Surge Capacity Secondary & Community care, mental health & learning disability (Trusts)

Ensuring readiness PHA/HSCB/BSO Surge Assessment group Reviewed Trust Plans Regional workshop mid-June Trust self-assessment checklists Report on readiness 30 th June Plans resubmitted end July Face to face meetings with Trusts Resubmitted checklists – significant progress Surge assessment report to next programme Board

Regional Business Cases Virology equipment & staff Critical care expansion – Adult – Paediatric Neonatal intensive care expansion Nursing & AHP training Appointment of staff to nurse banks Community respiratory equipment Beds & mattresses Other community equipment

Critical Care Capacity Estimated demand for critical care admission in NI Scenarios (i) 30% Clinical Attack Rate, 2% hospitalisation rate & 25% critical care admission (all age groups) (ii) 50% CAR, 2% hospitalisation rate & 25% cc admission rate (children) (iii) 50% CAR, 1% hospitalisation rate & 25% admission rate (children)

Critical Care Capacity Estimated demand for critical care admission in NI 0-4 years5-9 years10-14 yearsAdult >14 years Cumulative Over 15 week surge period 30% CAR 2% hosp rate % CAR 2% hosp rate n/a 50% CAR 1% hosp rate n/a In week 6 (peak) 30% CAR 2% hosp rate ** 50% CAR 2% hosp rate 62 66n/a 50% CAR 1% hosp rate 31 33n/a *This excludes neonatal intensive care demand **Maximum capacity in adult units is 158 beds

Additional paediatric critical care beds needed in peak week (7 day average length of stay & 98% occupancy) H1N1 Attack rates & hospital admission rates 30% CAR 2% admission 50% CAR 2% admission 50% CAR 1% admission 0-4 years years years Total

Critical care expansion plans Adult ICU beds - currently CSICU During peak surge will rise to 158 (increase of 126%) Requires 47 extra ventilators and 215 £1.4m Paediatric ICU beds – currently 8 in RBHSC During peak surge will rise to 29 in BHSCT plus 20 in DGHs (increase of 510%) Requires 38 extra ventilators and 220 £1.6m Neonatal (level 1) beds – currently 21 During peak surge will rise to 63 (increase of 200%) Requires 36 extra ventilators & 179 £2.3m

Challenges Critical Care capacity versus demand Application of triage (SOFA) and reverse triage As yet no agreed triage process for children Uncertainty on scale of cases of premature labour & hence neonatal demand Lead time for equipment procurement Phasing of increased critical care capacity (staff ratios & locations) Firm plans for staff redeployment (no double- counting)

Challenges Ensuring PPE availability and match to fit-testing Time for staff to have training for redeployment Core regional services – equity of access Timing of turndown of elective work Business case processes – Variation in Trust proposals (quantity and costs) to deliver similar services – Capacity of Trusts to develop cases to DHSSPS standards Public (& professional) expectation Timely & transparent communication to the public & professionals of changes in service access