1. NHS Fife Winter 2010-11

2. Preparation  Winter plans in place in each part of system  Joint escalation procedure agreed and in place  Agreement on information to be shared across the system

3. Blue admissions Pink discharges

4. Month 1  What significant changes did we note –Decrease in nursing home placements (29 v 44 from hospital and 59 v 99 in total) –Increase in delayed discharges ( total &>6 wks)

5. Blue admissions Pink discharges Amber Boarding bed days

6. Month 2  What significant changes did we note –Continued decrease in nursing home placements –Continued increase in delayed discharges ( total &>6 wks) –Increase in boarding bed days –Wards closed due to Norovirus –Cancelled operations due to lack of beds –Decrease A&E performance – 98% to 92 %, Increase in 12 hour breaches from 1 to 9 in week

8. Month 3  What significant changes did we note –Increase in nursing home placements –Wards closed due to Norovirus –Reduced number of cancelled elective operations due to lack of beds –Reduced numbers of admissions during severe weather –Increasing boarding bed days –increase in delayed discharges >6 weeks –Severe weather -2 weeks –Unfunded beds opened across system –Overall System at Red Status –Decrease A&E performance – 92% to 89%, Increase in 12 hour breaches to 23 in week

10. Month 4  What significant changes did we note –Wards closed due to Norovirus –Increased number of cancelled elective operations due to lack of beds –Variable boarding bed days –Significant increase in delayed discharges >6 weeks –Additional investment from Health and Social care –Decrease A&E performance – 89% to 86%, Increase in 12 hour breaches to 37 in week

12. Month 5  What significant changes did we note –Significant Increase in nursing home placements –No Wards closed due to Norovirus –Significant increase in nursing home placements –Increased number of cancelled elective operations due to lack of beds –Decreasing boarding bed days –Significant decrease in delayed discharges >6 weeks –Overall status between amber and red –Increase A&E performance – 86% to 94%, decrease in 12 hour breaches to 11 in week

14. Month 6  What significant changes did we note –Increase in nursing home placements –Wards closed due to Norovirus –Reduced number of cancelled elective operations due to lack of beds –Significant decrease in total delayed discharges –Closure of unfunded beds –Decrease in nursing home placements –Overall status amber by middle of March –Increase A&E performance –to 94%, decrease in 12 hour breaches to 5 in week

16. Review  Difficult winter in contrast to success in previous year  System under significant pressure from early November  Exacerbated by severe weather end of November into early December  Inability to discharge patients in timely manner from acute and community hospitals  Emergency admissions similar to previous years but increase in proportion due to falls and fractures

17. Key areas  Significantly reduced ability to discharge to residential care and home care due to demand overtaking available resources- both financial and staff  Severe weather during November and December 2010 impacting on patients ( e.g. increased fractures and falls) and staff (e.g. transportation).  Concern about the process for making decisions to resolve issues around patient flow

18. What are our plans for 2011-12  Table top exercise with Senior Management team and Partnership Management Group to test escalation procedure (August 2011)  Contingency plan being developed in event of major incident during move to new hospital  Opportunity to introduce new models of care and enhance intermediate care systems as part of change fund proposals.