1. Local Unscheduled Care Action Plan and Winter Planning 2013-14 Health and Social Care Partnership Meeting 24 Oct 2013

2. This is about people.... Delays cause harm Especially for older people Especially where they are at risk of falls And/or have cognitive impairment/dementia

5. Mortality

8. Bed Availability We have 620 beds on the Victoria site 500 are available for acutely ill patients as emergencies and patients coming in for operations We take in about 70-80 emergencies per day about 50 of these are medical patients We discharge people home or into community hospitals, residential or nursing home care Our key issue is flow we think we have got the capacity about right....

9. Local System Health Check Deciding Our Priorities  Does A&E have enough resources to assess and transfer or discharge patients within 4 hours?  What evidence is there that a lack of available beds is delaying the transfer of emergency patients?  How many beds are lost to delayed discharges?  How many available beds are lost by not discharging 50% of patients before midday?  How many available beds might be freed up by improving access to other services, e.g. physiotherapy, diagnostic tests?  What is the impact of an increasingly elderly population?  What would be the impact of directly admitting patients to specialty wards?, e.g. stroke, cardiology

10. High Level Actions  Making the existing surge capacity ward in Victoria Hospital permanent (now ward 6 previously ward 15)  Opening and staffing 10 additional community beds  Opening and staffing a 10 th ICU bed over the Winter  Development of community intermediate care beds  Developing, staffing, equipping and stocking 28 contingency beds in ward 13  Continue to work with wards to increase the numbers of patients discharged before midday  Availability of additional discharge vehicles to enable discharge of patients with shorter lengths of stay and those patients referred to the discharge hub and hospital at home

11. Measuring Success  Patient experience, e.g. avoiding harm  Staff experience  4 hour emergency access standard  No. of patients who breach 12 hour  Rate of A&E attendances  Number of patients boarding  Number of patients delayed for discharge  Number of patients assessed through discharge hub and discharged within 48 hours

12. Early Feedback from the HUB Report – w/c 7 October 2013 Emerging success

13. Winter Framework  Role of capacity meetings – who is key?  Winter hub  Escalation  Text alerts – status and breaches  Development of system barometer - Green, Red, Critical / Black  Action cards  Problem Assessment Group  Capacity escalation procedure  Critical - high level group – discharge / transfer of additional 30 patients within 24 hours

14. System Barometer  Based on a points score  Developed in partnership with social care colleagues  Pressure indicators  When parameters are exceeded a point is added to the forecast. The score of the total points is plotted on the barometer which in turn represents the pressures on the system and determines an escalation level – Green, Red or Black GreenRedCritical 123456789101112131415

15. Pressure Indicators Admissions more than discharges>0 Medical bed shortfall>30 Surgical bed shortfall>10 Trauma & Orthopaedic bed shortfall>3 Emergency Medical / Surgical / T&O beds at 8am<16 Number of wards affected across the organisation (Infection)>1 Patients ready on community waiting list (including Tayside)>25 Patients ready on Edison>50 Predicted transfers to community hospital<5 Number of stroke patients awaiting Acute Stroke Unit bed>0 Number of Patients Boarding>8 Number of patients waiting on Trauma list>10 Extra capacity opened>0 Wait for Homecare & ICASS from the discharge hub>48 hrs Unfilled bank ShiftsTBC

16. Other Contingencies  Severe weather  Norovirus  Pandemic  Seasonal flu Esplanade Kirkcaldy