1. NHS Borders Development of Escalation Policy Dr. Simon Watkin Consultant Respiratory Physician Borders General Hospital simon.watkin@borders.scot.nhs.uk

2. Setting NHS Borders Borders General Hospital Primary and Community Services Mental Health Social Services Scottish Ambulance Service Partnership forum Population 106,500 280 beds total 102 GIM beds including 30 MAU and 12 HD 30 DME, 30 stroke/palliative/community

3. Numbers

4. Length of stay

5. Why might you need an escalation plan? 95+% bed occupancy Delayed and cancelled surgery 4 hour waiting breached Medical boarders Norovirus Severe weather Influenza

6. Development of Escalation Policy Executive support Large scale 1 day event Small working group weekly Agreed policy Executive mandate Implementation group “Thin” policy document Clear operational arrangements

7. Who was involved? AHPs Bed Management BGH Clinical Board Borders Emergency Care Services Borders Improvement Support Team Communications Team Community Hospital Superintendents Discharge Liaison Domestic and Portering Services Infection Control IM&T Mental Health Clinical Board PACS Clinical Board Pharmacy Planning and Performance Public and Patient Representatives Scottish Ambulance Service Scottish Health Council Social Work Voluntary

8. Timescale ConceptApril Workshop June Executive approvalAugust ImplementationOctober

9. Positives Creative and innovative Multi professional Alignment of objectives Better, safer treatment Efficient Cost effective

10. Now what? Implementation group Data quality Action cards Patient flow action team Monitoring Trial period Re-assess Re-calibrate

11. ColourCapacityLevel of Concern for Service Delivery Black No capacity to meet actual unscheduled demand Critical Red Insufficient capacity to meet predicted planned and unscheduled demand Severe Amber Limited capacity but discharges are predicted Moderate Green Sufficient capacity to meet predicted planned and unscheduled demand Nil / Minor

12. Status at Midnight Treatment Capacity Staffing Levels Support Services Risk Levels Repatriation / Boarders Board Status

13. ColourAction Black All staff are required to contribute to managing this through direction from Patient Flow Action Team. Red All those with roles and responsibilities outlined in Action Cards must prioritise these over normal duties. Amber Limited number of staff involved in actions as directed through the Clinical Boards. Green No requirement for actions in additional to normal procedures.

14. How do we set the whole system status? RedRedRed AmberRedRed AmberAmberRed GreenRedRed Green AmberRed GreenAmberAmber GreenGreenRed GreenGreenAmber GreenGreenGreen

15. What’s next? Have we got the thresholds correct Can all groups react in real time Will we learn anything we do not already know Equitable spread of risk Common understanding

16. "If you are too good at adjusting to the current system, you may never realise that the system needs changing“ Edward de Bono