Patient and Public Council Winter Review and DToCs 15 June 2018

Introduction Winter Review Urgent care patient flows and activity Preparation for Winter 2017/18 What happened in Winter 2017/18? Lessons learnt Planning for Winter 2018/19 Delayed Transfers of Care (DToC) An introduction to discharge planning What is a DToC? The challenges of reporting Next steps…

Winter Review What is ‘Winter’? Media focus on ‘urgent care’ (same day or within 24 hours) Across primary, community, ambulance service and secondary care Rapid response social care

Three Phases PRE-HOSPITAL HOSPITAL HOSPITAL TO HOME (MANAGING A&E DEMAND) HOSPITAL HOSPITAL TO HOME

Patient Flow to Acute Systems (% based on April – August 2017 Data) UNITED LINCOLNSHIRE HOSPITALS (ULHT) SITES AT LINCOLN, GRANTHAM & BOSTON A&E 86.5% NEL 84.1% NOTTINGHAM UNIVERSITY HOSPITALS (NUH) A&E 29% NEL 25.2% A&E 4.1% NEL 6.0% QUEEN ELIZABETH HOSPITAL KING’S LYNN (QEH) A&E 10.9% NEL 15.3% A&E 4.1% NEL 5.8% A&E 54.9% NEL 55.0% NORTH WEST ANGLIA HOSPITALS (NWA) SITES AT PETERBOROUGH & STAMFORD

Preparation for Winter 2017/18 Lessons learn from 16/17 Earlier planning and for a longer period (October 2017 – Easter 2018) Self care and population education NHS 111 and Clinical Assessment Service (including CAS for Care Homes) New ambulance service targets (response times and Hear and Treat / See and Treat) LCHS Single Point of Access and ‘virtual’ service across Lincolnshire organisations Urgent care streaming at hospital sites Improved pathways for hospital care delivery – including extra bed capacity Greater resources for discharge planning and a more resilient care sector

Winter 2017/18 – The Challenges Backdrop Increasing demand and acuity Limited capacity Workforce challenges Primary and social care pressures Reality Available budgetary support for winter came too late – design and mobilisation issues Increased demand on healthcare, particularly urgent care services nationally, with a surge in January 2018 Influenza strain (impacting demand and workforce) – Australia and New Zealand Norovirus (resulting in lost beds in hospitals and care homes) Unprecedented weather conditions

Winter 2017/18 – The Successes Better public communication ‘Communications Network’ Tools for self-management Clarity of service availability Improved integrated working Across all sectors Senior decision-makers Regularity A ‘can-do’ attitude Surge / MADE / Perfect Week events

Winter 2018/19 What is happening now? Monitoring our activity trends and informing our clinicians Regular activity monitoring at North West Anglia Locality dashboards Practice urgent care deep dives Utilisation of transitional care capacity Engaging our communities Sharing our messages (including z-card distribution) College engagement Development of locality working – NTs and PCH Drawing together of health, care and voluntary sector services to offer MDT delivery Care planning for our most vulnerable patients Patient-centred planning and delivery

Winter 2018/19 Next Steps Communication, education and empowerment Winter communications plan development – Aug 2018 onwards Engaging and empowering carers and families Development of locality working – NTs and PCH Care planning for our most vulnerable patients Improved integration with secondary care Maximising our resources Reviewing our working practices to identify efficiencies, e.g. earlier intervention to support hospital inpatients and reduce delays Robust plans for additional service provisions – should funding be delivered Restructuring / growing our urgent care services Development of Urgent Treatment Centres / GP Access Hubs Building on admission avoidance opportunities

Discharge Planning Services to reduce the length of stay through effective discharge planning and to reduce delays to discharge. Approximately 1/3 of all hospital inpatients have ongoing needs and require facilitated discharge, with adult social care and / or health input. Significant public funding invested to facilitate improved discharge pathways and reduce delays, both through BCF / iBCF and health funding.

Improved Better Care Fund The Better Care Fund & Improved Better Care Fund Better Care Fund announced by Government in June 2013 (£3.8bn) to support the ‘joining-up’ of health and social care services to support improved public wellbeing and to facilitate individuals being able to remain in their own homes for as long as possible. Additional allocations announced in 2015 (iBCF) and March 2017 (Supplementary iBCF). Lincolnshire’s BCF for 2017/18 totalled £226m , including £154m additional contribution from CCGs and LCC. One of the largest pooled budgets across health and social care community in England. Key focus on minimising delayed transfers of care (DToC), in both acute and community. Implementation of the High Impact Change model is a condition of iBCF.

Delayed Transfer of Care? And what is it not? What is a Delayed Transfer of Care? And what is it not? Once a patient has been declared ‘medically fit’ or ready for transfer home or to the next destination, there is a 72 hour period gifted to facilitate discharge. Beyond this, the discharge is considered to be ‘delayed’ and the patient is recorded with a Delayed Transfer of Care (DToC) status. Not a ‘bed blocker’!

DToC – A Complex Landscape Social Care delays in discharge arising due to social care provision factors Joint Responsibility delays in discharge arising due to both social and health provision factors Health community care delays secondary care delays delays in equipment provision family / patient delays (self funders and disputes) The majority of delays will be declared as ‘health’, though may not be directly due to failures in health care pathways. Reporting of delays nationally at organisation and unitary authority level (not CCG level)

DToC Performance (Acute) Blue = Health Orange = Social Green = Joint

Discussion