1. Preparing for Winter 2011/12 Guidance Overview Stuart Low Planning Manager Scottish Govt NHSScotland Business & Performance Mgt Team

2. 2010/11 NHSScotland Winter Review NHS Boards experienced similar challenges and pressures to 2009/10. NHS Boards experienced similar challenges and pressures to 2009/10. Key challenges: Key challenges: Balance emergency & elective activity. Balance emergency & elective activity. Manage patient flow from admission through to discharge. Manage patient flow from admission through to discharge.

3. 1 Agree and test escalation policies. 2 Undertake detailed analysis and planning to effectively schedule elective activity (both short and medium-term) based on forecast emergency and elective demand, to optimise whole systems business continuity. 3 Agree staff rotas for the festive period in November to match projected peaks in demand. 4 Optimise patient flow by implementing Estimated Date of Discharge as soon as patients are admitted or scheduled for admission with supporting processes to proactively manage discharge at regular intervals throughout the day. 5 Ensure Consultants are available to discharge patients over weekends and the festive holiday period. 6 Agree anticipated levels of homecare packages that are likely to be required over the winter (especially festive) period. 7 Utilise Rapid Response Teams of multi-disciplinary professionals to facilitate discharge. 8 Ensure that communications between key partners, staff, patients and the public are effective and that key messages are consistent. Efficient utilisation of capacity & optimisation of patient flow: Priority Actions

4. 1. Agree & test escalation policies Clear thresholds and authorities for triggering & standing down. Clear thresholds and authorities for triggering & standing down. Sustainable resourcing, encompassing full use of beds in community hospitals. Sustainable resourcing, encompassing full use of beds in community hospitals. Take into account likely impact of admissions on elective work. Take into account likely impact of admissions on elective work.

5. 2. Analysis & planning to schedule elective activity & optimise business continuity Use structured analysis, tools and metrics to manage variation around electives. Use structured analysis, tools and metrics to manage variation around electives. 18 Weeks RTT due for delivery on 31 Dec 11. Important to pre-plan & model elective activity to minimise disruption. 18 Weeks RTT due for delivery on 31 Dec 11. Important to pre-plan & model elective activity to minimise disruption. 98% 4 Hr A&E Emergency Standard continues to be important for patient outcomes. 98% 4 Hr A&E Emergency Standard continues to be important for patient outcomes.

6. 3. Agree staff rotas (in Nov) to match projected peaks in demand Anticipate & plan Consultant cover to manage predicted activity by end of Nov 11. Anticipate & plan Consultant cover to manage predicted activity by end of Nov 11. Take into account predicted peaks in demand and match resource accordingly. Take into account predicted peaks in demand and match resource accordingly. Any plans to reduce number of hospitals accepting emergency admissions should be clearly communicated to partner organisations. Any plans to reduce number of hospitals accepting emergency admissions should be clearly communicated to partner organisations.

7. 4. Optimise patient flow by implementing Estimated Date of Discharge as soon as patients are admitted Discharge planning should commence at the point of admission / pre-admission assessment. Discharge planning should commence at the point of admission / pre-admission assessment. Embed traffic light systems to proactively prepare for discharge. Embed traffic light systems to proactively prepare for discharge. Regular (daily) multi-disciplinary team ward rounds & bed meetings. Regular (daily) multi-disciplinary team ward rounds & bed meetings. Use predictive data to help schedule discharges to maintain optimisation of patient flow. Use predictive data to help schedule discharges to maintain optimisation of patient flow.

8. 5. Ensure Consultants available to discharge over weekend’s and festive holiday period Ensure Medical Consultant cover to perform dedicated discharge rounds. Ensure Medical Consultant cover to perform dedicated discharge rounds. Support Nurse Led Discharges where appropriate. Support Nurse Led Discharges where appropriate. Ensure that key partners can provide pharmacy, transport & social care services to support discharge process. Ensure that key partners can provide pharmacy, transport & social care services to support discharge process.

9. 6. Agree anticipated level of homecare packages, likely to be required. Ensure availability of care packages to meet predicted demand (especially over the festive holiday period). Ensure availability of care packages to meet predicted demand (especially over the festive holiday period). Early, ongoing & detailed engagement with local social care partners is essential. Early, ongoing & detailed engagement with local social care partners is essential. NHS Boards & local authorities should have joint escalation plans / approaches to resolve issues. NHS Boards & local authorities should have joint escalation plans / approaches to resolve issues.

10. 7. Utilise ‘Rapid Response Teams’ to facilitate discharge. RRT of multi-disciplinary professionals, with access to homecare packages, should be used wherever possible. RRT of multi-disciplinary professionals, with access to homecare packages, should be used wherever possible. Take discharge requirements of patients receiving treatment at GJNH into account. Take discharge requirements of patients receiving treatment at GJNH into account. Ensure that patients at high risk of admission are identifiable on contact & that processes are in place to prevent admissions where possible. Ensure that patients at high risk of admission are identifiable on contact & that processes are in place to prevent admissions where possible.

11. 8. Ensure that communications are effective and that key messages are consistent. Shared information across key partners should include: Shared information across key partners should include: Key contacts Key contacts Level of service cover Level of service cover Bed states Bed states Decisions taken outside of agreed arrangements. Decisions taken outside of agreed arrangements. Communications with the public, patients & staff should use all available mediums. Communications with the public, patients & staff should use all available mediums. NHS 24 leading on 2011/12 ‘Be Ready for Winter’ campaign. NHS 24 leading on 2011/12 ‘Be Ready for Winter’ campaign.

12. Get Ready for Winter Week (24-30 October 2011) Raise awareness of winter risks and their consequences. Raise awareness of winter risks and their consequences. Highlight steps people can take to reduce and manage these risks. Highlight steps people can take to reduce and manage these risks. Provide information, resources & support available across a number of sectors. Provide information, resources & support available across a number of sectors. Ready Scotland Website Ready Scotland Website Ready Scotland Website Ready Scotland Website

13. Important Factors to Consider Implement norovirus outbreak control measures. Implement norovirus outbreak control measures. Out of Hours self assessment. Out of Hours self assessment. Seasonal flu, staff protection and outbreak resourcing Seasonal flu, staff protection and outbreak resourcing Use of management information. Use of management information. NHS Board resilience. NHS Board resilience.

14. Signing off Winter Plans Opportunity to provide feedback on draft guidance at Regional Winter Planning events. Opportunity to provide feedback on draft guidance at Regional Winter Planning events. Final version issued to Chief Execs – early October. Final version issued to Chief Execs – early October. NHS Boards expected to implement Priority Actions & address other important factors. NHS Boards expected to implement Priority Actions & address other important factors. No requirement to submit winter plans to SG H&SC Directorate. No requirement to submit winter plans to SG H&SC Directorate. Chief Execs should: Chief Execs should: discuss winter plans at Oct / Nov Board meeting. discuss winter plans at Oct / Nov Board meeting. personally sign-off and publish plans by end Nov. personally sign-off and publish plans by end Nov.