NHS GREATER GLASGOW AND CLYDE

WINTER PLANNING REPORT

Grant ArchibaldDirector Emergency Care & Medical Services

Winter Planning Process (1)

•The 2010/11 Winter Plan for NHS Greater Glasgow and Clyde was developed on a single system basis and included partners who are involved in the delivery of services

•Scottish Ambulance Service

•NHS 24

•GP OOH Service

•Mental Health and Addiction Services

•ACUTE

•CH(C)Ps

•Dental Services

•Pharmacy

Winter Planning Process (2)

Board approved the Winter Plan in October 2010

•Final plan signed off by Chief Executive in November 2010.

•Plan uploaded onto the Board website and sent to the Scottish Government

To support Winter Plan

•Board wide Escalation Plan signed off in November 2010 – supported by Agency Escalation Plans

•Senior On-Call Rotas for each agency

•Winter Planning Group

Timeline of Winter Pressures (1)

October 2010 – November 2010

Key pressures re Delayed Discharges overall impact on A&E performance – dropped to 96% and 94% respectively

27th November 2010 – Scottish Government introduced daily Severe Weather Winter Reporting to brief Cabinet Secretary. This required reporting on series of key indicators :

•Number of Staff absences – Nursing/Medical/Other•A&E Activity•Number of 12 hour breachers•Cancelled outpatient clinics –•Cancelled electives •Discharges – number of patients occupying a bed who could not return home due to weather •Out of Hours – description of activity•Description of what plans were in place to manage over the next 24 hours

Timeline of Winter Pressures (2)

6th December 2010 – 27th December 2010Extreme snow fall/freezing icy conditions – sustained from this date until 20th December 2011Immediate impact on•SAS – transport fleet

•Discharging of patients from hospital to home

•significant numbers of staff had difficulty in getting to work during the first few days of the extreme weather

•Increase in emergency orthopaedic trauma

•Community Day Centres closed and some Health Centres closed

•GP OOH – home visits

•significant increase in emergency activity and admissions

•reductions in outpatient and elective activity

Timeline of Winter Pressures (3)

•29th December 2010 • Prevalence of H1N1 increases

31st December 2010 •Severe Weather Reports extended to include Flu reporting

January 2011 – first two weeks•continued increase in emergency admissions

•increased number of H1N1/Flu like/Respiratory illnesses

•ITU demand increased significantly

Winter Activity (1)

Wider Position :

GP OOH – 24th December 2010 to 5th January 2011•10% increase in overall activity •25% increase in PC EC attendances•90% Home Visits managed within the KPI timeframes

NHS 24 – 24th December to 5th January 2011•25% increase in call demand•3rd January 2011 – highest daily call demand since festive period in 2004•Category 3 calls – did not manage to respond to all within the KPI timeframes

SAS – 6th December 2010 to 5th January 2011•12% increase in GP calls to service•5% increase in urgent (999) calls

Winter Activity (2)

ACUTE :

• A&E attenders •24th December to 7th January 2011: 5% increase on previous year

•Emergency Admissions •25th December to 7th January 2011 : 9% increase on previous year•1st to 5 th January Emergency medical admissions increased by more than 20% compared to 2009/10•3 days when emergency admissions exceeded 500 patients•3 days when emergency medical admissions exceeded 300 patients•ITU activity increased significantly

•UCC Performance•December : 94%•January to date: 90%•12 hour breachers during period 24th December to 17th January - 9

Winter Activity

NHSGGC - TOTAL EMERGENCY ADMISSIONS BY DAY24 DEC - 07 JAN

200

250

300

350

400

450

500

550

DATE

EM

ER

GE

NC

Y A

DM

ITS

PE

R D

AY

2009-10

2010-11

Winter Activity

NHSGGC - MEDICAL EMERGENCY ADMISSIONS BY DAY

0

50

100

150

200

250

300

350

DATE

NO

OF

AD

MIS

SIO

NS

2009-10

2010-11

Winter Activity

NHSGGC - NEW A&E ATTENDS BY DAY

600

800

1000

1200

1400

1600

1800

DATE

NE

W A

&E

AT

TE

ND

S P

ER

DA

Y

2009-10

2010-11

Winter Activity

NHSGGC UNSCHEDULED CARE - 4HR TARGET COMPLIANCE BY WEEK

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

DATE

NO

OF

A&

E A

TT

EN

DS

80%

82%

84%

86%

88%

90%

92%

94%

96%

% C

OM

PL

IAN

CE

NHSGGC A&E ATTENDERS

NHSGGC ATTENDERS WAITING < 4 HRS

% WAITING < 4 HRS

Response to Exceptional Pressures (1)

ACUTE• Daily COO / Director level Winter Planning Meetings• Opened additional capacity – 98 beds• Extended opening of 5 day wards and CDU at Stobhill/SGH – 20

beds• Increased Paediatric ITU beds from 16 to 18• 9 additional Adult ITU beds opened at peak time of activity during

first two weeks in January 2011• Elective programme reviewed - converted elective to emergency

capacity – 24 beds• Increased number of consultant ward rounds• Increased Consultant input within A&E• Additional ambulances available Out of Hours • Improved utilisation of Minor Injury Units

Response to Exceptional Pressures (2)

GPOOH• Additional GPs available for PCEC centres at peak times of activity• 4 wheel drive vehicles used to support SAS accessing patients

NHS24• Category 3 calls – GP OOH supported managing this demand• Established Scottish Flu Response Line

CH(C)Ps• Increased Home Visiting

SAS• Implemented Escalation Plan• British Army, Coastguard, British Red Cross, and GPOO services called upon to

assist in transportation of patients• Significant number of Outpatient and Day Hospital transport of patients cancelled • Ambulances focussed on hospital transfers and emergency cancers/renal patients

Future Winter Planning (1)

• Continue to progress planned improvements in length of stay and bed usage

• Ongoing management of delayed discharges

• Review plans to deal with exceptional surges in emergency activity

• Review policies and procedures for managing in severe weather conditions

• Continue to review patient pathway through A&E to reduce attendances/ admissions– improve utilisation of Minor Injury areas– assessment areas

Future Winter Planning (2)

• Review of all out of hospital measures – – alternatives to admission– early supported discharge– access to community services including mental health and addiction– GP Out of Hours Services

• SAS - Review of Transport Fleet

• GGHB Whole System Review of Winter Planning

• National Review to consider experiences of all Scottish Boards and agencies

All Year Response to managing key pressures in system

•System wide Improvement Action Plan for Unscheduled Care (ATOS)

•March 2011 – Flow Mapping•Local team engagement to identify patient processes

•May 2011 – Stakeholder Engagement Event – whole system•Presentation of data analysis•Identified key priority issues to be addressed

•17th June 2011 – Stakeholder Event to agree future workplan

Managing Activity Pressures

Managing Activity Pressures

WAY FORWARD

• Essential to recognise this is not just a product of extreme winter

• A new paradigm in demand and capacity• Using structured analysis and tools to devise

specific, hard edged solutions• Develop a programme of sustained improvement• Achieve a new system-wide steady state, which

is also capable of managing demand variations