1. Surge, Escalation and Patient Flow North East Master Class 2014 Gill Carton NHS Confidential / Protect / Unclassified - Slide 1

2. Context During the winter monitoring period of 2013/14 the North East experienced significant periods of surge and escalation. The winter debrief event identified and recommended the need to share best practice, guidance and recommendations to better manage winter pressures 2014/15. This session of the Master Class event will focus on surge, escalation and patient flow NHS Confidential / Protect / Unclassified - Slide 2

3. The purpose of the presentation To revisit the local winter statistics 2013/14 demonstrating episodes of surge and escalation Identifying and responding to surge Patient flow check list and experience Explore innovation and best practice to improve patient flow NHS Confidential / Protect / Unclassified - Slide 3

4. Surge Indicators North East Escalation Plan (NEEP) Level A&E Attendances and Performance Emergency Admissions Emergency Readmissions Rates Average Non Elective LOS Ambulance handover and turn around delays Beds Unavailable due to Delayed Transfers Of Care (DTOC) Gastrointestinal infectious disease outbreaks Influenza NHS Confidential / Protect / Unclassified - Slide 4

5. NEEP Levels NHS Confidential / Protect / Unclassified - Slide 5 North East Escalation Plan (NEEP) levels Provider No. of times each escalation level was reached %age Split NEEP 1NEEP 2NEEP 3NEEP 1NEEP 2NEEP 3 CITY HOSPITALS SUNDERLAND 13741512.7%72.5%14.7% COUNTY DURHAM AND DARLINGTON 066360.0%64.7%35.3% GATESHEAD HEALTH 4553444.1%52.0%3.9% NORTH TEES AND HARTLEPOOL 56361054.9%35.3%9.8% NORTHUMBRIA HEALTH 5943057.8%42.2%0.0% SOUTH TEES HOSPITALS 6534363.7%33.3%2.9% SOUTH TYNESIDE 20542819.6%52.9%27.5% NEWCASTLE UPON TYNE HOSPITALS 4755046.1%53.9%0.0% Total305 4159637.4%50.9%11.8% Period: 05/11/13 to 31/03/14 - Data Source: RAIDR

6. Ambulance Handover delays At Trusts across the North East: Over 104,000 ambulance arrivals were recorded by NEAS from November 2013 to March 2014 2,871 delays were reported during the same time period via SITREP When comparing 2012/13 to 2013/14 over a comparative 16 week period ambulance handover delays have reduced by 39% There were 83 ambulance handover delays reported over 2 hours NHS Confidential / Protect / Unclassified - Slide 6 Source: NHS England Daily SITREP

7. Ambulance Handover Delays NHS Confidential / Protect / Unclassified - Slide 7 Data Source: NHS England Daily SITREPs

8. A&E Attendance and Performance At Trusts across the North East from November 2013 to March 2014: There were over 500,000 A&E attendances of which over 300,000 were at major A&E departments There were 18,000 4 hour breaches recorded. Of the 8 Trusts, 3 met the 95% Target each week over this time A&E attendances at major A&E departments are slightly higher than over the same time period last year but the number of 4 hour breaches are slightly lower NHS Confidential / Protect / Unclassified - Slide 8 Source: NHS England A&E Weekly SITREP – w/e 10/11/2013 to 30/03/2014

9. Emergency Admissions At Trusts across the North East from November 2013 to March 2014: There were over 136,000 emergency admissions of which over 84,000 were at major A&E departments Emergency Admissions are slightly higher this year than over the same time period last year. NHS Confidential / Protect / Unclassified - Slide 9 Source: NHS England A&E Weekly SITREP – w/e 10/11/203 to 30/03/2014

10. Emergency Re-Admission Rates Average Emergency Re-Admission Rate January - December 2013 TrustRatio City Hospitals Sunderland95.28 County Durham And Darlington102.87 Gateshead Health102.68 North Tees and Hartlepool96.55 Northumbria Healthcare98.51 South Tees Hospitals101.08 South Tyneside96.99 Newcastle Upon Tyne Hospitals98.23 NHS Confidential / Protect / Unclassified - Slide 10 HED - (Healthcare Evaluation Data)

11. Average NEL LOS Average NEL LOS February 2013 - January 2014 TrustDays City Hospitals Sunderland5.33 County Durham And Darlington4.12 Gateshead Health5.01 North Tees And Hartlepool4.55 Northumbria Healthcare6.38 South Tees Hospitals4.51 South Tyneside5.71 Newcastle Upon Tyne Hospitals5.42 NHS Confidential / Protect / Unclassified - Slide 11 HED - (Healthcare Evaluation Data)

12. Beds Unavailable due to Delayed Transfers of Care (DTOC) NHS Confidential / Protect / Unclassified - Slide 12 At Trusts across the North East: 12,266 beds were reported as unavailable from November 2013 to March 2014 via SITREP due to DTOC When comparing 2012/13 to 2013/14 over a comparative 16 week period the number of beds unavailable due to DTOC has reduced by 22%

13. Responding To Surge Forecasting, met office, predictive tools and planning using trends analysis business intelligence Triggers for escalation Action plans Identify and create additional capacity with appropriately skilled work force Extension of services that support keeping patients at home (rapid response) assessment and treatment (ambulatory care) early supported discharge (discharge to access) Extended GP access in/out of hours 7 day working Stay calm winter campaign self help advice

14. Patient Flow Model Dedicated base Information flows in and out Teleconference facilities Review membership Review frequency Action planning

15. The Perfect Week Exciting new initiative Rapidly improving patient flow producing a step change in performance, safety and patient experience Run over one week the whole organisation focusses on improving the emergency care pathway

16. Examples of Actions Cancellation of non-essential meetings Consultants cancelling non essential sessions Daily walk about visits to wards by executives and senior clinicians Reviewed out patient commitments Reassign non-clinical staff to become ward liaison officers to support pressures allowing clinical staff to focus on direct patient care Implementation of internal professional standards to improve patient flow e.g. agreeing faster response times Free up staff to focus on service improvement

17. Questions ?