1. Winter Evaluation for 2013/14 Winter Planning for 2014/15 Dr Paul Kaiser, Clinical Lead IESCCG Richard Cracknell, Winter Planning Manager Mark Cooke, Senior Transformation Lead 1

2. Hospital Ambulance Liaison Officer (C) Collaborative working Supported 7 day working 65% fewer delays reported Positive patient outcomes in handover and response times Reduction of financial consequences (AA) Admission Avoidance | (C) Capacity | (ESD) Early Supported Discharge Top 5 Patient Flow Winter Schemes 2013-14 Evaluation Based Primary Care Contract COPD (AA) Positive patient outcomes Reduced respiratory admissions 2,253 patient contacts by Primary Care 1,407 prescriptions issued 24% reduction in COPD admission than last year (Jan- March) 4% reduction in overall respiratory admissions than last year (Jan- March) Additional Consultant hours in ED, EAU and Capel Ward (AA/C/ESD) Positive patient outcomes Supported 7 day working Reduced waiting times for patients Improved patient flow Senior clinical decision making 20% additional weekend discharges on Capel Ward than before consultant 95% year end ED performance met Weekend Diagnostic, Therapies and Pharmacy (AA/C/ESD) 4% increase in weekend dispensing Supported 7 day working Positive patient outcomes Collaborative working 12% of patient seen by therapies were discharged the same day 58% of patients seen by therapies were discharged at the weekend Community Escalation Beds and Discharge Planning Nurses (AA/C/ESD) Supported 7 day working Positive patient outcomes, being treated in the right place Collaborative working Reduced patient length of stay in hospital Used by 218 patients Average length of stay 9 days

3. Winter Schemes from 2013/14 with brief outline of activity Care UK Out of Hours GP in the Emergency Department Supporting Ipswich Hospital in the evening and at the weekend. This scheme saw 1217 patients from ED, and was extended to cover the Easter bank holiday weekend seeing another 149 patients Nov - March £151,648.00 Easter £17,850.00 Adult Community Services Social Care Crisis Response Service Provide a point of contact and resource to manage immediate crisis. 47 people were referred to this service Nov - March £90,000.00 Adult Community Services Extended capacity in the Flexible Dementia Service Supporting people at home and at the point of discharge. 20 patients were supported resulting in unnecessary residential placements and enabling them to return home Nov - March £100,000.00 EEAST Hospital Ambulance Liaison Officers (HALO) Providing a link between the hospital and ambulance service. EEAST saw 65% fewer delays over the winter period Nov - March £46,038.00 EEAST Extended patient transport hours Providing cover between 6-8pm Monday - Friday. 89 patients were discharged and transported out of hours Jan - March £11,625.00 Ipswich Hospital 21 Escalation Beds Funded in patient beds to improve patient flow and placement reducing the number of medical outliers and ED breaches Nov - March £529,758.00 Ipswich Hospital Children services Increased bed base and opening times of assessment unit. Reduced the need to transfer children out of area Jan - March £100,000.00 Ipswich Hospital Weekend diagnostics Additional weekend CT, MRI and ultrasound service for inpatients and outpatients. On average 32 patients were seen each weekend Jan - March £51,600.00 Ipswich Hospital Additional therapy support to ED Weekend therapy services in ED to prevent unnecessary admissions. 15 patients were seen assessed and discharged home as a result of the scheme Jan - March £39,000.00 Ipswich Hospital Woodbridge ward therapy Weekend therapy services on short stay wards to increase discharges and MDT planning. 447 patients have been seen with 258 discharges been progressed at the weekend Nov - Feb £53,217.00 Ipswich Hospital Additional consultant hours to ED and EAU and Capel Ward Increased senior decision maker presence has resulted in 20% additional discharges, reduced waiting times and improvements in patient flow Nov - March £220,000.00 3

4. Ipswich Hospital Escalation discharge team for Medicine and Surgery Additional 8hrs on Saturday and Sunday to progress patients towards discharge Jan - March £49,000.00 Ipswich Hospital Additional pharmacist and ward technician Providing weekend pharmacy and escalation ward cover. There has been a 4% increases in weekend dispensing Jan - March £24,133.00 Ipswich Hospital Paramedic support in ED To support the ED in achieving the 95% standard. Supported ED in meeting the 95% standard throughout winter Jan - March £90,000.00 Ipswich Hospital Emergency Flow nurse on SAU Ensuring patient flow is maintained and delays reduced Jan - March £10,500.00 Ipswich Hospital Additional staffing on SAU To support the flow and turnaround of surgical patients Jan - March £69,000.00 Ipswich Hospital Local equipment store Supporting early discharge of patients requiring equipment Jan - March £20,000.00 Ipswich Hospital Discharge co-ordinator Supporting the hospital coordinator and patient flow. Jan - March £70,977.00 Ipswich Hospital Discharge Lounge with enhanced washing and dressing team Enabling patient flow and reducing delays in discharge. The team were based on the escalation wards maximising discharges Jan - March £100,065.00 Primary Care COPD - Winter contract Assessment of COPD patients with a view to actively manage their condition over winter Dec - March £48,088.00 Primary Care GP redirect in hours - Winter contract Ability to redirect patient back to Primary care from ED when appropriate Dec - March £41,000.00 IESCCG Winter Community Escalation Beds and Discharge planning nurses 21 community based beds. 218 patients used this scheme with an average lengenth of stay of 9 days Nov - March £365,000.00 IESCCG & WSCCG Sessional Communications Plan Joint communication plan on pre hospital care, including a cinema campaign, social media and public engagement events Nov - March £36,375.00 Voluntary Sector 9 projects aimed at reducing hospital admissions and attendances. These schemes had a total of 1357 patient contacts. East Anglia's Childrens Hospital Home Start East Suffolk Ipswich Housing Action Group St Elizabeth Hospice Town Pastors Ipswich Headway Ipswich and East Suffolk ICENI Ipswich Ipswich Winter Night Shelter Suffolk Young Peoples Health Project £100,000.00 4

5. Winter Planning Workshops 2014/15; building on the successes of last winter Ipswich and East Suffolk CCG performed well through winter 2013/14 System escalation has been effectively managed by the CCG through the Winter Planning Managers and Contracts team Ipswich Hospital was the 10 th best performing hospital in England, during winter 2013/14, at achieving the 4 hour standard in ED In planning for winter 2014/15 the health and care system have agreed the principles of winter as; –Patients being treated in the right place –Working as a system to avoid point of crisis –Collaborative working across Health and Care system including the voluntary sector –7 day working and availability of services 7 days a week –Build flexibility in the system –Improving system-wide communication –Quick mobilisation across the system 5

6. Winter Planning Workshops 2014/15; building on the successes of last winter The CCG has received 40 provider bids for winter 2014/15. These were shortlisted to 21 bids. These bids were then divided into 3 categories; admission prevention, pull based discharge and self-care (including reablement). Similar bids were grouped together and workshop attendees were asked to review these bids to design one integrated scheme to remove duplication and demonstrate partnership working in order to benefit the needs of patients. A total of 5 integrated schemes have been developed and are being progressed further. Primary Care is invited to share their ideas for winter 2014/15 Primary Care is asked to consider, what makes winter different? 6