Governing Body 24 January 2017

Urgent care system pressures - December Governing Body 24th January 2017

Focus on Escalation over Winter CCG support for all 3 systems – Wiltshire accountable for SFT (via Local Delivery Board) Daily Gold calls and support for Silver/Operational calls and meetings 7 days a week reporting to NHSE (national Operational Pressures Escalation Framework – OPEL One to Four) Winter Plans and A&E Improvement Plan (Governing Body 22.11.16) Strong Communication Plan and media messages Priority Initiatives to Support System Improvement: FRONT DOOR: Clinical Hub pilot – extended and enhanced (support NHS111 and ambulance) ED Validation line at NHS111 – clinical review of all calls with ED disposition GPs at SFT to review “medically fit for discharge” patients from 12th January BACK DOOR: MADE Event at all 3 hospitals pre Christmas and focus on discharge Integrated Discharge Team focus Improving system flow – rehabilitation support workers in Wiltshire Health and Care to provide interim support and plug domiciliary care shortfalls from February

Operational Pressures Escalation Levels OPEL One The local health and social care system capacity is such that organisations are able to maintain patient flow and are able to meet anticipated demand within available resources. The local A&E Delivery Board area will take any relevant actions and ensure appropriate levels of commissioned services are provided. Additional support is not anticipated. OPEL Two The local health and social care system is starting to show signs of pressure. The local A&E Delivery Board will be required to take focused actions in organisations showing pressure to mitigate the need for further escalation. Enhanced co-ordination and communication will alert the whole system to take appropriate and timely actions to reduce the level of pressure as quickly as possible. Local systems will keep NHS E and NHS I colleagues at local regional level informed of any pressures, with detail and frequency to be agreed locally. Any additional support requirements should also be agreed locally if needed. OPEL Three The local health and social care system is experiencing major pressures compromising patient flow and continues to increase. Actions taken in OPEL Two have not succeeded in returning the system to OPEL One. Further urgent actions are now required across the system by all A&E Delivery Board partners, and increased external support may be required. Regional teams in NHS E and NHS I will be aware of rising system pressure, providing additional support as deemed appropriate and agreed locally. National team will also be informed by DCO/local regional teams through internal reporting mechanisms. OPEL Four Pressure in the local health and social care system continues to escalate leaving organisations unable to deliver comprehensive care. There is increased potential for patient care and safety to be compromised. Decisive action must be taken by the local A&E Delivery Board to recover capacity and ensure patient safety. All available local escalation actions taken, external extensive support and intervention required. Regional teams in NHS E and NHS I will be aware of rising system pressure, providing additional support as deemed appropriate and agreed locally, and will be actively involved in conversations with the system. Where multiple systems in different parts of the country are declaring OPEL Four for sustained periods of time and there is an impact across local and regional boundaries, national action may be considered.

Summary of activity / performance over 5 weeks Data analysed for 5 weeks – 28th November 2016 to 8th January 2017 compared to same period 2015/16 CCG Total is a total of the main three acutes SFT changed their system between the two years All data as submitted by the providers for the daily dashboard reports (no age breakdown yet) More detailed analysis and lessons learnt at future meetings

4 hour performance (target 95%)

A&E Attendance 15/16 compared to 16/17

A&E Admits

Medical Outliers

Delayed Transfer of Care

Referral to Treatment (RTT) impact CCG performance dropped in Nov to 89.43% mainly due to data quality issues at SFT. RUH 91.5%. GWH 92% SFT and GWH are both yet to submit Dec data to UNIFY due to data quality concerns All three acute providers have cancelled significant amounts of elective surgery in Jan 2017 due to NEL pressures. The CCG has provided additional funding to GWH and SFT to support proactive backlog clearance and successfully bid for additional funding. Pre-referral outsourcing continues at pace with more than 2,000 clinically appropriate patients transferred to Independent Sector since May 2016.

Summary All three systems have seen an increased A&E attendance over this 5 week period and mainly at OPEL 3 Robust plans were in place pre Christmas and focus on discharge to ensure capacity and flow All three Trusts have not met the 95% target in these 5 weeks Maintain focus on NHS111 and Clinical Hub Ensure transfer the learning from GPs at SFT Medical outliers are up compared to same period last year – with escalation beds/areas open Delayed Transfer of Care numbers have increased – focus on all calls – acute and community to access appropriate beds/packages of care Current focus to de-escalate to OPEL 2 and maintain flow.