1. Patient and Public Council Winter Review and DToCs
15 June
2018

2. Introduction Winter Review Urgent care patient flows and activity
Preparation for Winter 2017/18
What happened in Winter 2017/18? Lessons learnt
Planning for Winter 2018/19
Delayed Transfers of Care (DToC)
An introduction to discharge planning
What is a DToC?
The challenges of reporting
Next steps…

3. Winter Review What is ‘Winter’?
Media focus on ‘urgent care’ (same day or within 24 hours)
Across primary, community, ambulance service and secondary care
Rapid response social care

4. Three Phases PRE-HOSPITAL HOSPITAL HOSPITAL TO HOME
(MANAGING A&E DEMAND)
HOSPITAL
HOSPITAL TO HOME

5. Patient Flow to Acute Systems
(% based on April – August 2017 Data)
UNITED LINCOLNSHIRE HOSPITALS (ULHT)
SITES AT LINCOLN, GRANTHAM & BOSTON
A&E 86.5%
NEL 84.1%
NOTTINGHAM UNIVERSITY HOSPITALS (NUH)
A&E 29%
NEL 25.2%
A&E 4.1%
NEL 6.0%
QUEEN ELIZABETH HOSPITAL
KING’S LYNN (QEH)
A&E 10.9%
NEL 15.3%
A&E 4.1%
NEL 5.8%
A&E 54.9%
NEL 55.0%
NORTH WEST ANGLIA HOSPITALS (NWA)
SITES AT PETERBOROUGH & STAMFORD

6. Preparation for Winter 2017/18
Lessons learn from 16/17
Earlier planning and for a longer period (October 2017 – Easter 2018)
Self care and population education
NHS 111 and Clinical Assessment Service (including CAS for Care Homes)
New ambulance service targets (response times and Hear and Treat / See and Treat)
LCHS Single Point of Access and ‘virtual’ service across Lincolnshire organisations
Urgent care streaming at hospital sites
Improved pathways for hospital care delivery – including extra bed capacity
Greater resources for discharge planning and a more resilient care sector

7. Winter 2017/18 – The Challenges
Backdrop
Increasing demand and acuity
Limited capacity
Workforce challenges
Primary and social care pressures
Reality
Available budgetary support for winter came too late – design and mobilisation issues
Increased demand on healthcare, particularly urgent care services nationally, with a surge in January 2018
Influenza strain (impacting demand and workforce) – Australia and New Zealand
Norovirus (resulting in lost beds in hospitals and care homes)
Unprecedented weather conditions

8. Winter 2017/18 – The Successes
Better public communication
‘Communications Network’
Tools for self-management
Clarity of service availability
Improved integrated working
Across all sectors
Senior decision-makers
Regularity
A ‘can-do’ attitude
Surge / MADE / Perfect Week events

9. Winter 2018/19 What is happening now?
Monitoring our activity trends and informing our clinicians
Regular activity monitoring at North West Anglia
Locality dashboards
Practice urgent care deep dives
Utilisation of transitional care capacity
Engaging our communities
Sharing our messages (including z-card distribution)
College engagement
Development of locality working – NTs and PCH
Drawing together of health, care and voluntary sector services to offer MDT delivery
Care planning for our most vulnerable patients
Patient-centred planning and delivery

10. Winter 2018/19 Next Steps Communication, education and empowerment
Winter communications plan development – Aug 2018 onwards
Engaging and empowering carers and families
Development of locality working – NTs and PCH
Care planning for our most vulnerable patients
Improved integration with secondary care
Maximising our resources
Reviewing our working practices to identify efficiencies, e.g. earlier intervention to support hospital inpatients and reduce delays
Robust plans for additional service provisions – should funding be delivered
Restructuring / growing our urgent care services
Development of Urgent Treatment Centres / GP Access Hubs
Building on admission avoidance opportunities

11. Discharge Planning
Services to reduce the length of stay through effective discharge planning and to reduce delays to discharge.
Approximately 1/3 of all hospital inpatients have ongoing needs and require facilitated discharge, with adult social care and / or health input.
Significant public funding invested to facilitate improved discharge pathways and reduce delays, both through BCF / iBCF and health funding.

12. Improved Better Care Fund
The Better Care Fund &
Improved Better Care Fund
Better Care Fund announced by Government in June 2013 (£3.8bn) to support the ‘joining-up’ of health and social care services to support improved public wellbeing and to facilitate individuals being able to remain in their own homes for as long as possible.
Additional allocations announced in 2015 (iBCF) and March 2017 (Supplementary iBCF).
Lincolnshire’s BCF for 2017/18 totalled £226m , including £154m additional contribution from CCGs and LCC.
One of the largest pooled budgets across health and social care community in England.
Key focus on minimising delayed transfers of care (DToC), in both acute and community.
Implementation of the High Impact Change model is a condition of iBCF.

13. Delayed Transfer of Care? And what is it not?
What is a
Delayed Transfer of Care?
And what is it not?
Once a patient has been declared ‘medically fit’ or ready for transfer home or to the next destination, there is a 72 hour period gifted to facilitate discharge.
Beyond this, the discharge is considered to be ‘delayed’ and the patient is recorded with a Delayed Transfer of Care (DToC) status.
Not a ‘bed blocker’!

14. DToC – A Complex Landscape
Social Care
delays in discharge arising due to social care provision factors
Joint Responsibility
delays in discharge arising due to both social and health provision factors
Health
community care delays
secondary care delays
delays in equipment provision
family / patient delays (self funders and disputes)
The majority of delays will be declared as ‘health’, though may not be directly due to failures in health care pathways.
Reporting of delays nationally at organisation and unitary authority level (not CCG level)

15. DToC Performance (Acute)
Blue = Health
Orange = Social
Green = Joint

16. Discussion