maintaining systems resilience through the winter in eastern cheshire
TRANSCRIPT
Maintaining System Resilience Through Winter
Jacki Wilkes/Charles MalkinGoverning Body
22 February 2016
Setting the scene….Eastern Cheshire demand for hospital services down year on year
Unintended consequences include:• shift in demand across the system• achieving 95% A&E waiting time target more of a
challenge
Q4
Provider Attendances Admissions 4 hr
Performance 2015/16
Attendances Admissions 4 hr
Performance 2014/15
EAST 6,835 1,404 91.05% 7,234 1,701 85.10%
What’s different this year….
• Plan against a review of capacity and demand- emphasis on flow, people and processes
• Innovative approach to measuring system resilience
• Intelligent approach to promoting self care through ‘Choose Well Think Pharmacy’
• Using data from these sources to target key audiences:
GP practices & snow white• What it tells us:Age range of patients (0 – 9, 65+, jobless)What’s wrong with them (coughs, sore throats,
diarrhoea , flu symptoms)• Most of these people should be self-caring or
seeing the pharmacist
The science bit:
• Targeting key audiences through: School newsletters Job Centres CVS network Partners HealthVoice• Events• GP screens• But global communications needed too
What are we doing about it?
Whole audience – a new approach!
• Outdoor advertising: Billboards – Waters Green Morrisons – Congleton & Poynton Macclesfield, Knutsford & Wilmslow Railway Stations Waitrose – Poynton 32 telephone kiosks 25 buses Radio
How are we saying it?• Whole audience:Outdoor advertising (reach: nearly 112,000)Free sheets (reach: around 150,000)Health & Social Care Directory (reach: 24,000)• Total reach = 286,000 – excluding targeted
comms• And it works across borders
• CCG web pages: + 1,000 page impressions per month in Dec 2015 & Feb 2016
• Twitter: nearly 4,000 followers• Klout score: 49• Facebook: 75 likes• LinkedIn: 98 followers• HealthVoice & Caring Together feeds
How are we saying it?
• Outdoor advertising must be concise• 111 is best option for reducing demand on
GPs & A&E for urgent care• Self-care is best option for minor ailments
Why NHS 111 and self-care?
• Outputs: Audience reach % take-up of media releases Sentiment & AVE ROI: Potential £25k net saving
• Outcomes: Awareness (competition, Citizens’ Panel, on-street) Behaviour change
How do we measure impact?
Primary Care: General Activity Levels
Pressure on Appointments
OtherClick on title for
further infoMDGH (Acute) -
Status: StaffBed Cap v Demand ED Wait
Unplanned Closed Beds
Non-IP Beds in use
COMMUNITY: EAST 14.00 I/M Care I/M Care Nursing HITS IRS
COMMUNITY: S&VR 14.00 I/M Care IRS OoH-SVR
Staffing Home Visits D&V12/11/2014
Green12/11/2014
Beds Overall RAG AM12/11/2014
Beds Nursing Matrons11:00 0-1 Hours East Locality SVR Locality
Depts/ Elective Green
Patient Demand Accessing Services Flu Services AdmissionsBusiness Critical Packages
PM (prev day) OoH-East Packages
Yellow
Click to see Primary Care Peer Groups: Flu InfoCli ck for Data Click for Data
12/11/2014
Care Home Bed AvailabilityW/C: 27/10/14 44
With Nursing 14With Nursing/EMI 5With Nursing & Without Nursing 0With Nursing & Without Nursing/EMI 1With Nursing & Care in yr home + supported living/EMI 3With Nursing / With Rehab (illness or injury)/EMI 0
Without Nursing 13
Without Nursing/EMI 5Without Nursing / With Rehab (illness or injury) 3
Attends Breaches147 3
% Factor for Projections:Respiratory System -5.00% Paediatrics 0.00%Primary Cardiac -5.00% Falls 0.00%
Ma intenance
16:00
Adelphi (Adult Elderly)
2
Bollin (Adult) 5
Croft (Organic) 1
cl ick for note
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins Snow Other Adverse Met Office 10 day ind42 4 0 0 9.52% 88 22 1 0 26.14% 12/11/2014 8 No None None
13/11/2014 10 No None NoneJobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins 14/11/2014 7 No None None
7 2 0 0 28.57% 22 7 0 0 31.82% 15/11/2014 7 No None NoneAvg time to
notification to clinical handover:
08:22Avg time to ambulance
clear:
Avg time to notification to clinical handover:
07:53Avg time to ambulance
clear: 16/11/2014 8 No None None
17/11/2014 8 No None None18/11/2014 7 No None None
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins 19/11/2014 7 No None None49 4 0 0 8.16% 95 19 2 0 22.11% 20/11/2014 7 No None None
21/11/2014 6 No None NoneJobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins
34 1 1 0 5.88% 28 5 0 0 17.86%Avg time to
notification to clinical handover:
10:30Avg time to ambulance
clear:
Avg time to notification to clinical handover:
10:05Avg time to ambulance
clear:
Under Development
Total AvailableClick for Full Data
Availability to admit patients (maximum 3)
Click for Data / Commentary
Capacity to Admit Status
25.22
A&E 4hours & DTOCS - Wythenshawe Hospital Site
MDGH - # of empty beds
29.23
12/11/2014 12:00
Previous day's total
NWAS - Wythenshawe Hospital
11/11/2014
Commentary: Temperatures over the next few days are marginally higher compared with the equivalent
period in 2013. Emergency activity levels, where weather temperature influences, would therefore
indicate similar levels.
Green
Community Domiciliary Care
Green
Target Time from Referral to Assessment for Mental Health
patients assessed as being medically fit
24.25Infection Control
This remains amber for care home placements, green for team and domiciliary care.
Staffing Hospital Team
AmberPrevious day's total
Liaison A&E (Target 1hr)
NWAS - Leighton Hospital
12/11/2014 12:00
Previous day's total
NWAS - Stepping Hill HospitalNWAS - MDGH
96.30%
12/11/2014 Green
12/11/2014 12:00
12/11/2014 12:00
Previous day's total
12/11/2014
Community Pharmacy
MDGH DTOCs
CWP - East
21.38
97.96%
20 2711/11/2014 11/11/2014
ECCCG - all Practices Congleton / Holmes ChapelKnutsford C.H.A.W.
Poynton / Bollington / Disley Macclesfield
A&E 4hours & DTOCS - Stepping Hill Hospital Site
11/11/2014
Residential/ Nursing Care Bed
Packages
Overall RAG for CWP
Green
Click for DataEast Cheshire Hospice
07/11/2014
12/11/2014 13:30
Yellow
Green
Green
Click for ECT Community Data
Amber
Click for ECT Intermediate Care Data Click for SVR Community DataClick for ECT (Acute) Data
Yellow
Click for ECT Communication
Amber
Yellow Amber
Green
GreenYES
AAU Functioning?
Click for System Status Detail
Yellow Green
YELLOW
Green
System Overall Status:
Green
Yellow
12/11/2014
4
3
24
Green
Green
4
24 Red
Position on Scale:
Green
DNs
Last Update:
YELLOW
YELLOW
NHS EASTERN CHESHIRE CCG - URGENT CARE MONITORING DASHBOARD
Amber
Amber
Social Care Click for Weekly Data
A decision to admit to organic bed when
need and risk assessment identifies
this plan
Liaison Wards (Target 48hrs)
Green
Green
NWAS - LIVE PORTAL UPDATES
11/11/2014
Click for A&E Data
8
A&E 4hours & DTOCS - Leighton Hospital Site
GreenGreen
11/11/2014Green
WeatherClick for Weather Data
Minimum Temperature
2014-15 Projected2013-14 - Actual
A&E 4hours - MDGH Site
95.80%
89.80%
12
17
11/11/2014
Click for DTOC Data
MDGH - EMERGENCY ADMISSIONS BY CONDITION - 2013-14 / 2014-15MDGH Medical Outliers
02468
1012
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number Respiratory System
02468
1012
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number Primary Cardiac Conditions
02468
10121416
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
NumberPaediatrics
10
20
30
40
50
28/10
29/10
30/10
31/10
01/11
02/11
03/11
04/11
05/11
06/11
07/11
08/11
09/11
10/11
11/11
MDGH Number of Emergency Admission via A&E (trend last 14 days)
-3
0
3
6
9
12
15
12/11
13/11
14/11
15/11
16/11
17/11
18/11
19/11
20/11
21/11
22/11
23/11
24/11
25/11
26/11
Degrees C 2013/14 2014/15 Minimum Temperature
0123456
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
NumberFalls
15
20
25
30
28/10
29/10
30/10
31/10
01/11
02/11
03/11
04/11
05/11
06/11
07/11
08/11
09/11
10/11
11/11
MDGH Number of DTOCs by Day (trend last 14 days)
Measuring wider system resilience…
Measuring true impact of the 4 point plan
Next steps….
• Refresh external review data and analysis from snow white
• new plan for 16/17 building on success from 15/16 • Develop wider system measures e.g impact of
reducing Length of stay on primary and community services
• Deliver 95% performance on A%E waiting time and maintain