new operational resilience and capacity plan epsom and st helier … · 2014. 10. 16. · a 111...

Operational Resilience and

Capacity Plan

Epsom and St Helier Hospitals

local health and social care

economy

Key stakeholders:

Sutton CCG London Borough of Merton

Merton CCG Sutton and Merton Community Services

Surrey Downs CCG London Ambulance Service

Epsom and St Helier Hospitals Trust HealthWatch Sutton

London Borough of Sutton Age UK Sutton

South East CSU

South West London and St Georges Mental Health Trust

October 2014

Version 1.1

2

Plan Number OP – 1

Plan Author Megan Milmine – QIPP Programme Director

Ratified By Sutton Urgent Care Working Group

Date Ratified July 2014

Next Review Date August 2015

Distributed To All UCWG member organisations

Data Protection Act 1998 Data Protection issues have been considered with regard to this policy. Adherence to this policy will therefore ensure compliance with the Data Protection Act 1998 and internal Data Protection Policies. Diversity Policies Equality issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with Equal Opportunity legislation and internal Equal Opportunity policies. Freedom of Information Act 2000 Freedom of Information issues have been considered with regard to this policy. Adherence with this policy will therefore ensure compliance with the Freedom of Information Act 2000 and internal Freedom of Information Policies. Health and Safety Act 1974 Health and Safety issues have been considered with regard to this policy. Adherence with this policy

will therefore ensure compliance with Health and Safety legislation and internal Health and Safety

policies.

Human Rights Act 1998 The Human Rights Act 1998 has been considered with regard to this policy. Proportionality has been

identified as the key to Human Rights compliance. This means striking a fair balance between the

rights of the individual and those of the rest of the community. There must be a reasonable

relationship between the aim to be achieved and the means used.

Revision & Amendments Revision History

Revision

of

Version

Version

Changed

to

Description of

Change(s) Reason for Change Authors Date

0.1 0.2 Information

provided by

UCWG members

Development of

Operational resilience plan

MM 15/07/2014

0.2 1.0 Plan approved by UCWG MM 19/08/2014

1.0 1.1 Demand

modelling graphs

ESH Demand and

Capacity modelling

inserted

MM/DF 15/10/2104

For any updates or changes please contact Megan Milmine [email protected]

0208 251 0145

mailto:[email protected]

3

CONTENTS

1. Introduction 4

2. Good Practice Principles - Non-elective Care 4

- Elective Care 13

3. Wider context and considerations 16

4. Existing work and links to other planning 21

4.1 Engagement with independent and voluntary sectors 21

4.2 Social Action Fund 24

4.3 The Care Act 2014 24

4.4 Better Care Fund 25

5. Governance 25

5.1 Overview 25

5.2 Reporting arrangements 26

5.3 Chair 27

5.4 Independent Review of 2013/14 27

5.5 Identifying Local Needs 28

6. Capacity and Resilience escalation framework 30

4

1 Introduction

This local Operational Resilience and Capacity Plan has been developed by all the key partners across

our health and social care economy. This includes:

Sutton CCG

Merton CCG

Epsom and St Helier Hospitals Trust

London Borough of Sutton

London Borough of Merton

Sutton and Merton Community Services (RMH)

London Ambulance Service

South West London and St Georges Mental Health Trust

South East CSU

HealthWatch Sutton

Age UK Sutton

Local Pharmaceutical Committee

Each of these partner organisations plays an active role on either or both of our Urgent Care and

Planned Care Working Groups, which together jointly form our System Resilience Group. The

partners have all signed off this plan as fit for purpose for our local area.

The plan covers each of the areas of ‘good practice’ as well as detailing our local arrangements for

both non-elective and elective care and our escalation framework for shared support across the local

area.

2 Good Practice principles Non-elective care pathways

Good practice Local commentary Lead organisation

Timescales

Planning Better and more accurate capacity modelling and scenario planning across the system

The Trust undertook a bed modelling exercise ahead of winter 2013/14 to determine the number of non-elective beds required throughout the winter period. This assisted in identifying additional escalation capacity required to successfully manage non-elective demand throughout winter 2013/14 The Trust will undertake a further demand and capacity exercise based on activity levels experienced throughout winter 2013/14 and will use this to model non elective capacity requirements for this winter. Alongside this the Trust has also reviewed

ESH

Aug 2014

5

Work with NHS111 to identify services best able to meet patients’ urgent care needs

its current substantive bed base and made recommendations for re-aligning the medical and surgical ward allocations. This will be implemented in August 2014. The purpose of this exercise is to ensure an appropriate bed base for medical and surgical specialties resulting in increased efficiencies and a reduction in the number of outliers. Sutton CCG has recently commissioned a Resource Utilisation Benchmarking (RUB) process which will support GP practices within Sutton to understand the differences between their own practice and that of their peers. The process will include identification of key areas for improvement and development of action plans – particularly in relation to reductions in emergency admissions and referrals to Out patients. Background A 111 caller is assessed using NHS Pathways software. The assessment provides a patient disposition, location, time, symptom group and service discriminator to search the directory of services (DoS). The DoS will return a list of appropriate services the call handler can signpost the patient to. In some cases the call handler will be able to book an appointment directly for the patient. The DoS is the responsibility of Sutton CCG and the return is dependent on the profile for each service, which is agreed by the CCG and provider of the service. A review to ensure the 111 service is optimised to direct urgent calls to appropriate services needs to include the CCG and providers of urgent care services. Sutton CCG has outsourced administration of the DoS to the South London CSU (SLCSU). Assurance of DoS

- All services profiled on the DoS have been reviewed in the last year.

- There is a process in place for 111 providers to feedback any issues or

Sutton CCG Sutton CCG

Sept-Oct 2014 Completed Ongoing

6

incorrect information on the DoS. These are reviewed by the SLCSU DoS lead and actioned as appropriate.

- Each new DoS profile is reviewed and signed off by the service commissioner , the service provider , and the 111 SCCG clinical lead.

Work undertaken for resilience work to optimise DoS

- SLCSU DoS lead, Sutton CCG, Epsom & St Helier and SELDOC (OOH) will review current 111 signposting to check new service provision is on the DoS and current patient pathways are in line with local commissioning decisions. This will identify any primary care dispositions that are currently being signposted to ED due to local gaps in provision.

- The ED and other local urgent care DoS profiles are reviewed and the group identifies any patient dispositions that could be excluded from the ED profile to stream patients to other services a UCC for example.

- The SLCSU DoS lead will run a gap analysis over the summer to be completed by 30th September. This will review all symptom groups and discriminator combinations that search the DoS and look for gaps where there is no service profiled to receive them . This will result in an ED “catch all return” of the DoS. The report once complete will be presented to the 111 CQRG and UCC COG for sign off.

Sept 2014

Primary Care Additional capacity for primary care

Ambulatory Care The Trust has been successful in establishing effective ambulatory care pathways on both sites. Appropriate patients are managed via ambulatory pathways and can be signposted to the service by A&E and the medical on call team. The service is operational 12 hours per day Monday to Friday. During winter it is anticipated that the service will be available at the weekend.

ESH

Ongoing

7

Proactive care and avoiding unplanned admissions All practices with Sutton CCG have signed up to the Unplanned Admissions Enhanced Service and will be aiming to achieve at least a 2% reduction in unplanned admissions in 2014/15. In addition, our locally agreed GP engagement scheme sees practices working on active identification and case management of their high risk patients with both practice based and locality based multi-disciplinary meetings occurring to support high quality care of identified patient cohorts. Flu Planning Acute and Community providers have submitted their flu plans. In addition, the CCG has developed its own flu plan to cover periods of enhanced winter flu outbreaks of flu pandemics – the plan has been shared as an example of ‘best practice’ across London CCGs, The Trust will work towards achieving 75% of frontline staff vaccinated against flu during 2014/15. Plans in place include recruitment to support with administering flu vaccine. There are currently 12 peer vaccinators in the Trust, however, training dates have been established for additional staff to undertake this function during 14/15. The communication team are developing plans to promote the flu vaccination campaign using internal communication methods, use of social media, and Trust PC screensavers. Key Trust staff will also have a flu vaccination message at the end of every email. Weekend and evening clinics will be established and staff will visit ward and department areas to administer the vaccine to staff.

SCCG ALL

Ongoing Ongoing

Seven day working

Improve services to provide more responsive and patient centred delivery 7/7

The Trust will provide more responsive and patient centred services seven days a week through: Discharge registrars working on both hospital sites on Saturday and Sunday Enhanced clinical site manager support on both sites over the weekend period.

ESH

Ongoing

8

SRGs link to BCF principles in wider planning agenda Seven day working arrangements

Provision of additional paediatric doctors working over the weekend period A&E Consultants working in the A&E department on both sites on Saturday and Sunday and into the evening period Ambulatory care pathways in place on both sites over the weekend There is shared membership across the SRG and the Planned and Unplanned Care BCF work streams to ensure a shared set of principles and a joined up approach. It is recognised across all partners that there is a strong alignment across the work of the SRG and the BCF. This is one of the National Conditions within the BCF. SCCG, LB Sutton and SMCS are working with other local partners to assess current 7 day capacity and where there are gaps in establishing an integrated system that will support hospital discharge and reduce unnecessary admissions at weekends. This issue is being considered by Unplanned Care and Planned Care multi agency and multi sectoral work streams that have been established to assure delivery of the Better Care Fund metrics and national conditions in Sutton.

SCCG SCCG/LBS/ SMCS

Completed Ongoing

Patient Experience

Expand, adapt, improve pathways for high intensity users within ED

The Trust has undertaken focussed whole system work in relation to care of the elderly and respiratory patient pathways. This has involved mapping of existing pathways and the development of an integrated pathway linking secondary, community, and social care. The pathway also involves close working with the voluntary sector. Specialty in-reach to A&E is in place for respiratory and care of the elderly specialties and there is a fully developed OPALS service on both hospital sites. The Trust has also acted as a pilot site across London for work on frequent users of A+E services by those with underlying mental health issues.

ESH

Ongoing

9

Consultant-led rapid assessment and treatment systems within ED and AMU Optimise patients’ medicines prior to discharge Minimise delayed discharges and ensure good practice on discharge

Consultant led rapid clinical assessment is in place within both emergency departments. During the winter the service will operate from 1000-2200 hours on both sites. The model is consultant led where possible and is supported by a dedicated nurse. Effective senior decision making at the front door has led to improved pathways of care for patients. Within the acute trust - Increased pharmacy provision as part of the Older Persons Pathway Team currently in development. Increased pharmacy cover at evening and weekends. Increase pharmacy cover to attend Ward Rounds on AMU/SAU. SCCG has funded a domicillary pharmacist to undertake Medicines Use Reviews (MURs) for patients identified as requiring this facility. Also undertaking specific MURs for groups of patients participating in targeted programmes, for example COPD health coaching. Proposal also awaiting approval for a pharmacist specifically targeted at Care Home residents to support reductions in medication errors and complications resulting in readmission. The Trust has implemented a weekly > than 7 day LOS meeting on both hospital sites. The meeting is chaired by a member of the Trust senior management team and discusses all patients who have been in hospital for > than 7 days with the identification of key actions required to ensure timely and appropriate discharge. The Trust also participates in a once weekly conference call involving the CCG, community services, and social services on both hospital sites. The purpose of the call is to identify key actions required to expedite timely and appropriate discharge. The Trust has implemented a Pre-1300 Hour Discharge Group chaired by the

ESH ESH SCCG ESH/LBS

Ongoing Ongoing Ongoing Ongoing

10

Reduction in permanent admissions of older people to residential and nursing home care

Chief Operating Officer. The group looks to identify key actions that will improve the Trust's ability to discharge patients prior to 1300 hours. Actions include provision of a laptop for junior doctors to use on the consultant ward round in order to speed up access to results and completion of discharge summaries, and provision of an additional porter to assist in the delivery of patient's take home medication. The Trust is currently leading a service improvement initiative 'One Ward One Team' which focuses on improving patient flow through the introduction of the patient flow bundle. LB Sutton is already in the bottom 10% nationally for admissions to long term care and this success is predicated on the ability to successfully deliver complex packages of care in the community. Within the BCF submission that is with NHS England there is a target of maintaining the 2013/14 outturn figure. This takes into account demographic changes and increases in the complexity of need within the community. Under the BCF plans are in place to further develop integrated approaches to care, so that those most at risk of admission to hospital and care homes will have an integrated health and social care plan with a named lead professional to co-ordinate their care. The Council has expanded its START reablement team from 1/7/13 with the investment of CCG reablement monies, this has led to a significant increase in reablement activity and the team has also been enhanced with the inclusion of OT and PT seconded from SMCS which reduces handoffs and therefore improves the patient experience. The Council and CCG monitor the performance of START through existing governance arrangements and further work is underway under the auspices of the Older people’s pathway to scrutinise

LBS LBS

Ongoing Ongoing

11

Utilise patient risk stratification tools to gain a better understanding of the needs of the 2-5 % of highest risk pts

outcomes for those patients who were not maintained at home after 91 days, and identify issues which need to be addressed. START is currently hosting colleagues from DH (health economists)under the ‘Connecting’ Programme and as part of this it is anticipated that a cost benefit analysis tool will be developed for the benefit of commissioners. The Older Persons Pathway Steering Group are currently developing a risk of readmission tool and pathway which will support identification of at risk patients and ensure appropriate services are put in place to support patients at home immediately post discharge from the Acute setting. Primary Care are currently implementing risk stratification tools to identify high risk of admission patients and ensuring appropriate discussion of needs at MDT meetings with Community Teams. All Sutton GP Practices are using the risk stratification tool, as well as Practice level knowledge, to identify at least 2% of their practice population who are at high risk of avoidable admissions. Practices as part of their Avoiding Unplanned Admissions Enhanced Service work will adopt a case management approach; developing personalised care plans with reviews by working with appropriate local community services in a Multi-Disciplinary Team (MDT) way. Aiming to better understand individual patient needs, ways to meet the identified need and prevent unplanned admissions.

ESH SCCG

Ongoing Ongoing

Measurement Use of real time system-wide data

Sutton CCG practices are the pilot site for an Urgent Care Dashboard system being developed by South London CSU. The platform is already utilised widely across

SCCG Nov 2014

12

Sussex and is being adapted for South West London. Sutton CCG has agreed to be the pilot testing site for an Urgent Care Dashboard being developed by South London CSU (versions of the dashboard already operate successfully across most of Sussex). The Dashboard will enable GP Practices to see almost ‘real time’ data on their patients that have attended, or been seen by, an urgent care service within the last 24 hours. Data will be provided by Epsom and St Helier Hospitals, St Georges Hospital, SELDOC out of hours GP service and Sutton & Merton Community Services. The dashboard enables GPs and other members of the practice to target care in response to urgent care activity, with the aim of supporting patients to manage their care in a planned way. SLCSU customers have indicated that delivery of an UC dashboard in GP practices to target care is a key business requirement, and underpins their urgent care strategy. The project should be initiated in early 14/15 aiming for completion Autumn ’14. All practices in Sutton will have the opportunity to trial the Dashboard and provide feedback to further develop the system and its reporting. The UC Dashboard is a clinical outcomes focused report. Its purpose is to provide GP practice clinical staff with a view of whom within their patient population have accessed urgent care so that they have greater transparency of how their patients are moving through the system and can target care for these patients as required to support an increase in planned care management and a reduction in unplanned activity.

13

Elective Care Pathways

Good practice Local commentary Lead organisation

Timescales

Planning Review and update Patient Access policy RTT training programme Annual capacity and demand planning

Trust elective care lead to review and revise Access Policy and supporting standard operating procedures. A training programme for all staff, developed in conjunction with the Education Department will be in place by Q4 2014/15 Directorate Management Teams to undertake D&C analysis by end of October 2014 for all specialties. Sustainable capacity to be corrected on Trust systems where appropriate and business cases for additional capacity to be taken to Operational Management Group by December 2014. To be reviewed annually as part of business planning.

ESH ESH ESH

Aug 2014 Q4 2014/15 Dec 2014

Building on existing work

Existing capacity mapping

Capacity reviews undertaken in February 2014 for T&O, Dermatology and Gynaecology. These specialty reviews will be refreshed to ensure accuracy.

ESH Oct 2014

Pathway design

RTT timeline per speciality Communication of patient choice information

General Manager, Planned Care and Performance chairs a bi-weekly operational performance meeting which monitors RTT performance against agreed timeframes. Examples of this is 13 weeks first wait target for routine referrals, 6 weeks diagnostics. Targets for referral to DTA to be agreed for core surgical specialties and monitored at bi-weekly meeting. Choice of provider routinely forms part of the pre-referral discussion with patients: patients in Sutton predominantly choose to be treated at their local hospital, St Helier, for secondary care, or St George’s for tertiary services, however they are made aware of their right to choose their provider of planned care by their referring clinician. GPs discuss the likely timeline should surgery be required, to ensure that patients are willing and

ESH ESH SCCG

Oct 2014 Ongoing

14

‘Right size’ outpatient, diagnostic and admitted waiting lists

available to be treated within 18 weeks. Part of the demand and capacity work described above

ESH

Oct 2014

Measurement Review local application of RTT rules against national guidance Data quality Performance management

Daily RTT PTL produced and used by operational staff. Performance monitored in twice-weekly operational meetings, weekly general manager meeting and monthly Directorate performance meeting. The Trust follows a performance management framework which is reviewed annually. Example of Performance dashboard shown at Appendix 1. 2 WTEs allocated to RTT data quality completely separate from operational teams (sits within Information team). This provides a programme of clear validation checking. Audit of work will be undertaken in Q4 2014/15 Planned Care activity and waiting times are routinely monitored via Unify2 submissions from trusts. In addition, Epsom and St Helier NHS Trust supply referral information to the South East CSU where it can be used for early identification of changes to expected referral patterns. Epsom and St Helier Trust are supplying further specialty breakdown waiting list information which provides more information than the Unify2 submissions about current wait times for all specialties, by commissioner. Performance against trajectories and waiting time targets including cancer, diagnostics and RTT are reported within the monthly Sutton CCG Integrated Report from the CSU Acute Commissioning Team, and the Performance and Quality Report that is discussed by the CCG Executive and Quality Committees before final review by the CCG Governing Body.

ESH ESH SCCG

Ongoing Q4 2014/15 for next audit Ongoing

15

Supporting KPIs

The Planned Care Working Group for Epsom and St Helier, chaired by Sutton CCG, will monitor the trust’s progress against plan to clear the 16+ week backlog. South East CSU monitor performance against contract KPIs, routinely challenging activity and performance outside agreed parameters. Cancer waiting times are monitored closely, with every breach investigated and reported through the Clinical Quality Review Groups.

SECSU/SCCG

Ongoing

Governance Assurance at board level

Monthly performance report with actions to improve poor performance send to Board. Paper on implementation of actions above to be taken to September Trust Executive Committee and subsequent board. The Planned Care Working Group component of the SRG is chaired by the Chief Clinical Officer of Sutton CCG and includes representatives from Epsom and St Helier NHS Trust, Merton CCG and Surrey Downs CCG (Terms of Reference attached). The Working Group reports into Sutton CCG’s Executive Committee, which reports to the CCG Governing Body.

ESH SCCG

Quarter 2 2014/15 Ongoing

16

3 Wider context and considerations

Consideration Local commentary Timescales

Planning Discharge Planning Avoiding inappropriate delays in A+E

London Borough of Sutton currently ensures at least 2 social workers are on duty at ESTH 5/7 to support the hospital in discharging patients or preventing admission, in addition the START reablement team are on call from 7am to 11pm 7/7 and can respond as required to prevention of admission cases at A&E and AMU. Further staff will be deployed on the ESTH site as needed to support POA and discharges in times of high demand. START are able to commission emergency care over 24hours at home in order to support prevention of admission if required and this will continue. In order to meet winter demand the Council will undertake a recruitment exercise for START reablement workers commencing in August 2104 to ensure capacity to receive discharges is maximised. The Council has recently invested in delivering locality based commissioning with local approved care agencies with the aim of reducing delays in handing over packages with long term needs to the private sector at the end of START reablement and provides early notification of long term packages to the private sector to enable providers to plan and establish a sufficient workforce to meet need. In addition the council sponsored a recruitment event for private sector providers recruiting to social care services boroughwide. The Council has streamlined its internal micro commissioning process so that a ‘short goal orientated plan’ is all that is required to commence the START provision on discharge from hospital and formal assessment and support planning/authorisation of personal budget is only required at the end of the reablement episode when long term needs have been identified. This was implemented in July 2014. Consultant led rapid clinical assessment is in place within both emergency departments. During the winter the service will operate from 1000-2200 hours on both sites. The model is consultant led where possible and is supported by a dedicated nurse. Effective senior decision making at the front door has led to improved pathways of care for patients. The UCC on the St Helier site operates a model of redirection to primary care where appropriate. This model operates 7 days per week, with redirections to the

Ongoing Ongoing

17

Unscheduled care Flu planning Maintaining and improving financial performance

OOH GP service occurring evenings and weekends. The Trust has maintained a redirection rate of around 16% for the last 6 months. Reducing unscheduled care episodes is a key priority for the partners across Sutton. Our BCF plans and the Joint Health and Wellbeing Strategy in place across the CCG and Local Authority support this priority. A number of our local investments for 2014/15 focus on this area, for example the new Community Prevention of Admission team provided by our community team and supported by the START Local Authority team. The UCWG invited ECIST (Emergency Care Intensive Support Team) to support us in a whole system review across Sutton and from this a series of recommendations was provided to the UCWG which in turn was used to develop a work plan to address key areas of need in 2014/15. Our key providers (acute and community) have plans in place for vaccination of staff for the coming winter and will be seeking to achieve a vaccination rate around 75%. Public Health teams in our local authorities take the lead in preparing for vaccination of other groups, such as the voluntary and independent sector and are developing plans in order to meet this requirement. Updated flu plans will be completed by Sept 2014 by London Borough of Sutton Public Health. SCCG has also developed its own internal flu plan to ensure our role as coordinator of support and capacity discussions across the Borough can be maintained in times of significant disruption from flu. We are the first CCG in London to undertake this exercise and our plan has been shared across London as an example of best practice. The significant contributions made to achieving our ambitions for reductions in unplanned activity by the CCG, LA and Acute Trust demonstrate our commitment to maintaining or improving financial performance in 2014/15 and beyond. We have jointly made significant investment in our Integrated Older People’s Pathway and we have commenced our joint working under the banner of the Better Care Fund, with CCG and LA contributing significantly more to the fund than national minimum requirements. Sutton CCG and UCWG also contribute to the South West London Collaborative Commissioning process and are involved in all the Clinical Design Groups in operation.

Ongoing Sept 2014 Ongoing

18

Managing referrals effectively

This process will ensure that our plans over the next 5 years are developed in an affordable way that maintains the stability of the health and social care system across South West London and ensures our population receive the highest quality of care in a safe and efficient environment. Sutton CCG is in the process of contracting with consultants in both St George’s and St Helier’s Hospitals to provide easy access to ‘specialist advice’ for all referring clinicians in general practice using a cloud based software tool. Advice requests are on an individual patient basis with an expected turnaround time of 24 hours. Experience in Wandsworth CCG has shown that up to 50% of all advice requests result in no onwards referral to secondary care being made.

Aug/Sept 2014

Patient experience

Right care, right time, right place Children’s services

The St Helier hospital site has had a co-located Urgent Care Centre since 2011. The UCC has been implemented using a phased approach, with the final phase (paediatrics) going live in July 2014. The OOH GP service has also been co-located with the ED and UCC since November 2013 allowing for smooth redirection of patients to primary care where this is appropriate. Sutton has worked with LAS over the last 3 years to develop a number of Appropriate Care Pathways (ACPs) to ensure residents calling 999 are either conveyed to the correct location or treated at home, where possible. We have recently implemented an ACP for direct referral from LAS teams to the Community Prevention of Admission Team; also in operation are ACPs for residents who have fallen or for direct referral to community nurses or GPs. The Paediatric UCC on the St Helier Hospital site went live on 7th July 2014 – this will now ensure that children requiring urgent attention are seen in a timely manner by a team, including GPs, who are best placed to meet their needs. Future commissioning discussion is undertaken at SWL Children's work stream Clinical Design Group. SCCG currently commission a children’s home care team at ESH to support children with LTCs at home. Also SCCG commission continuing health care packages to support children at home eg children on ventilators.

Ongoing Ongoing

19

Mental health services

Both the Epsom and St Helier hospital sites have dedicated psychiatric liaison teams. The Liaison Psychiatrist on the St Helier has led pilot work looking at frequent attenders to A+E and working with this group of patients to better support their underlying mental health needs. As part of the system resilience funding, we propose to support South West London and St George’s Mental Health Trust to extend their liaison psychiatry and home care team resource across Epsom and St Helier Hospitals.

Ongoing, plus additional support through SRG funding

Chronic conditions and home care

Care for patients with chronic conditions

Sutton CCG take the lead on care for patients with chronic conditions. Use of risk stratification is now standard across all of our 27 GP practices and we have worked closely with our colleagues in community services to realign nursing and therapy teams to the 3 localities operated across Sutton. In addition, each locality has a multidisciplinary team, led a member of the community services and these groups meet on a monthly basis to discuss high risk patients and develop case management plans jointly. The CCG has also commissioned a private company, Totally Health, this year to provide health coaching for patients with COPD – the programme will support 100 of our most frequent attenders at A+E to better manage their condition through self care and more proactive case management with their general practice team. If successful, this pilot is likely to be widened to include other chronic conditions as well. GP Practices as part the Unplanned Admissions Enhanced Service work will make contact with patients within 3 days of discharge notification being received. MDT working to prevent future unplanned admissions and sharing intelligence with SCCG aims to improve care for patients with chronic conditions. Finally, through the BCF, the CCG and LA have agreed to fund 4 Integration Facilitators (all of whom have a background in either health or social care) whose role it is to support the integration agenda across health and social care and promote the use of community prevention of admission where possible. The facilitators also liaise with the acute trust teams to ensure existing pathways, such as our Older People’s Pathway, have strong links back out into the community for seamless transition of care.

Ongoing

20

Planning for care home residents

The CCG operates 2 innovative work streams aimed at getting to know our care homes, understanding the quality of care provided in our care homes and by working with our partner organisations to share information and improve the quality of life for our residents in care homes.

Quality Assurance in Care Homes – Joint Intelligence Group A joint intelligence group was set up in March 2014. The purpose of the group is to provide quality assurance in our care homes in Sutton by the following:-

To share information to increase the safety, health and wellbeing of adults in Nursing and Residential homes in Sutton;

To determine whether the individual provider, has performance or quality issues that pose a risk to any particular individual or to the general client group;

To construct jointly and implement a performance management plan that provides professional support to all those at risk and that reduces the risk of harm and improves performance of provider and raises quality;

To improve provider accountability;

To Improve support for staff involved in care delivery

Care Home Training Forums Two Care home forums have been implemented since April, the initial forum was to find out what support care homes need. We now run a series of care home forums and include topics the care homes request, the training is facilitated by our community providers as part of the CQUIN 2014/2015. The aim is to engage with providers of care homes to develop ideas for service change, to support them to meet the needs of their residents and to motivate the staff to support them with training to enable them to deliver the 6 C’s of care. This will improve the quality of life of the residents and reduce avoidable emergency admissions. In addition, the CQUIN with our community provider SMCS this year is focused on reducing LAS conveyances from care homes to the acute trust through a reduction in 999 calls. We expect to see a 10% reduction in call volumes to LAS as a result of the additional training and support given to care home staff by the community nursing teams. Our work with care homes is unique across London and the team have recently been invited to share our approach with NHSE (London) where 2 presentations have taken place.

Ongoing

21

4 Existing work and links to other planning

4.1 Engagement with the independent and voluntary sectors

Capacity Planning

1) Elective care

Organisation worked with

Key contact Capacity Service description Pricing model

Clockhouse, Epsom

Removed for public version

30 spinal patients

Orthopaedics PbR tariff

St Anthony’s, Cheam


120 patients in August

Dermatology PbR tariff

2) Step Up/Step Down care/Home care

Organisation worked with

Key contact Capacity Service description Pricing model

Age UK, Sutton


Home from Hospital – minimum 168 patients/ yr

Community based support for a minimum of 168 patients per annum, aged 65+, who are registered with a GP in Sutton CCG, particularly those with no family/friend support networks, by offering low intensity practical and emotional help for a four week period to prevent an acute hospital admission, reduce re-admission or upon discharge from hospital. The service will cater for individuals with lower level needs resulting from diagnosed health needs. Activities will include shopping or assistance with shopping, cleaning, preparation of light meals and will act as a trigger for onward referral to other services.

£95,880 per year of which 75% direct staff costs and 3% volunteer costs

Age UK, Sutton


Community Helpers – minimum 120 per annum

The Community Helpers service will assist a minimum of 120 patients per annum, aged 65+ who are registered with a Sutton CCG GP with a nine to twelve month programme of confidence building, motivation and the ability to mix with others, connect to social groups and take part in activities they enjoy.

£70,770 per year of which 62% direct staff costs and 7.5% volunteer costs

Age UK, Sutton


Caring Neighbour

The Caring Neighbour will provide a range of targeted invention measures to a minimum of 100

£63,550 per year of

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– minimum 100 patients per annum

patients per annum aged 65+ who are residents of the London Borough of Sutton by raising awareness of how to keep warm and well in winter and cool and hydrated in summer. The service will offer twice weekly reassurance calls for a period of three months, information & advice, access to crisis support [breakdown of heating, support with crisis loans, warm and well season pamphlets, referral to Food Bank and/or donated non-perishable foods]. Two targeted campaigns will take place to address ‘keeping warm and well in winter’ and ‘cool and hydrated in summer’.

The service will:

Where practical offer people support to complete tasks for themselves rather than having them done for them e.g. taking someone shopping rather than doing the shopping for them.

Supply low level practical support with cleaning, shopping, and light meals.

Refer individuals to chargeable and non-chargeable services which promote independence or other appropriate services.

Provide a regular visit from a Home from Hospital volunteer at a time and day (approximately 2 per week supported by wellbeing calls) agreed with the patient.

Ensure individuals have access to information and advice and can be signposted to social support networks in the community.

Assist patients to feel part of the community again by connecting them to a befriender (approximately once a week as agreed with the patient) to help increase confidence, motivation and ability to mix with others and take part in activities/ interests they enjoy.

Twice weekly reassurance phone calls.

In extreme weather conditions [summer or winter], a fast track emergency shopping for vulnerable adults.

which 51% direct staff costs and 4% volunteer costs. 16% based on twice yearly awareness campaign costs.

23

Referral to London Borough of Sutton services to include the Crisis Loan and Grant scheme and Sutton Food Bank.

Deliver two local campaigns to raise awareness of keeping warm in winter and cool and hydrated in summer.

Advice on how to stay warm and well in winter and cool in the summer.

Emergency support from Age UK Sutton and other services offered by voluntary providers.

The staff are responsible for undertaking individual risk assessments to ensure the safety of their staff in the community.

The Services provided by Age UK are an integral part of the reducing admissions to A&E work

streams which incorporate acute and secondary NHS care, primary care and community services,

local social services and voluntary agencies as part of the older persons pathway. Interdependencies

and other services associated with the Age UK work include:

Rapid Response Team

A&E staff

Ward Managers

Discharge Teams

Social Services

Users and Carers

Community Services

Primary Care

Voluntary Agencies

IAPT

Community Pharmacists

Safer Neighbourhood teams

Sutton Food Bank

London Borough of Sutton Crisis Loans & Grants

Age UK Sutton Emergency Fund

4.1.1 Governance arrangements

The voluntary sector and wider representation of patients and the public in governance processes are

achieved through a number of groups and committees. Patients and the public are represented

through the CCG’s Patient Representation Group (chaired by HealthWatch Sutton) which has a

representative from every GP practice in Sutton. HealthWatch Sutton are also represented on our

local Urgent Care Working Group and the CCG’s Clinical Effectiveness Group, Quality Committee and

as an observing member on the CCG Governing Body.

Voluntary Sector representation is provided by Age UK Sutton and Sutton Carer’s Centre who sit on a

variety of groups including the Urgent Care Working Group and the Better Care Fund Transformation

Board and workstream groups.

24

4.2 Social Action Fund

The Social Action Fund presented an exciting opportunity to further explore our pilot work with the

voluntary sector to support safe and effective discharge of patients from an acute care setting. A

joint bid by Sutton CCG, Age UK Sutton, Epsom & St Helier University Hospitals Trust and the London

Borough of Sutton was submitted to the fund but we were unsuccessful in securing funding. The bid

aimed to expand on our work with a Pathfinder role within the Acute Trust – a paid role developed

to support patients over the age of 65 years to create links with voluntary, community and social

services support they may require on discharge to allow them to remain independently at home.

Due to the unsuccessful bid we proposed to utilise a portion of the system resilience funding to

continue trialling this model over the winter of 2014/15.

4.3 The Care Act 2014

Sutton Council has a Care Act Implementation Programme lead by a Programme Team to implement

the requirements of the Care Act.

It has a governance structure (shown below) comprising of a Care Act Programme Board which

reports to the Smarter Council Prevention Programme Board and Adults Social Services and Health

Committee and updates the Health and Wellbeing Board. The governance structure makes reference

to the BCF.

In addition, monthly Care Act Programme Highlight Reports are on the agenda of the monthly One

Sutton Commissioning Collaborative meetings and quarterly Sutton Safeguarding Adults Board.

25

We have just completed 26 workshops which analysed the draft Regulations and Statutory Guidance

and are aware of the points raised reference the Care Act stated in your email below and are

currently planning to or are in the process of implementing actions regarding the issues raised.

We have a Workstream which is presently considering the effect of the new draft national Eligibility

regulations and have taken part in 2 PSSRU studies which is considering the implications of the draft

guidance on Council across the Country. There may be further changes to the National Eligibility

Criteria following the DoH Consultation as ADASS and Councils have been lobbying the DoH

regarding the draft new National Eligibility Regulations and guidance.

The finalised Regulations and Statutory Guidance are not due out until October when we may need

to revise our implementation plans. At this time, a full presentation will be given to the Urgent Care

Working Group to ensure all the members are aware of the implications.

4.4 Better Care Fund

There is shared membership across the SRG and the Planned and Unplanned Care BCF work streams

to ensure a shared set of principles and a joined up approach. It is recognised across all partners that

there is a strong alignment across the work of the SRG and the BCF.

5 Governance 5.1 Overview

The Urgent Care Working Group facing Epsom and St Helier Hospitals has always enjoyed strong

membership commitment from a wide range of partner organisations. In addition, we are able to

share good practice and ensure smooth working across boundaries as the group includes members

from three CCG areas – two from the London region and one from Surrey. As a result of our

previous successes and well established relationships, the Urgent Care Working Group will continue

to function in its current format, along with the addition of several new members to the group

including Local Pharmaceutical Committee and Voluntary Sector representation.

Alongside the UCWG, a Planned Care Working Group (PCWG) has been established. The PCWG

utilised a number of members of the UCWG and meetings will be planned where possible to coincide

with each other to ensure effective use of member time. The PCWG is chaired by the Chief Clinical

Officer of Sutton CCG and includes members from Merton and Surrey Downs CCGs as well as the

Acute Trust.

Together, these two groups will make up our local System Resilience function, and will report to the

CCG Executive Committee and Governing Body on a regular basis to ensure strict governance and

assurance are applied to the local monitoring of elective and non-elective care.

26

5.2 Reporting arrangements

5.2.1 Central Resilience Funding

Sutton UCWG must agree resilience funding use from three different areas – Sutton, Merton and

Surrey Downs CCGs. Agreement has been reached across all three CCGs to make final decisions at

the Sutton-led UCWG for any funding requests from Epsom and St Helier Trust.

As in previous years, the UCWG has operated a clear and robust process for the development, sign

off and monitoring of system resilience funding bids. Providers are requested to follow a number of

principles when submitting bids including:

Clear demonstration of the outcomes the scheme is expected to achieve

Bids are not expected to cover services that are already in place, unless the bid is for significant expansion of the service in terms of capacity or opening hours

How the bid supports the acute trust to deliver the 95% A+E target

In addition, the UCWG support the stance provided by the national guidance that schemes should

focus on extending the provision of community, mental health, social services and voluntary sector

support to support enhanced resilience.

The timeline for agreeing resilience bids for the area is as follows:

2nd July – bid templates circulated to all providers across the boroughs

21st July – meeting of the UCWG to discuss bids and request further information as required from

providers

22nd July – all providers informed of the process for re-submitting bids by 29th July, along with

requests for additional information required

29th July – all bids resubmitted by providers

30th July – suggested bids submitted to Tripartite panel as part of operational resilience assurance

19th August – meeting of UCWG to agree allocations across the 3 boroughs, subject to confirmation

of LAS contribution required

5.2.2 Marginal Tariff savings

The table below shows the re-investment of marginal tariff savings from Sutton CCG:

Service

Funding invested

(£000)

Rapid Response Team £284

Growth funding for community services £175

Kinesis Referral management £40

Risk stratification tool for General Practice £32

Total £531

27

5.2.3 Other local funding and investments

The CCG, Local Authority and Acute Trust have jointly funded a significant investment in extra

resource to support our integrated Older People’s Pathway work. In addition, the CCG has funded a

number of other schemes that support prevention of admission and re-admission, delivery of

financial performance and delivery of both QIPP and BCF targets.

5.3 Chair

The UCWG is chaired by Dr Jonathan Cockbain, Clinical lead for Urgent Care for Sutton CCG. The

PCWG is chaired by Dr Chris Elliott, Chief Clinical Officer for Sutton CCG. Each chair is responsible for

holding group members to account for their contribution to system resilience and achievement of

the agreed KPIs across the groups.

5.4 Independent analytical review of 2013/14

The UCWG has reviewed information provided from across the borough, including LAS, Acute Trust,

Social Services and Community Services data in order to understand our current demand for services

and whether acuity and complexity have actually increased. It is clear from data from a variety of

sources that we whilst are dealing with an increase in complexity, the volume of demand has not

tended to increase over the last 1-2 years. Our reasons for this conclusion are as follows:

Opening of the St Helier UCC may have created extra capacity and therefore demand for

urgent services may have increased – this has not occurred

Emergency admissions rate at Epsom and St Helier hospitals remain steady, however the

number of patients requiring resuscitation facilities in A+E has significantly increased (see fig

1 and 2 below)

LAS 999 calls have increased significantly and current performance is well below target

Introduction of teams such as Community Prevention of Admission and Rapid Response are

allowing more patients to be managed at home or discharged directly from A+E (findings

based on clinical audit) thereby redistributing demand away from Acute Trusts

Resources such as equipment (beds, hoists etc) have noticed an exponential increase in

demand as more patients are managed away from an acute trust setting

Fig 1

28

Fig 2

In addition to analysing data from local sources as described above, the UCWG invited the

Emergency Care Intensive Support Team (ECIST) to undertake a whole systems review on our behalf

in order for us to better understand key areas to focus our attention on. This review has driven the

formation of the UCWG workplan based on the recommendations of the ECIST team.

5.5 Identifying Local Needs

Significant work has been undertaken on a number of pathways identified as key for our local

population – these include Older People and people with Respiratory conditions. Supported by

ECIST, Epsom and St Helier Trust have implemented the changes shown in the example below and

have shared their plans with the UCWG to ensure integrated solutions are developed where

possible.

Older People’s Pathway

ECIST Recommendation Trust Update

Continue to expand the older persons assessment and liaison Service (OPALS) admission avoidance team which is beginning to deliver excellent outcomes.

Business Case approved based on successful pilots during 2012/13 and ICOPP Pathway

Whole System Older Persons Pathway continues to evolve.

Devise a strategic plan for the management of the frail elderly person, to include robust plans to expand the area of Comprehensive Geriatric Assessment (CGA).

Already developed as part of the Elderly Care Transformation Programme and continues to evolve through the Older Person’s Whole System Pathway.

• *A similar model for specialist respiratory assessment has also been established

29

Implement a model that facilitates early and timely CGA direct from ED or AMU.

This model was in place as part of the existing OPALs Model at both sites, and was further enhanced during the winter pilot initiatives.

AMU/ ED CGA fully implemented at EGH

AMU CGA fully implemented at StH site, however ED in-reach still relies on the appointment of Interface Geriatrician to fully implement in this area.

Undertake an in-depth piece of work to explore the possibility of geriatricians having a pivotal role to play in providing an early CGA, integrated with the existing OPALS admission avoidance team or other means of implementing whole scale early CGA across the Trust.

• Appointment of the Interface Geriatrician will allow for whole scale implementation.

Strengthening the OPALS team and consideration given to how it can robustly offer a service 7 days a week with extended hours. It may be worth altering the therapy focus from downstream wards to the front door.

The business case approval has allowed for strengthening of the OPALs Team to support 7 day working and further joint working with other teams across the system.

• Changes to therapy provision has been supported by CCG funding and is being implemented and monitored through the Older Persons Pathway Programme.

30

6 Capacity and Resilience Escalation framework

WHOLE SYSTEM ESCALATION – EXPLANATION OF LEVELS AND TRIGGER POINTS

Level CMS

Green 120-180 • A&E target of 95% being maintained • No 4 hour breaches since midnight • Time to rapid clinical assessment no longer than 15mins. • Available capacity exceeds predicted demand • Cubicles available in A&E • No delays in ambulances off-loading patients • Capacity available on AMU

• Resuscitation bays available

Amber 181-220 • No breaches since midnight but non clinical breaches likely to occur • Time to rapid clinical assessment exceeds 15 minutes for 1 or more patients • More than 4 patients awaiting initial A&E assessment • Only 2 cubicle spaces available in Majors • Delays transferring to AMU due to limited immediate capacity being available

• Difficulties identifying available inpatient capacity for patient transfers from critical care

Red 221-250 • One or more non clinical breaches since midnight. Further non clinical breaches likely to

occur • Time to rapid clinical assessment in excess of 1 hour for 1 or more patients • More than 6 patients awaiting initial assessment in A&E • Single longest wait for non-clinical reason in A&E exceeds 6 hours for 1 or more patients • No cubicle spaces available in majors but resuscitation capacity available • 1 or more ambulances waiting to off load in majors • No capacity available on AMU • Available capacity (including potential discharges) is less than predicted demand • Inability to transfer patients from critical care to an inpatient bed within 6 hours

• 2 or more tertiary referrals requiring repatriation delayed in excess of 24 hours

Black 251+ • Multiple non clinical breaches since midnight (greater than 4) • 1 or more patients waiting 4 hours following DTA with no plan • Potential for 12 hour trolley wait breaches • Single longest wait for non-clinical reason in A&E exceeds 6 hours for 3 or more patients • Time to rapid clinical assessment in excess of 1 hour for 4 or more patients • More than 8 patients awaiting initial A&E assessment • 3 or more ambulances waiting to off load • No available trolley space in majors or resuscitation • Majors patients being treated in minors • No available in patient capacity • Minimal (less than 10) definite discharges • 2 or more patients waiting in excess of 6 hours for transfer from critical care

• 4 or more tertiary referrals requiring repatriation delayed in excess of 24 hours

6.1 System wide escalation framework – Response Level Green

31

Response Level: Green Organisation Type: Acute Trust Name: Epsom and St Helier University Hospitals NHS

Trust

Contact Details

Name Role Phone Mobile Email

Actions Executive

In Hours Out of Hours

Monitor regular SITREP updates

Provide a point of escalation for senior management


Chair 2200 hour conference (Monday to Friday) and 1500 hour conference call (Saturday and Sunday)

Provide a point of escalation for senior manager on call

Senior Management



Provide a point of escalation for operational management team


Participate on 2200 hour conference call (Monday to Friday) and 1500 hour conference call (Saturday and Sunday)


Operational


Daily attendance at site specific bed meetings to identify definite and potential discharges and actions required to maximise patient flow

Review elective care requirements, critical care transfers, and patients requiring repatriation from other hospitals

Provide regular SITREP updates and escalate any areas of concern in relation to patient flow

Review number of medically fit for discharge patients and delayed transfers of care

Update Ambulance Service Capacity Management System every 2 hours

Liaise with social services and community service providers in relation to those patients who require social care/community support to facilitate discharge

Provide regular SITREP updates and monitor any change in site status that may impact on patient flow

Escalate any areas of concern to the senior manager on call


External Actions

32

Social Services to provide a daily update in relation to the status of those patients awaiting discharge with social care input/support

Community Services to provide a daily update in relation to the status of those patients awaiting discharge with community services support

Twice weekly conference call between Acute Trust, Social Services, Community Services, CCG, and CSU

Weekly sector conference call

Mutual Aid Requirements None

33

Response Level: Green Organisation Type: Mental Health Name: South West London and St. George’s

Mental Health NHS Trust

Contact Details


Actions Executive

In Hours

Out of Hours

No actions at this level


Senior Management




Operational


Normal service provision

Service cover by Duty medical rota

External Actions

None required

Mutual Aid Requirements

None at this level

34

Response Level: Green Organisation Type: 111 Service Name: Care Uk

Contact Details


Actions Executive


Business as usual

Business as usual

Senior Management


Business as usual

Business as usual

Operational


Business as usual

Business as usual

External Actions

Nil


Nil

35

Response Level: Green Organisation Type: Clinical Commissioning Group Name: Sutton CCG

Contact Details


Actions Executive

In Hours Out of Hours via SWL director on call

Business as usual

Business as usual

Senior Management


Business as usual

Business as usual

Operational


• No action required. • Review CMS and SITREPS daily

Business as usual

External Actions

• Coordinate weekly teleconference on Tuesdays at 10:30am


Business as usual

36

Response Level: Green Organisation Type: Charity Name: Age UK Sutton [Home from Hospital, Community

Helpers & Caring Neighbour contract

Contact Details


Actions Executive


Business as usual

Business as usual

Senior Management


Business as usual

Quality & Performance Director contactable out of normal

working hours

Operational

In Hours Out of Hours 11am – 7pm

9am – 5.30pm 9am – 5.30pm

Home from Hospital – 7 day service, 11am -7pm Community Helpers befriending – 5 day service 9-5.30pm Caring Neighbour – 5 day service 9-5.30pm

External Actions

Weekly review of referrals


Nil

37

Response Level: Green Organisation Type: Adult Social Services Name: London Borough of Sutton

Contact Details


Actions Executive

In Hours Out of Hours Monitor sitrep reports Provide a point of escalation for senior manager on

call

Senior Management

In Hours Monitor sitrep reports


Out of Hours Provide a point of escalation for operational

manager on call

Operational

In Hours Daily attendance at AMU white board

meeting/A&E Receive and prioritise section 2 notices

Provide daily update on patients where S5 notification has been sent

Monitor and ensure timely throughput of services users with START

Dial into weekly conference call Attend Friday sitreps meetings

Provide early notification of long term care packages with START to independent sector

Suspend and restart packages as notified

Out of Hours START 7/7 response (to 11pm)- prevention of

admission/emergency duty Escalate any concerns to senior manager on call

External Actions Hospital to streamline and organise internal communications to reduce need for duplication of

information flows communication protocol with Social services needs to be established and implemented

Hospital to send section 2 notifications only when patients are fit to be assessed Twice weekly conference call

Mutual Aid Requirements None

38

Response Level: Green Organisation Type: London Ambulance Service Name: St Helier station

Contact Details


Actions Executive

In Hours Out of Hours Contact can be made with the named person above during normal office hours. However if unavailable please contact the Duty Operational AOM on 0207 783 2329 or for local issues the Duty Station Officer team can be contacted on 07778552358.

The London Ambulance NHS Trust has a number

of escalation methods dependant on demand and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE

Levels which mainly affect the Emergency Operations Centre and is used to manage

demand at times of high call volume.

Duty Operational AOM on 0207 783 2329

Duty Station Officer team can be contacted on 07778552358





Senior Management


As Above

As Above

Operational


As Above

As Above

External Actions The London Ambulance NHS Trust has a number of escalation methods dependant on demand and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE Levels which mainly affect the Emergency Operations Centre and is used to manage demand at times of

high call volume. Copies of both documents are available on request.


39

Response Level: Green Organisation Type: Community Services Name: Sutton and Merton Community Services

Contact Details


Actions Executive

In Hours Out of Hours Contact relevant Executive Director for advice if required.

Contact Executive on-call if required 020 7352 8171.

Senior Management

In Hours Out of Hours Contact relevant Divisional or Clinical Director for advice if required.

Contact relevant on-call manager for advice if required.

Operational


Referrals for discharge from acute hospitals via Administration Centre for Community Services – 0845 5672000

Admission Prevention within the community to be undertaken by the Community Prevention of Admission Team 020 8251 0152 8am to 7pm Monday to Friday. Accessible for GPs, Social Services and Community Services

Rapid Response at St. Helier and STAR at St. Georges, teams at allocated acute trusts Monday to Friday 8am to 8pm and 10am to 6pm Saturday to Sunday

Normal referral to intermediate care bedded areas

Acute Therapies attend daily bed meetings at St. Helier and feedback to community as required

Weekly conference call with acute trusts and the key stakeholders to manage flow and DTOC

Prevention of Admission Team over weekends – 10am to 6pm – Community Prevention of Admission Team through St. Helier Rapid Response Team on 020 8296 2789

Prevention of admission Daily – 4pm to 7am admission undertaken by twilight and night nursing service 020 8254 8488/07770 684841

External Actions

40


41

6.2 System wide escalation framework – Response Level Amber

Response Level: Amber Organisation Type: Acute Trust Name: Epsom and St Helier University Hospitals

NHS Trust

Contact Details


Actions Executive



Provide a point of escalation for senior management



Provide a point of escalation for senior manager on call

Senior Management





Participate on 2200 hour conference call (Monday to Friday) and 1500 hour conference call (Saturday and Sunday)

Provide a point of escalation for the operational management team and consider supportive actions required to maintain site resilience

Operational



Review elective care requirements, critical care transfers, and patients requiring repatriation from other hospitals






42


Liaise with social services and community service providers in relation to those patients who require social care/community support to facilitate discharge

Escalate any issues that are likely to impact on patient flow/site resilience to the Deputy Chief Operating Officer

External Actions

Social Services to provide a daily update in relation to the status of those patients awaiting discharge with social care input/support

Community Services to provide a daily update in relation to the status of those patients awaiting discharge with community services support

Twice weekly conference call between Acute Trust, Social Services, Community Services, CCG, and CSU



Consider and implement any mutual aid requirements between Trust sites (Treat and Transfer/allocation of planned care activity)

43

Response Level: Amber Organisation Type: Mental Health Name: South West London and St. George’s


Contact Details


Actions Executive




Senior Management




Operational


Prioritise emergency/urgent referrals Hold routine assessments

Prioritise emergency/urgent referrals

Hold routine assessments

External Actions

None required


None at this level

44

Response Level: Amber Organisation Type: 111 Service Name: Care Uk

Contact Details


Actions Executive


Business as usual

Business as usual

Senior Management


Business as usual

Business as usual

Operational


Business as usual

Business as usual

External Actions


45

Response Level: Amber Organisation Type: Clinical Commissioning Group Name: Sutton CCG

Contact Details


Actions Executive

In Hours Out of Hours via SWL director on call Business as usual

Business as usual

Senior Management

In Hours Out of Hours via SWL director on call Business as usual

Business as usual

Operational


• No action required. • Review CMS and SITREPS daily

Business as usual

External Actions

• Coordinate weekly teleconference on Tuesdays at 10:30am


Business as usual

46

Response Level: Amber Organisation Type: Charity Name: Age UK Sutton

Contact Details


Actions Executive


CEO contactable out of hours

Senior Management


Quality & Performance Director contactable out

of normal working hours

Operational


External Actions Regularly review capacity plan to include re-alignment of internal staff resources if required


Discuss with commissioners as required

47

Response Level: Amber Organisation Type: Adult Social Services Name: London Borough of Sutton

Contact Details


Actions Executive


Monitor sitrep reports

Provide a point of escalation for senior manager on

call

Senior Management


Monitor sitrep reports Provide a point of escalation for operational

management team

Provide a point of escalation for operational

manager on call

Operational


Daily attendance at AMU white board meeting/A&E

Receive and prioritise section 2 notices Provide daily update on patients where S5

notification has been sent Monitor and ensure timely throughput of

services users with START Dial into weekly conference call Attend Friday sitreps meetings


Suspend and restart packages as notified Escalate any issues that are likely to impact on

assessment and commissioning capacity to service manager/commissioning manager

START 7/7 response (to 11pm)- prevention of

admission/emergency duty Escalate any concerns to senior manager on call

External Actions

Hospital to streamline and organise internal communications to reduce need for duplication of information flows communication protocol with Social services needs to be established and

implemented

48

Hospital to send section 2 notifications only when patients are fit to be assessed Twice weekly conference call

Mutual Aid Requirements Community social work teams alerted to possible need to release staff to support in Hospital in

reach.

49

Response Level: Amber Organisation Type: London Ambulance Service Name: St Helier Station

Contact Details


Actions Executive

In Hours Out of Hours Contact can be made with the named person above during normal office hours. However if

unavailable please contact the Duty Operational AOM on 0207 783 2329 or for local issues the Duty Station Officer team can be contacted on

07778552358.

The London Ambulance NHS Trust has a number of escalation methods dependant on demand

and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE









Senior Management


Operational


External Actions


The London Ambulance NHS Trust has a number of escalation methods dependant on demand and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE Levels which mainly affect the Emergency Operations Centre and is used to manage demand at times of

high call volume.

Copies of both documents are included available on request.

50

Response Level: Amber Organisation Type: Community Services Name: Sutton and Merton Community Services

Contact Details


Executive


Executive to be updated by senior management twice daily

Check if, how and whether CCGs and NHS England to be updated

To be handled by the Executive on call at The Royal Marsden on 020 7352 8171

Senior Management


Regular conference calls to review impact on community services i.e. patient referrals, staff capacity, staff absenteeism, weather and travel issues and take relevant actions

As above

Operational


Undertake actions as per ‘GREEN’

Acute Trusts to contact community services via Administration Centre 0845 567 2000 or key service managers for requirements for supported discharge, once identified

Caseloads reviewed to facilitate urgent disharges, delays and caseload blockers in order to improve system flow.

Under action as per ‘GREEN’

External Actions To update relevant CCGs and NHS England as necessary


51

6.3 System wide escalation framework – Response Level Red

Response Level: Red Organisation Type: Acute Trust Name: Epsom and St Helier University Hospitals NHS

Trust

Contact Details


Actions Executive



Provide a point of escalation for senior management and advise in relation to any additional supportive actions required

Approve the use of additional escalation capacity



Consider the requirement for more frequent conference calls if required

Provide a point of escalation for the senior manager on call and advise in relation to any additional resources/supportive actions required

Senior Management



Maintain a presence in the site office in order to maintain command and control and

provide a point of escalation for operational management team

Agree additional directorate management support required to provide additional site resilience

Consider the requirement to cancel elective activity and escalate to the COO/Deputy COO should this be required

Consider utilisation of additional escalation capacity and seek approval from COO/Deputy COO

Senior manager level escalation to CCG, Social Care, and Community Service colleagues in order to identify additional supportive actions required


Participate on the 2200 hour conference (Monday to Friday) and 1500 hour conference call (Saturday and Sunday)

In liaison with the Executive Director on call consider the requirement for more frequent conference calls if required

Consider utilisation of additional escalation capacity and seek approval from the executive director on call

Provide a point of escalation for the operational management team and advise in relation to any additional supportive actions required

Consider the requirement to attend site in order to provide additional site resilience/support

Operational



Consider the requirement for additional bed meetings throughout the day



Update Ambulance Service Capacity

52

Contact clinical teams to agree key actions required to maximise patient flow

Contact support services (Radiology/Pharmacy/Facilities) to agree key actions required to maximise patient flow

Review elective care requirements, critical care transfers, and patients requiring repatriation from other hospitals and prioritise key actions required




Liaise with A&E clinical team to identify additional supportive measures required

Liaise with social services and community service providers in relation to those patients who require social care/community support to facilitate discharge requesting urgent feedback within 2 hours

Liaise with the relevant ambulance service to inform them of site status/pressure

Escalate any issues that are likely to impact on patient flow/site resilience to the Deputy Chief Operating Officer

Management System every 2 hours

Liaise with A&E and Speciality teams to identify additional supportive measures required


External Actions

Social Services to provide twice daily updates in relation to the status of those patients awaiting discharge with social care input/support

Community Services to provide twice daily updates in relation to the status of those patients awaiting discharge with community services support

Consider the requirement for daily conference calls between Acute Trust, Social Services, Community Services, CCG, and CSU

Senior manager level escalation to CCG, Social Care and Community Service Colleagues



Consider and implement any mutual aid requirements between Trust sites (Treat and Transfer/allocation of planned care activity)

53

Response Level: Red Organisation Type: Mental Health Name: South West London and St. George’s


Contact Details


Actions Executive




Senior Management


Operational Manager to consider any support options available.

On-call Manager to consider any support options available.

Operational


Beds under pressure Prioritise emergency/urgent referrals

Review discharge assessments Hold routine assessments

Notify Operational manager of situation

Beds under pressure

Prioritise emergency/urgent referrals Review discharge assessments

Hold routine assessments Notify on-call manager of situation

External Actions

As per Hospital Major incident Plan

Mutual Aid Requirements Nil

54

Response Level: Red Organisation Type: 111 Service Name: Care UK

Contact Details


Various Operational Supervisor

02034021111 select opt. 1

[email protected]

Actions Executive


Varied as per on call rota – please contact Supervisor

desk who will contact Director on call

Senior Management



desk who will contact Senior on call

Operational



desk who will contact Supervisor on call

External Actions


55

Response Level: Red Organisation Type: Clinical Commissioning Group Name: Sutton CCG

Contact Details


Actions Executive

In Hours Out of Hours Via SWL director on call • Issue communication across health economy

summarising alert status reports from Trusts Liaise with SLCSU on call for surge and

capacity

Senior Management

In Hours Out of Hours Via SWL director on call • Where provider to provider issues have been

escalated and still remain unresolved, facilitate discussions in for example emergency discharge planning.

• Consider review of capacity of OOH provider

Liaise with SLCSU on call for surge and capacity

Operational

In Hours Out of Hours Via SWL director on call • QIPP team to review CMS every 2-4 hours to

keep abreast of hospital status reports/CMS scores.

• Update the directors with regard to the level of escalation and any outstanding measures.


External Actions • Coordinate daily teleconference at 10am • If deemed appropriate communications to be issued to :

o General Practice by Locality Team (on behalf of the Urgent Care Clinical Lead) o Pharmacists by Medicines Mgt Team o Community Svcs, Mental Health, OOH provider by relevant commissioning lead


SLCSU to manage surge capacity

56

Response Level: Red Organisation Type: Charity Name: Age UK Sutton

Contact Details


Actions Executive


Maintain regular contact with commissioner & partners

Senior Management


Maintain contact with commissioners and partners as

required

Operational


Operational staff and volunteer team have access to

local flu vaccination programme

External Actions Fully participate with commissioners external conference call system

Regularly review capacity plan to include re-alignment of staff resources

Mutual Aid Requirements Discuss with commissioners as required

57

Response Level: Red Organisation Type: Adult Social Services Name: London Borough of Sutton

Contact Details


Actions Executive


Monitor sitrep reports Provide a point of escalation to senior

management and advise in relation to any additional supportive actions required

Instruct temp increase in SM purchasing authority to reduce authorisation time

Provide a point of escalation to senior manager on

call and advise in relation to any additional resources or supportive actions required

Senior Management


Monitor sitrep reports Provide a point of escalation for operational management team and advise in relation to any additional supportive actions required. Receive updates on social care capacity and

issues from operational managers and consider and implement any necessary actions Set aside twice daily time to QA and authorise

support plans

Provide a point of escalation for operational manager on call and advise on any additional

resources or supportive actions required.

Operational


Daily attendance at AMU white board meeting/A&E

Receive and prioritise section 2 notices Provide daily update on patients where S5

notification has been sent Monitor and ensure timely throughput of

services users with START Dial into weekly conference call Attend Friday sitreps meetings


Suspend and restart packages as notified Provide daily updates on START and independent sector capacity/issues

START 7/7 response (to 11pm)- prevention of admission/emergency duty Increase START capacity through use of temp agency staff as necessary

Escalate any concerns to senior manager on call Extend hospital in reach operating hours/staffing out of hours as necessary

58

Provide daily updates on placement availability

Senior practitioner and broker to maintain office presence on site?

External Actions

Hospital to streamline and organise internal communications to reduce need for duplication of information flows- communication protocol with Social services needs to be established and

implemented Hospital to send section 2 notifications only when patients are fit to be assessed

Twice weekly conference call


Community social work teams release staff from non urgent work to support in Hospital in reach.

59

Response Level: Red Organisation Type: London Ambulance Service Name: St Helier station

Contact Details


Actions Executive



07778552358.











Senior Management


Operational


External Actions

Mutual Aid Requirements The London Ambulance NHS Trust has a number of escalation methods dependant on demand and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE Levels which mainly affect the Emergency Operations Centre and is used to manage demand at times of

high call volume.

Copies of both documents are available on request.

60

Response Level: Red Organisation Type: Community Services Name: Sutton and Merton Community Services

Contact Details


Actions Executive


Increased frequency of conference calls with senior management

Review necessity of training and meetings taking place

Review actions as per ‘AMBER’

Consider trigger points that all actions at the current level have been taken and organisation cannot meet demand

To be handled by the Executive on call of the Trust.

Senior Management


Regular conference calls with the Acute Trusts and Social Services to discuss impact on all organisations

Invoke Business Continuity

Consider recovery plan

As above

Operational


Actions as per ‘AMBER’

Acute Trust to contact key SMCS Service Managers to arrange representation at escalation meeting and expedite discharge and aid admission avoidance

Respond to extra commissioning requests

Review business continuity

As for ‘AMBER’

On call SMCS Manager to participate in teleconferences and action requests

61

External Actions To advise CCGs and NHS England


62

6.4 System wide escalation framework – Response Level Black

Response Level: Black Organisation Type: Name:

Contact Details


Actions Executive



Provide a point of escalation for senior management and advise in relation to any additional supportive actions required

Liaise with Medical and Nursing Director colleagues to agree additional supportive actions required

Ensure Trust CEO is aware of the site status

Approve the use of additional escalation capacity

Director level escalation to CCG, Social Care, and Community Service colleagues in order to identify additional supportive actions required



Consider the requirement for more frequent conference calls if required

Provide a point of escalation for the senior manager on call and advise in relation to any additional supportive actions/resources required

Consider the requirement for escalation to the CSU Director on Call

Senior Management



Maintain a presence in the site office in order to maintain command and control and

provide a point of escalation for operational management team

Consider the requirement for director level command and control

Consider and agree additional directorate management support required to provide additional site resilience

Consider the requirement to cancel elective activity and escalate to the COO/Deputy COO should this be required

Consider utilisation of additional escalation capacity and seek approval from COO/Deputy COO

Senior manager level escalation to CCG, Social Care, and Community Service colleagues in order to identify additional supportive actions required


Participate on the 2200 hour conference (Monday to Friday) and 1500 hour conference call (Saturday and Sunday)

In liaison with the Executive Director on call consider the requirement for more frequent conference calls if required

Consider utilisation of additional escalation capacity and seek approval from the executive director on call

Provide a point of escalation for the operational management team and advise in relation to any additional supportive actions/resources required

Consider the requirement to attend site in order to provide additional site resilience/support

Operational


Daily attendance at site specific bed Provide regular SITREP updates and

63

meetings to identify definite and potential discharges and actions required to maximise patient flow

Agree additional bed meetings throughout the day

Contact clinical teams to agree key actions required to maximise patient flow

Contact support services (Radiology/Pharmacy/Facilities) to agree key actions required to maximise patient flow

Review elective care requirements, critical care transfers, and patients requiring repatriation from other hospitals and prioritise key actions required




Liaise with A&E clinical team to identify additional supportive measures required

Liaise with social services and community service providers in relation to those patients who require social care/community support to facilitate discharge requesting urgent feedback within 2 hours


monitor any change in site status that may impact on patient flow



Liaise with A&E and Speciality teams to identify additional supportive measures required


External Actions

Social Services to provide an on-site presence to support the facilitation of discharge for those patients awaiting discharge with social care input/support

Community Services to provide an on-site presence to support the facilitation of discharge for those patients awaiting discharge with community services support

Daily conference calls between Acute Trust, Social Services, Community Services, CCG, and CSU

Director level escalation to CCG, Social Care and Community Service Colleagues



Consider and implement any mutual aid requirements between Trust sites (Treat and

Transfer/allocation of planned care activity)

Liaise with Commissioners in relation to the provision of additional step down facilities

64

Response Level: Black Organisation Type: Mental Health Name: South West London and St. George’s


Contact Details


Actions Executive


Operational Director to consider support options available.

Director on-call to consider support options

available.

Senior Management

In Hours

Out of Hours

Operational Manager to consider any support options available.

Notify Service and Operational Director

On-call Manager to consider any support options available.

Notify Director on-call

Operational


Beds under pressure Prioritise emergency/urgent referrals

Review discharge assessments Hold routine assessments

Notify Operational manager of situation

Beds under pressure

Prioritise emergency/urgent referrals Review discharge assessments

Hold routine assessments Notify on-call manager of situation

External Actions

As per Hospital Major incident Plan


65

Response Level: Black Organisation Type: 111 Service Name: Care Uk

Contact Details


Actions Executive



desk who will contact Director on call

Senior Management



desk who will contact Senior on call

Operational



desk who will contact Supervisor on call

External Actions


66

Response Level: Black Organisation Type: Clinical Commissioning Group Name: Sutton CCG

Contact Details


Actions Executive

In Hours Out of Hours Via SWL director on call • QIPP programme Director/ Director of

Commissioning/COO to facilitate health economy conference call as required where situation is likely to last longer than 4 hours.


Senior Management

In Hours Out of Hours Via SWL director on call • CCG to communicate as appropriate across

health economy on de-escalation as triggers are reviewed and capacity/pressure deemed to be restored to normal levels


Operational

In Hours Out of Hours Via SWL director on call • QIPP team to constantly review CMS to obtain

up to date information on hospital status reports/CMS scores

• Consider increasing capacity of OOH provider to support acute trust


External Actions • Update the NHS England Local Area Team with regard to the level of escalation and any outstanding

measures. • If deemed appropriate communications to be issued to :

o General Practice by Locality Team o Pharmacists by Medicines Mgt Team o Community Svcs, Mental Health, OOH provider by relevant commissioning lead

Mutual Aid Requirements • SLCSU to manage surge capacity

67

Response Level: Black Organisation Type: Charity Name: Age UK Sutton

Contact Details


Actions Executive


Conference calls with commissioner as required.

Senior Management


As above

Operational


Expedite safe discharge to support community &

social services where possible. Charity operational staff are required to comply

with Age UK Sutton business continuity plan

External Actions Fully participate with commissioners external conference call system

Regularly review capacity plan to include re-alignment of staff resources Confer with commissioners if provider requires additional suitably qualified staff

Mutual Aid Requirements Discuss with commissioners as required

68

Response Level: Black Organisation Type: Adult Social Services Name: London Borough of Sutton

Contact Details


Actions Executive

In Hours Out of Hours Monitor sitrep reports

Provide a point of escalation to senior management and advise in relation to any

additional supportive actions required Instruct temp increase in SM purchasing authority to reduce authorisation time

Instruct redeployment of staff from community teams to support hospital in reach

Director level escalation in order to identify additional supportive actions required

Provide a point of escalation to senior manager on call and advise in relation to any additional

resources or supportive actions required

Senior Management

In Hours Out of Hours Monitor sitrep reports

Provide a point of escalation for operational management team and advise in relation to any

additional supportive actions required. Receive updates on social care capacity and

issues from operational managers and consider and implement any necessary actions

Set aside twice daily time to QA and authorise support plans

Provide a point of escalation for operational manager on call and advise on any additional

resources or supportive actions required.

Operational

In Hours Out of Hours Daily attendance at AMU white board

meeting/A&E Receive and prioritise section 2 notices

Provide daily update on patients where S5 notification has been sent

Monitor and ensure timely throughput of services users with START

Dial into weekly conference call Attend Friday sitreps meetings


Suspend and restart packages as notified Provide daily updates on START and independent

START 7/7 response (to 11pm)- prevention of admission/emergency duty Increase START capacity through use of temp agency staff as necessary Escalate any concerns to senior manager on call

Extend hospital in reach operating hours/staffing out of hours as necessary

69

sector capacity/issues Provide daily updates on placement availability

Senior practitioner and broker to maintain office presence on site?

External Actions

Hospital to streamline and organise internal communications to reduce need for duplication of information flows -communication protocol with Social services needs to be established and

implemented Hospital to send section 2 notifications only when patients are fit to be assessed

Twice weekly conference call


Community social work teams release staff from non urgent work to support in Hospital in reach.

70

Response Level: Black Organisation Type: Name:

Contact Details


Actions Executive



07778552358.











Senior Management


Operational


External Actions The London Ambulance NHS Trust has a number of escalation methods dependant on demand and normal staffing levels. This include Resource Escalation Action Plan (REAP) as well as SURGE Levels which mainly affect the Emergency Operations Centre and is used to manage demand at times of

high call volume.

Copies of both documents are available on request.


71

Response Level: Black Organisation Type: Community Services Name: Sutton and Merton Community Services

Contact Details


Actions Executive


Regular teleconferencing with senior management

Actions as per ‘RED’

Consideration of cross border/organisation mutual aid

To be handled by Executive on call at the Trust as above

Senior Management


Review of priority services and re-deploy staff as necessary via regular teleconferencing with service managers

To be handled by Executive on call at the Trust as above

Operational


Actions as per ‘RED’

Implement business continuity to support the Acute Trusts

Service Managers to participate in conference calls and/or meetings as appropriate

Implement extra commissioning requests

Clinical Directors to be involved with service wide reconfiguration as required

Divisional Director to be notified of whole system actions and plans – dissemination

As per ‘RED’ but with

Increased teleconferencing with acute providers and whole system

Increased divisional communications through existing channels

Presence at DTOC and bed management meetings.

72

as required

External Actions To advise CCGs and NHS England


73

APPENDIX 1

Screenshot of the Epsom & St Helier Trust Performance Dashboard for RTT monitoring

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APPENDIX 2

Demand and Capacity Modelling for Epsom and St Helier Hospitals

new operational resilience and capacity plan epsom and st helier … · 2014. 10. 16. · a 111...

Documents