Managing Key Risks Duncan Pollock Health Care Manager Medical Specialties

Key Risks Fewer beds Possible ward closures – infection Increased demand and peaks Change fund progress

1. Fewer beds Issues Fewer surgical beds Fewer medical beds Dermatology redesign Fewer rehab beds Fewer continuing care beds Less opportunity for medical boarding Actions ongoing LEAN has reduced medical LOS on 2 main sites by 0.4 & 0.3 days. Short stay beds (<72 hrs) ring fenced Priority ward rounds Acute medicine clinics Revised escalation ZERO boarding aspiration

2. Possible ward closures Issues Continued IC support Flu isolation arrangements Vaccination levels D&V isolation and re-opening policies Actions IC commitment to patient flow meetings Reinforce and relearn rules successfully applied in the past Aim to > vaccination levels, particularly in key ‘winter’ areas (on ward with target) Enhanced and targeted re-clean arrangements

3. Increased demand and peaks Issues Attendances rising Holiday periods Sustained pressure Higher acuity Poor weather Actions Planned deployment of clinicians working in corporate departments (actively helping work up patients for discharge). Controlled annual leave Extra consultant ward rounds Deploy additional domestic and portering support where required

4. Change fund progress Issues Actions Change Fund will support winter planning. Reducing unplanned admissions and acute bed days in the over 75 population through effective, integrated community services and closer coordination of services between acute and community. New tiered model of care will support a range of services from carer support and volunteering to specialist, integrated care in the community. Actions In the interim . . . Increase ambulance services for more discharges Extra community equipment for expanded out of hours care Extra assessment and discharge from acute services Extra targeted care home support Prepare 12 surge beds in a designated area that can be opened as part of escalation policy