Buckinghamshire
Integrated Care Partnership
CCG Governing Body
Executive Summary
Winter Plan
Key lessons from 18/19
2 Your community, Your care : Developing Buckinghamshire together
Over 50 members of the Bucks ICP and neighbouring organisations attended the winter wash up for 18/19. Feedback from the event was shared widely across the ICS, with the key messages of: • Collaboration is key – structured and regular communication is needed, as are trusted
relationships to resolve challenges • Communications across the system – consistent communications to staff and patients
across the ICP will keep messaging simple, and avoid conflicting messages • Weekend flow is vital – we need to build robust services that functions 7 days a week • Structured approach to escalation – we need calm, consistent and equitable escalation
via OPEL, and to review the approaches taken to increase system bed capacity • Engagement of the charitable sector – we want to work with the charitable sector to
enable patients to remain at home safely and leave hospital when they no longer need acute care
• Saving patient and staff time – designing systems that are timely, simple and reduce duplication and distress caused through over complexity
Priorities for winter 19/20
3 Your community, Your care : Developing Buckinghamshire together
For both adults and children: • Reduce A&E attendances • Reduce NEL admissions • Facilitate timely discharge
The Bucks ICP plan aligns to these three objectives and the delivery of a home first approach
Clinical areas of focus
4 Your community, Your care : Developing Buckinghamshire together
As a integrated system, these are the key areas we have committed to developing • Paediatrics
• Increased medical and nursing coverage in ED and the paediatric decision unit (PDU)
• Rapid access to consultant support via additional hot clinics • Frailty
• Falls and frailty vehicle to support patients calling 999 and 111 • Silver phone for immediate consultant advice for primary care,
including paramedics • Mental health
• Providing bespoke mental health support away from ED, for acutely unwell patients
• Safe havens across Buckinghamshire, in areas of high need
BOB UEC Funding
• The ICS has been allocated £320,598 for winter transformation schemes
• Monies have been allocated on a capitation basis, which gives Bucks £94k
• The AEDB has agreed two schemes to be funded from this allocation
• The implementation of MiDoS for SCAS, an enhanced version of the DOS, and a way of reducing conveyance – cost £16k (£50k cost across STP)
• The delivery of a falls and frailty vehicle 5 days a week for 22 weeks, with the service aligned to the days of peak demand. This will be delivered as an ICS with input from BCC and BHT with SCAS to maximise admission avoidance opportunities.
5 Your community, Your care : Developing Buckinghamshire Together
BCF Winter Funding
6 Your community, Your care : Developing Buckinghamshire Together
Scheme Name Estimated output Expenditure Description
Brokerage support in
hospitals – waiving
charges to patients
c13 referrals per month £83k From November 18 to March 19, 87 referrals received – 7 day
response offered to SMH and Wexham hospital sites
Flu vaccinations –
increasing uptake by
independent sector
providers and wider Bucks
population
All care home and
preferred home care
providers contacted and
frontline social care staff
targeted; information to
general population
£15k Increase uptake and immunisation against flu of non-health
population to improve general system resilience – 8 clinics held in 18-
19, earlier start and wider scope in 19-20 to increase inclusion
Intermediate nursing care
home beds - 3
To support reablement
services, to offer
intermediate care home
beds
£234k To reduce targeted individuals coming out of hospital to regain their
skills and independence and reduce long term care costs
Residential Placements
(flexible across all service
groups and models)
OR 71 nursing
78 residential
£1,671,318 Based on average cost of £821 for a new nursing placement over 6
months
Based on average cost of £901 for a new residential placement over 6
months
Home Care and Dom Care OR 86,134 hours £1,671,318 Based on average £19.40 per hour; 221 people if 15 hours each per
week for 6 months
Personalise Care at Home
– Live in care
OR Between 46-76 sets of
24/7 care for 6 months
£1,671,318 24/7 live in care for 6 months
Operational structure for 19/20
7 Your community, Your care : Developing Buckinghamshire together
Day Support
Monday
• SMH check and challenge • Wycombe >7 day review • Forward planning
Tuesday
• SMH check and challenge • NSIC LOS review • Buckingham >7 day review • Directors call
Wednesday • Amersham >7 day review • SMH MADE/DPTL*
Thursday • SMH check and challenge
Friday • SMH check and challenge • ICP LLOS directors call
Other
• Daily System call • Twice weekly Frimley
Medically Stable huddle
Winter team 19/20: ICP: Frances Woodroffe – Winter Director BHT: Helen Byrne – Director of Site and Patient Flow BHT Clinical Lead: [waiting for a name and title] CCG: Nicola Newstone – Head of Urgent Care CCG: Dal Sahota – Clinical Director Urgent Care BCC: Tom Chettle – Head of Service Oxford Health: Donna Clarke – Service Director SCAS: Mark Begley – Head of Operations FedBucks: Asma Ali – Services Director FedBucks Clinical Lead: Gemma Jones – Clinical Director, Urgent Care Voluntary sector: TBC South Bucks Managerial Lead: Ian Sadler – Commissioning Manager South Bucks GP Liaison: Dr Sonia Tariq South Bucks Clinical Lead: Dr Nicola Turner
*MADE = multi-agency discharge event DPTL = discharge patient tracking list
Admission and discharge gap
8 Your community, Your care : Developing Buckinghamshire Together
Every day it is a challenge to discharge as many patients as are admitted When there are not enough discharges, this causes patients to wait in ED for beds This is not the care anyone would want for a loved one Nationally there is a focus on reducing the overall length of time patients spend in Emergency Department, and avoiding patients going to ED unless clinically essential We need to work with our community to encourage appropriate use of our Emergency Department To enable a smooth and timely journey through the hospital, we need to enable safe and timely discharge and care in the right setting We need to design new pathways for patients, working across the Integrated Care Partnership, to provide the right care, in the right place for patients
How we can close the gap:
• Robust implementation of SAFER & increased consultant coverage at the front door
& hot clinics – 24 beds (equivalent to 5% LOS reduction)
• Non weight bearing -15 beds
• Alcohol detox – 5 beds
• Community based IV Antibiotics - 7 beds
• Integration of hospital and social care discharge team and delivery of Single Point of
Access – 15 beds
• Adherence of choice policy + brokerage to support self funders – 4 beds
• Protect assessment areas from bedding – 5 beds
• Delivery of medical day unit – 6 beds
• Front door frailty – 8 beds
• Total – 89 beds
Measures of success:
• Reduction in the number of patients waiting in ED >12 hours
• Reduction in the percentage of patients with a LOS >20 days
• An additional 9 extra weekend discharges
9 Your community, Your care : Developing Buckinghamshire Together
Areas of focus for improving patient care and experience
Real time patient flow
10 Your community, Your care : Developing Buckinghamshire Together
Live dashboards now give visibility of flow across BHT. Delivery of a ICP reporting system to replace Alamac goes live in September, and a ward dashboard in October.
Ensuring the safety of our patients
• ED: SHINE in place – emergency department safety checklist
• Safe staffing huddle twice daily
• Ward patient safety huddle
• Director of flow- reviewing safe placement of patients in escalation and plus
one
• Safe care element of health roster – live view of staffing taking into account
numbers and needs of patients
• Allocate on arrival staffing (2 Registered Nurse & 4 Health Care Assistants)
• Intentional rounding
• Acute & Community Flu immunisation plan
• Norovirus plan
• CCG/BHT joint quality visits to core services
• Normal practice of monitoring SI, incidents, complaints
11 Your community, Your care : Developing Buckinghamshire Together
An integrated approach to discharge
• Spending time in a hospital bed when you are not acutely unwell is harmful
• Existing discharge process are complicated and cause unnecessary delays
in patients leaving hospital
• There is clear focus in the ICP to work collaboratively in improving
discharge pathways to simplify and speed up process by:
– Integrating hospital and social care discharge teams
– Delivery of single point of access for professionals to refer patients who
do not require acute hospital care – avoiding admission and enabling
discharge
– Bringing forward the planning of discharge to take place in parallel to
the patient becoming medically ready
– Implementing national best practice for patient flow including the
SAFER patient flow bundle
12 Your community, Your care : Developing Buckinghamshire Together
A system approach to escalation
• Nationally a system call OPEL (Operational Pressures Escalation
Levels) is in place to provide consistency and structure to identifying
• We want to work across the ICS to align our thresholds for
escalation
• As an ICP we are working to review the existing OPEL structure and
ensure the actions across both BHT and system partners are
appropriate, timely and sufficient to mitigate risk.
• This is particularly relevant for days of greatest risk and escalation,
where anticipatory action can prevent the system reaching OPEL 4
13 Your community, Your care : Developing Buckinghamshire Together
Ensuring the well being of our staff
• Clear messaging to all staff to look after their personal wellbeing and take their breaks
• Staff and wellbeing service in place – over winter this can be delivered in situ in ED and other critical clinical areas and be accessible and available for staff to drop in and be signposted elsewhere if required
• Regular walk-abouts by executives and other senior leaders across all acute and community sites to troubleshoot and ensure visible and easy access to the leadership team – the team are constantly aware of the system position, and respond in particular to teams under pressure
• Flu vaccinations offered on site to all staff, peer vaccinators in place to further enhance coverage
• ‘Go Engage’ programme to support collaborative and successful team work
• Before you got home checklist to be rolled out, particularly focused in key patient flow areas
• How can we better support our primary care staff?
14 Your community, Your care : Developing Buckinghamshire Together
CHC and End of Life CHC
• We have integrated our placement commissioning team with Bucks CC to identify placements
so patients can move from hospital in a timely way, thus improving flow
• We are implementing a Nursing Needs Assessment for hospital patients to reduce the number
of patients who require a CHC checklist before they leave the hospital and move into a
nursing home
• We are increasing capacity and implementing LEAN processes within the CHC team to
ensure timely turnaround of CHC applications
• We will be piloting an out of hospital pathway for some patients who have had a CHC
checklist and it shows a full (Decision Support Tool) assessment is required. This will allow
discharge of patients from hospital sooner in a more home-like environment
End of Life
• We have the Airedale /Immedicare 24/7 nurse video consultation system in place in 37 of the
largest care homes with the highest rates of hospital admission, covering 50% of the 4,000
care home beds in Buckinghamshire. This reduces the need for hospital admission, improves
quality of care for residents and has led to fewer hospital admissions from care home
residents dying in hospital
• We are exploring ways in which end of life providers can increase capacity for supporting
people to die in their own homes rather than in hospital
15 Your community, Your care : Developing Buckinghamshire Together
South Bucks
• Paediatric advice line purchased for South Bucks patients to reduce attendance
– audited and impact on ED attendances and OP demonstrated
• From 1st July Buckinghamshire will be starting D2A Dom care in zone 1 (4hrs per
day) and 2 (7hrs per day) and 1 bed in Parkfields for Buckinghamshire CCG
patients in Wexham Park Hospital.
• D2A will be increased to a maximum capacity from January 2020 of 10hrs per
day in Zone 1 Dom care; 15hrs per day in zone 2 Dom care and 3 beds in
Parkfields.
• Further discussions with Wexham Park Hospital regarding the Cardiology and
Respiratory work streams
• Monmouth Team coding challenges to reduce price
• Develop dashboard to include tracking metrics – HRG level
• Real time access to the Bucks admissions and attendances to WPH is now
available and graphs are produced by CSU
16 Your community, Your care : Developing Buckinghamshire Together
Glossary OPEL (slide 2)
• Operational Pressures Escalation Levels. A graded (OPEL 1-4) set of actions to assist health and care systems in managing patient flow
NEL admissions (slide 3)
• Non-elective: care/admissions that are not pre-planned
Hot clinics (slide 4)
• Rapid access clinics aimed at reducing admission rates
Silver phone (slide 4)
• Direct access by phone to a consultant geriatrician
Safe havens (slide 4)
• Professional out of hours support for those in mental health crisis
DoS (slide 5)
• Directory of Services, an NHS online directory of thousands of health services, accessible by health and social care professionals
Intermediate nursing care home beds (slide 6)
• Intermediate care services are provided to patients, usually older people, after leaving hospital or when they are at risk of being sent to hospital
MADE- Multi-Agency Discharge Event (slide 7)
• MADEs are a collegiate exercise, consisting of members across health and social care, to highlight and challenge system partners to reduce delays (internal and external) and support safe and timely discharges
ICP LLOS directors call (slide 7)
• ‘Long Length of Stay’ discussion between senior system partners to escalate issues and expedite planning
Choice policy (slide 9)
• A series of steps communicated to the patient about their expected length of stay, and planning for timely and effective discharge
SAFER (slide 12)
• Five elements of best practice to achieve good patient flow and outcomes
CHC LEAN processes (slide 15)
• A set of working practices to create the best value from available resources
17 Your community, Your care : Developing Buckinghamshire Together
Top Related