1. Unscheduled Care Learning Event Issues Identified from Winter Planning Review Michael Bloomfield 19 March 2015

2. 2014/15 Activity and Performance Data

3. Apr – Feb (13/14): 634,287Apr – Feb (14/15): 647,128Variance: 12,814% Variance: 2.0%

4. Apr – Feb (13/14): 178,260Apr – Feb (14/15): 184,024Variance: 5,764% Variance: 3.2%

5. Apr – Feb (13/14): 126,691 Apr – Feb (14/15): 128,830Variance: 1,690% Variance: 1.3%

6. Apr – Feb (13/14): 78.4%Apr – Feb (14/15): 77.9%Variance: -0.5%

7. Apr – Feb (13/14): 2,701 Apr – Feb (14/15): 2,561Variance: -140% Variance: -5.2%

8. Apr – Feb (13/14): 16,974 Apr – Feb (14/15) : 16,847Variance: -120% Variance: -0.7%

9. Apr – Feb (13/14): 2,574Apr – Feb (14/15) : 3,511Variance: 937% Variance: 36.4%

10. January – February 2015 vs 2014 Activity and Performance

11. 28/12/13-07/03/14 : 127,826 27/12/14-06/03/15 : 131,021 Variance: 3,195% Variance: 2.5%

12. 28/12/13-07/03/14 : 39,062 27/12/14-06/03/15 : 40,522 Variance: 1,460 % Variance: 3.7%

13. 28/12/13-07/03/14 : 27,363 27/12/14-06/03/15 : 28,216 Variance: 853 % Variance: 3.1%

14. 28/12/13-07/03/14 : 75% 27/12/14-06/03/15 : 73% % Variance: -2.1%

15. 28/12/13-07/03/14 : 563 27/12/14-06/03/15 : 1,195 Variance: 632 % Variance: 112.3%

16. 28/12/13-07/03/14 : 3,464 27/12/14-06/03/15 : 4,287 Variance: 823 % Variance: 23.8%

17. 28/12/13-07/03/14 : 718 27/12/14-06/03/15 : 960 Variance: 242 % Variance: 33.7%

18. Acuity Indicators Jan – Feb 2015Jan – Feb 2014Variance ED attendances aged 80+ 8,5347,747+ 787 (10%) Triage Categories 2 + 3 60,05556,243+ 3,812 (6.7%)

19. Emerging Learning from Review of Winter 2014/15

20. Winter Planning Earlier planning for winter, including confirmation of additional funding Greater understanding of the whole system based on robust data, not anecdote Elective activity profiled to maximise bed and staff capacity over winter period Schedule training and associated activities over 9/10 month period Match staffing levels to times of increased demand Additional ENP staffing levels to maintain minors flow

21. Community Preparedness Timely response to increase in demand, including at holiday periods ‘What good looks like’ for community services Greater understanding of capacity needed for complex discharges at key periods Development of ‘discharge to assess’

22. Escalation Include whole system, not just in hospital Develop clear early warning triggers across the whole system to prompt early action Need reliable, real time information to inform decision making Importance of senior leadership of escalation meetings Importance of visibility of senior clinicians in ED during times of high demand/increased pressure Provision of dedicated ambulance discharge capacity De-escalate early

23. System/Pathway Issues Understand the value of further development of Hospital Diversion Teams, Rapid Response Services, Physician of the Week, Discharge to Assess Further development of seven day services, including senior reviews Improve repatriation of patients between Trusts