1. Winter planning in Dumfries and Galloway

2. Surge in demand outstrips capacity Multi agency escalation policy signed off by CHP in 2010. Fully worked up and tested Flu Pandemic plan Fully worked up major incident plan Business Continuity Plans in place

3. Demand for Critical Care exceeds capacity Winter 2010-11 - greater numbers of H1N1 patients requiring ventilation with demand peaking at 2.5 times capacity. HDU used for additional ventilation capacity. Consideration being given to expand Non-Invasive Ventilation Capacity within the newly reconfigured respiratory ward

4. The added challenge: reduction of beds in DGRI Oct 2011 Development of a short stay unit for both medical and surgical procedures - opens Sept 2011 Extension 23 hour approach to surgery Introduction of enhanced recovery - major joints, colorectal, # NOF MDT huddles Capacity Management – over 7 day stays flagged and investigated 12 bedded ward closed but available as surge capacity

5. Maintaining patient flow Criteria led discharge – in place in Orthopaedics Optimisation of pathways to community beds Working closely with SAS to maximise ambulance capacity for transfer and discharge

6. Community Teams Exploring opportunities to extend the working week. Exploring opportunities to extend the capacity of our Short Term Augmented Response Team (STARS). Exploring opportunities to work more closely with our social services and social care partners.

7. Detailed analysis – a suite of measures Length of stay –DGRI –Specialty –CIS Health acquired infection Sleepers/ boarders Overall activity Readmissions – 7 days and 28 days 4 hour target

8. Detailed Planning System watch Elective admission list available for the capacity managers 2 weeks in advance Planning meeting 1 week ahead –Capacity Manager –Manager Day Surgery –Waiting list team

9. Patient flow compromised by lack of key staff Staff Flu Vaccination Consultant presence for discharges throughout festive period Community Hospitals fully staffed throughout festive period 4x4 vehicles available within NHS and OOHs fleet used to transport key staff

10. Norovirus Maintain focus upon hand washing 12 bedded ward closed but available as surge capacity Altered hours for domestic services 8.30 – 16.30 Clear escalation plan for domestic services Outbreak team maintain good communication.

11. Service resilience Transport – joint working with Council NHS transport routes have been shared with Council and input into their electronic navigation system Bank of drivers within the council pool available to NHS should major staffing difficulties arise Gritting major routes access routes to hospital facilities will be considered a priority

12. Flow of information is interrupted KWTT Be Ready for Winter Campaign supported and enhanced by local communications team Strong partnership working with all emergency scheme parties ensures early alert of major events, adverse weather warning etc. Communications team manage internal communication links

13. Heating for DGRI is interrupted Base load is delivered by Biomass boiler supported by contract with Scottish Gas and oil tanks Last year Scottish Gas supply interrupted Oil and woodchip supplies kept topped up.