 3 Moderate
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
• Continue to monitor every 6 hours
• Review ways of working with PCT Manage patients at home
where possible
• Offer patients timely appointments if calling with an urgent issue
• Only refer to A&E / 999 for acute emergencies
community beds)
• Continue to monitor and alert PCT if level 4 is predicted
• Implement SWAST escalation plan
possible
To include ECP’s in the status plan
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every 6 hours
TRIGGER
RESULT
Position resolved
health economy
83
•
•
•
•
•
•
•
•
More than 5% minus on CAT A8 (4 week average)
More than 10% demand increase (4 week average)
Hospital diverts affecting all areas of South Western (6 or more)
Staff sickness and absence between 10-15%
Consequence score on Trust risk matrix at level 4 significant
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
• Consider commissioning additional capacity within other services
e.g. urgent care / community care to meet increased demand
• Cancel advanced bookings
• AM Surgery - Urgent appointments and walk-ins only
• Manage patents at home where possible
• Only refer acute emergencies to A&E / 999
community beds)
possible
To utilise ECPs to assist with emergency demand / add ECPs to the
status plan
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every 2 hours
TRIGGER
RESULT
Position resolved
health economy
84
•
•
•
•
•
•
Trust continually unable to meet the nationally set targets
Trust is continually breaching the pressure levels set out in Level 4 escalation
Catastrophic incident or multiple major incidents declared
Threat to breakdown of the national infrastructure e.g. electricity, gas, water, transport
Staff sickness and absence above 20%
Consequence score on Trust risk matrix at level 5 catastrophic
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
• Continue to monitor hourly
• Consider commissioning additional capacity within other services
e.g. urgent care / community care to meet increased demand
• Urgent appointments and walk-ins only
• Only refer acute emergencies to A&E / 999
community beds)
possible
ECP’s within status plan for 999 utilisation
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every hour
TRIGGER
RESULT
Position resolved
health economy
Position worsens
Full escalation plan in operation
85
APPENDIX THREE
RISK ASSESSMENT
86
Risk Area
Risk Identified
Existing Controls
Influenza
Immunisation
Programme
Reduced uptake by
staff;
Immunisation action plan in
place;
Immunisation of all staff
‘at risk’;
Monitoring and evaluation of
programme against targets;
Public concerns around
the vaccine.
Liaison underway with all
partners regarding their
plans for immunisation of
staff;
Risk Rating
L
S
RR
3
3
9
LEVEL
Actions Required
Continue monitoring uptake of
immunisation.
Regular engagement with
practices;
Delayed
Discharges
Hospital
Infection
Delayed Discharges
due to NHS Funded
Continuing Healthcare
Assessments and
Decisions
Outbreak of infection in
hospitals wards /
Departments –
Norovirus, Clostridium
Difficile
Promotional material
distributed widely.
Regular meetings to discuss
delays and monitoring of
these cases;
3
3
9
Ongoing daily monitoring
throughout the year
Hospital plans for dealing
3
with a major outbreak /
serious incident of
communicable disease
Hospital and PCT Policies
and Procedures on
prevention and management
of outbreak of infectious
diseases
Management of Norovirus
4
12
Ongoing actions.
Action plan in place.
87
Plans in place to mitigate and
address issues.
Ambulance
Delays in ambulance
turnaround times turnaround times at
at A&E
A&E
and Clostridium Difficile;
Procedures for management
patients and staff with
suspected infectious
diarrhoea.
Financial incentives and
3
penalties for performance
outside of specific limits;
Ongoing review of cases
where delays outside a set
limit occur, with an
explanation of the
contributing circumstances
and remedial actions;
Routine reporting of
turnaround times in contract
management and
performance review
meetings.
88
4
12
Monthly meetings in place.
Ambulance Divert Policy
agreed across Dorset
APPENDIX FOUR
COMMUNICATION ACTION CARDS
89
PAN DORSET
COMMUNICATION ESCALATION PLAN
•
•
Steady state
Level 1 winter plan – long term planning
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
SITREP Report
CMS
•
•
ACTION
Watching brief on SITREP
Communication leads for organisations identified and regular communication made
to ensure ongoing updates and awareness
Liaison with PCT communication lead
Notification to PCT of communication contact
REPORT
FREQUENCY
Daily
Daily
TRIGGERS
RESULT
Escalation
to
level
2
Level 1 winter plan – winter preparedness
90
•
•
•
COMMUNICATION: LEVEL 2 – TRIGGERS
Potential service disruption or closures
Notification through resilience email
Level 1 winter plan – winter preparedness
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
SITREP Report
CMS
•
•
•
•
ACTION
Prepare draft statements on capacity of services to manage potential surge in
demand
Prepare draft statements about service changes, closures or opening times
Publish information about using services wisely
Capacity information and actions sent to primary care
Information about actions circulated to staff
Forward information to pharmacies about messages to the public
Update Twitter
Notification in practices about capacity of system
Information available about using services wisely (choose well)
Providing key messages to PCT
Agreeing any statements
Promote choose well message
Sharing key messages to PCT
Agreeing any joint statements
Sharing communication plan with PCT
REPORT
FREQUENCY
Daily
Daily
TRIGGERS
RESULT
De-escalation; return to Level 1 and inform PCTs
Position resolved
who will notify the SHA and local health economy
Requires affected organisations to agree media
Adverse media coverage
management, key messages and brief key
spokespeople
Level 2 cold weather alert
91
COMMUNCATION: LEVEL 3 – TRIGGERS
•
•
•
•
Alert via resilience email
Media coverage
Political interest
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
SITREP Report
CMS
ACTION
Issue media statements
Notification of any service closures or disruptions
Contact key stakeholders with updates on capacity
Update public communication channels with prevention and capacity advice
Brief staff on current capacity and share agreed messages
Update partners on communication actions and agreed messages
Communicate cold weather alerts to staff
Communicate cold weather alerts to managers of care and nursing homes
Update Twitter
Share agreed communication messages with staff and patients
Promote choose well
Liaise with PCT communication on media statements
Update communication channels with agreed messages
Provide patients with information about current service status
Communicate cold weather alerts to managers of residential homes
REPORT
FREQUENCY
Daily
Every 6 hours
TRIGGER
RESULT
92
Position resolved
•
•
93
•
•
•
•
Alert via resilience email
Media coverage
Political interest
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
ACTION
Issue media statements
Notification of any service closures or disruptions
Contact key stakeholders with updates on capacity
Update public communication channels
Develop information for staff about cold weather risks and prevention messages
Update partners on communication actions and agreed messages
Feedback intelligence from media or public
Communicate with nursing and residential homes about DH advice regarding cold
weather
Update Twitter
Share agreed communication messages with staff and patients
Promote choose well
Share information with staff about cold weather risks and what can be done to
protect against the cold to advise patients
Information to carers about how to manage the cared for person during cold weather
94
Social Care
SITREP Report
CMS
Liaise with LA communication on media statements and link with PCT Comms
Information to carers about how to manage the cared for person during cold weather
Communicate with domiciliary care providers and care homes about DH advice
regarding cold weather
Ensure web site and other electronic media are updated
REPORT
FREQUENCY
Daily
Every 2 hours
TRIGGER
RESULT
Position resolved
• Level 4 cold weather alert
95
•
•
•
•
Major incident confirmed
Command and control systems in place
LRF communication plan for severe weather invoked
SERVICE
PCTs
Primary Care
Acute Trusts
Community Care
SWAST
Urgent Care
Mental Health
Social Care
SITREP Report
CMS
ACTION
Set up media room at PCT and liaise with media cell
Implement media cell operating protocol
Ensure key spokespeople are briefed
Lead on health capacity issues, health risks and protective actions
Liaise with HPA on key health messages
Update website with key messages and Q&A info
Update Twitter
Liaise with media cell
Update staff on current capacity and actions
Liaise with PCT communication lead to agree approach
Lead MCOP
Update website with key messages and Q&A info
Brief staff and other stakeholders as appropriate, as per emergency plan
REPORT
FREQUENCY
Daily
Every hour
TRIGGER
RESULT
Position resolved
Position worsens
Full escalation plan in operation
96
APPENDIX FOUR
ACUTE TRUSTS ACTION CARDS
97
ACUTE TRUSTS - LEVEL 1 - TRIGGERS
•
•
•
•
95% or less bed occupancy level
Capacity meets predicted emergency and elective demands throughout the Trust
Critical care beds available
No infection control outbreaks
SERVICE
PCTs
Acute Trusts
Primary Care
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
Continue to monitor CMS
• Continue to monitor and update CMS
• Alert PCT to any potential issues / increase in demand
Continue to monitor and update CMS
• Continue to monitor and update CMS (service RAG rating and
community bed status)
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Minimum Twice Daily
TRIGGER
RESULT
One or more Trusts escalating to level 2
98
•
•
•
•
•
96-97% bed occupancy level
Possible risk of 4 hour ED breaches
Ambulance handover delays above 30 minutes
Infection outbreak contained within side room capacity
More than 1 Critical care bed
SERVICE
PCTs
Acute Trusts
Primary Care
Community Care
SWAST
Urgent Care
Mental Health
Social Care
ACTION
• Continue to monitor CMS
• Alert health and social care community via resilience if situation is
predicted to worsen
• Alert PCT via resilience if demand is predicted to increase above
capacity levels
Continue to monitor and update CMS (service RAG rating and community
bed status)
Need to liaise with Trust regarding actions to mitigate 30 minute handover
delays
•
•
Review all delays and take immediate action to expedite discharges
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Minimum twice daily
TRIGGER
RESULT
Position resolved
99
•
•
•
•
•
•
•
100% or more bed occupancy level
Predictors are indicating reduced capacity to continue
Predicted discharges less than predicted admissions
1 Critical care bed
Ward(s) closed due to an infection outbreak
Certain risk of 4 hour ED breaches
2 or more ambulances queuing to handover
ACTION
predicted to worsen
• Review outstanding CHC applications with a view to out of hospital
arrangements
• Alert health and social care community to prepare for teleconference
Acute Trusts
• Alert PCT via resilience of key issues and actions required
• Review all delays and take action with organisations as appropriate
• Flex capacity (staffing / consider additional beds / review elective
workload)
Primary Care
• Manage patients at home where possible
• Offer patients timely appointments if calling with an urgent issue
• Only refer to ED for acute emergencies (consider referral to RACE –
PHFT / from October RAC - RBHFT)
Community Care
• Pro-actively monitor bed states and communicate improvements
• Review all delays and take immediate action to expedite discharges
SWAST
• Increase see and treat / hear and treat where possible
• Make informed decisions regarding conveyance if one acute is
experiencing pressure
Urgent Care
• Manage patients via the telephone or at home when appropriate
• Only refer to ED for acute emergencies
Mental Health
• Review all admission requests to acute Trusts and only refer to ED for
acute emergencies
Social Care
• Adopt flexible staffing arrangements with neighbouring social service
departments in order to address vacancies
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every 4 hours
TRIGGER
RESULT
Position resolved
SERVICE
PCTs
100
• 100% or above bed occupancy level
• No critical care beds
• Outliers in situ
• More than 1 ward closed due to infection and escalating with new cases
• All capacity utilised
SERVICE
ACTION
PCTs
predicted to worsen
• Review outstanding CHC applications with a view to out of hospital
arrangements
• Facilitate health and social care wide teleconference
Acute Trusts
• Alert PCT via resilience of key issues and actions required
• Review all delays and take action with organisations as appropriate
• Flex capacity (staffing / consider additional beds / review elective
workload)
• Contact critical care network for bed availability
• Discuss potential for mutual aid with neighbouring Trusts
Primary Care
• Consider suspension of services in line with Primary Care Escalation
Plan
• Delay referrals to secondary care where appropriate
• AM Surgery - Urgent appointments and walk-ins only
• Only refer acute emergencies to ED (consider referral to RACE – PHFT
/ from October RAC - RBHFT)
Community Care
SWAST
• Increase see and treat / hear and treat where possible
• Make informed decisions regarding conveyance if one acute is
experiencing pressure
• Consider deploying officer to acute trust to support
Urgent Care
• Manage patients via the telephone or at home when appropriate
• Only refer to ED for acute emergencies
Mental Health
• Review all admission requests to acute Trusts and only refer to ED for
acute emergencies
Social Care
101
•
Adopt flexible staffing arrangements with neighbouring social service
departments in order to address vacancies
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every 2 hours
TRIGGER
RESULT
Position resolved
• Major Incident Declared
SERVICE
ACTION
PCTs
• Major Incident Room established
Acute Trusts
• Major incident declared and plan implemented
Primary Care
• continue to suspend services in line with Primary Care Plan
• manage patients at home where possible
• only refer acute emergencies to ED
• Consider closing Practices in line with Primary Care Plan
Community Care
• Ensure bed state and RAG rating for teams is updated online every
hour
SWAST
• Liaise with Trust and Inform NHS B&P of any significant handover
delays / internal pressures
• Reduce conveyance by utilising alternative services where possible
Urgent Care
• Stop all referrals to secondary care where appropriate
• inform PCTs of any significant service delays/internal pressures
Mental Health
• Cease all admissions to secondary care unless prior approval agreed
Social Care
• Identify with the discharge liaison staff those patients who require
social work input and are nearing discharge or those whose
discharges could potentially be brought forward
REPORT
FREQUENCY
SITREP Report
Daily
CMS
Every hour
TRIGGER
RESULT
Position resolved
PCTs who will notify the SHA and local health
economy
Position worsens
Escalation
102
APPENDIX SIX
WINTER COMMUNICATIONS PLAN
103
WINTER COMMUNCATION PLAN OCTOBER 2012 – FEBRUARY 2013 1. OBJECTIVES 1.1 This communications strategy supports the pan‐Dorset Winter Plan 2012/2013 which seeks to ensure that there is a managed approach to demand over the winter months. The communication activity is designed to unnecessary prevent admissions to hospital, and potential excess winter deaths. This winter there are five key strategic communications objectives: •
To inform and engage with key members of the public to help them to take preventative measures to avoid admission through ill health •
To reduce the spread of Norovirus in hospitals, care homes and other environments •
To encourage people to be good neighbours and look out for elderly or vulnerable people in the community •
To encourage people to keep their homes and themselves warm during the winter months •
To encourage the best use of local health services and using the right service [Choose well] 1.2 This coming winter activities will be more targeted to those people identified as vulnerable using existing and trusted networks and support organisations to target these audiences. 2.
BACKGROUND 2.1.
We have seen a year on year increase in emergency admissions into hospital and over the past year, desk top research has been undertaken to determine what academic research concludes. 2.2.
It appears that the elderly are more at risk due to “Age ‐related decline”: All body systems decline in efficiency with age, including the body’s ability to respond to temperature change. Low temperature is the main cause of illness and death in the winter in the older population 2.3.
High indices of cold related illness are associated with •
high average winter temperatures •
low living room temperatures •
limited bedroom heating •
low clothing protection •
Lag effects exist between onset of cold and illness/death 2.4.
However not all elderly face the same degree of risk, with aggravating factors which include •
frailty •
co‐morbidity •
poor home conditions 104
•
high‐risk behaviour •
social isolation •
limited access to health and social care services •
social inequality 2.5.
There are also a number of Illnesses which are exacerbated by cold including •
Thrombotic illness (eg heart attack and stroke). There is a 3‐7 day ‘lag effect’; deaths are related to outdoor cold exposure. •
Respiratory illness (eg COPD, bronchitis) 12 day’ lag effect’; deaths are gradually declining due to warmer homes •
Small number of deaths due to influenza, except in epidemic years, so important to get immunisation rates up. •
However fewer than 1% of winter deaths are due to hypothermia 2.6.
It was also found that not taking enough physical activity leads to an increased risk of a number of chronic diseases including coronary heart disease. Regular physical activity can reduce this risk and also provide other physical and possibly mental health benefits. The majority of adults are not active at recommended levels. Physical activity levels decline with age, but the body’s need to stay active does not. 2.7.
The research also considered inside vs outside cold. Few older people live in homes without central heating but many restrict their use of it mainly on grounds of cost (fuel poverty). Moving from a cold home to outside cold carries significantly more risk to health than moving from a warm home and relatively minor cold exposures in daily life are sufficient to induce significant hypertension and thicker blood, which strains the heart. It was also found that older people living in cold homes take more outdoor excursions in an effort to escape it. 2.8.
The Met Office ‘Early Warning System’ and advice booklets can bring about behavioural change among older people consistent with risk reduction. However, long‐held convictions about ‘healthy environments ’ (eg keeping bedroom windows open even on very cold nights) and anxieties about fuel costs are barriers to risk reduction 2.9.
As a result of the research and the conclusion that people needed information delivered through their doors from an authoritative source, a number of focus groups were undertaken to determine the best way forward for old people throughout Dorset. 3. AIMS 3.1. The strategy aims to achieve the following: Internal communications •
an increase in staff take up of the flu vaccination •
a more holistic approach to the overall well being of patients by noting concerns and referring them to the relevant agencies through the pan‐Dorset SAIL project •
increase awareness amongst all health professionals about the key objectives of the winter campaign and their role in preventing admissions to hospital and keeping people well 105
Public communications •
an increase in awareness of preventative measures people can take to keep themselves healthy and warm during the winter •
a wider awareness of support available in the community to help people over the winter months 4.
PUBLIC INFORMATION 4.1
The information to the public will specifically provide: •
advice on self care where appropriate and how to treat symptoms, avoiding hospital wherever possible – choose well •
advice on the importance of food and general hygiene to prevent virus spread and what do to in the event of infection •
information about the importance of having the flu jab to targeted groups •
information about the arrangements over the Christmas and New Year holiday period for accessing local health services and keeping well over the Christmas period •
specific information and advice about keeping warm and the health consequences of the cold •
specific information about what to do in icy and adverse weather to prevent slips and falls •
contact details for local organisations who are able to offer support KEY MESSAGES It is important that messages are consistent so the public receive clear and understandable messages about how to manage their health during the winter. •
•
Older people are at risk of serious complications over the cold winter months which can result in an unnecessary hospital admission. People can take simple steps to keep warm both inside and outside, and to keep well and healthy over the winter months •
•
People can help by looking out for elderly or frail relatives, friends and neighbours to ensure that they are not at risk of needing hospital care The NHS plans for and is prepared for the increase in hospital activity over the winter months and there is a joined up approach across Dorset to prevent admissions where possible, and to discharge patients safely where appropriate •
The NHS never shuts but does sometimes needs to change the way it delivers service to cope with increased demand. This may mean extra waits for people who have non‐urgent injuries or who have non‐urgent surgery planned. 106
TARGET AUDIENCES It is important to identify the key audiences who need to receive the key messages and information to ensure that they are informed about the local actions to take and support available. The following have been identified: •
Those most at risk from being admitted to hospital including those who are over 75, from care •
homes, those with no family or caring support and those with long term conditions. •
•
•
•
Carers to ensure there is information and support to keep carers healthy and so they know what to do to prevent admission Those identified as benefiting from the seasonal flu vaccination Groups who do not have English as a first language to ensure they are clear about processes to be followed over the winter months including recognised elders and community leaders Those voluntary organisations who support, care for or represent the more vulnerable target audiences •
Nursing, care and residential homes to ensure there is clarity about how to prevent admissions, when to call for an ambulance, when to call for a GP home visit and how to prevent the spread of infection. Link with the Think ahead, Think twice campaign. •
GPs to ensure they are up to date with the local position, they are aware of the campaigns and what they can do to support their patients •
Staff to ensure they are clear about local issues and so they are able to inform and reassure members of the public •
Schools and school children to encourage them to look out for elderly relatives and neighbours •
Hospital clinicians and support staff to ensure they are clear about the local position and are able to inform patients if surgery is postponed with agreed messages and to adapt and change schedules to account for an increase in emergency admissions. •
Local media to communicate messages and key information to the general public about keeping well, keeping an eye out for elderly and frail neighbours friends and relatives and good use of local services •
Communication colleagues in local authorities to join up activity to ensure the most effective use of resources and communication channels and to deliver a joined up approach. 107
CHANNELS A range of different channels will be used depending on who the target audience is. A winter newsletter/booklet specifically targeting older people to include information and advice that they have suggested would help them. Where possible this will be sent directly to targeted older people Thermometer cards to be given out at clinics or other places where older people go to help them understand the right temperatures Bookmarks and banners – building on last year’s work encouraging libraries to display the banners and bookmarks to help people take simple steps to keep warm and prepare for cold weather Email bulletins and alerts to partners with links to useful resources Online information Social media – to encourage younger people to look out for elderly relatives and neighbours Posters – can you afford not to keep warm this winter trying to tackle the perception that people can’t afford to put their heating on to keep warm Source website to ensure that cold weather support organisations and information is available Local media – press releases to target key audiences with keep well, keep warm messages Internal newsletters with colleagues from local authorities and other partners COLD WEATHER PLAN FOR ENGLAND The Cold Weather Plan for England provides a useful framework for assessing when messages need to go out and how these support a whole systems approach to the communication. Using the different cold weather alert levels, key communication activities will be undertaken in line with the plan. Communication action cards have already been prepared for partners which will be delivered in line with the overall plan EVALUATION The evaluation of the communication activities is often the most difficult as this is generally an awareness raising process. However the key objective for this work is to prevent unnecessary winter admissions to hospital. This data is collected and will be used to assess the impacts of the winter messages. Additionally surveys will be undertaken with users and voluntary sector organisations to determine the usefulness of the information and if this has helped people to keep warm. 108