Item 7 - Resilience Update
North Lanarkshire Council · 17 May 2023
Back to Health and Social Care Integration Joint Board — 17 May 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 REPORT Item No: 7 SUBJECT: Resilience Response TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 17 May 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board: For approval For endorsement To note 1.2 This paper sets out the actions being taken in response to current whole system service pressures. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The PFA is asked to: (1) Note that NHS Lanarkshire stood down its Covid Live Incident down in January 2023, though command structures have been adapted to continue to focus on ongoing wider resilience challenges, specifically around service pressures (2) Note that NHS Lanarkshire was able to move from black to red status on 6th March 2023, following a successful ‘firebreak’ as part of Operation Flow 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. Yes No N/A
Page 2
2 5.1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 The IJB received an update on Operation Flow at its meeting on 22nd March 2023 and again at the PFA meeting on 19th April 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 5.2.2 Following two further face to face planning sessions that brought together leaders from across the whole system, a Task and Finish structure has now been developed to take forward the key actions agreed for Operation Flow 2 (see appendix 1). 5.2.3 Five Task and Finish groups commenced on week beginning 24th April, with the aim to have the second stage of Operation Flow fully implemented by September 2023. 5.3 Delayed Discharge 5.3.1 One of the key aims of the Firebreak was to utilise multi-agency teams to review all inpatients on a daily basis, with the aim of improving the flow of the 95% of patients who don’t need supported discharge, but also supporting earlier identification of the 5% who will require support. 5.3.2 Performance in North Lanarkshire has been on an improving trajectory since February, though the Easter fortnight did present some challenges as demonstrated in figure 1, though performance has returned back to the mid-70s by the end of April. Figure 1 North Lanarkshire Delayed Discharges 5.3.3 Figure 2 shows that bed days were out with routine variation in January but have returned within the control limits in February. This contrasts with the Scotland position where delayed discharge bed days for standard delays are at pre Covid
Page 3
3 levels with special cause variation September – February 2023 (fig. 3). Since the operation flow ‘firebreak’ in late February/early March, delayed discharge performance has been on a positive trajectory. Figure 2 HSCP NL SPC Standard Bed Days Figure 3 NHS Scotland Standard Delays bed days 5.3.4 Performance at the 10th April 2023 Public Health Scotland data release (figure 4) showed North Lanarkshire continued below the Scottish average in terms of rates of delay for the overall adult population and in a similar position for 75+ delays.
Page 4
4 Figure 4 Patients in standard delay, rate per 100,000 for all HSCPs 5.3.5 The number of patients discharged with no delay dropped from 96% to 95% (target 98%) over the Easter fortnight (figure 5). Figure 5 All inpatient discharges 5.3.6 Whole system work continues on the Discharge Without Delay process, current performance (figure 6) shows the overall increase in patients aged 65+ who have a PDD set and remains consistently around 60% though this has dipped moving into April. Figure 7 shows a decrease in unplanned referrals to their lowest point in six months in the middle of March but these have increased again in recent weeks. Figure 6 Current Inpatients (at time of census) with a Planned Date of Discharge
Page 5
5 Figure 7 Current Inpatients (at time of census) with a SW referral that is unplanned 5.3.6 Factors affecting performance over Easter: Higher annual leave across the whole system Increase in sickness absence, including Covid Significant pressures on acute sites, with added complication of a peak of Covid inpatients hitting highest number in a significant number of months of over 130 Due to site pressures, referrals for supported discharge on the date of clinical readiness increased and planned dates of discharge dipped. It is important to note, however, that both Lanarkshire partnerships have not seen the deterioration in performance around Delayed Discharge as seen elsewhere in Scotland since the pandemic due to the significant improvements in use of planned dates of discharge and reducing numbers of unplanned referrals (though admittedly starting from a poor baseline) Demand for supported discharge remains very high, with over 130 referrals per week being received in recent weeks. To put this into context, during the peak winter pressures of 2019/20, North Lanarkshire had the highest rate of referrals for supported discharge in Scotland, averaging 77 referrals per week. 5.3.7 Current developments: New Home Assessment Teams are now live in 2 Localities and rolling out across the remaining 4. These teams provide wrap around care and assessment for 2wks in people’s own homes. This allows us to provide early supported discharge and assessments in the patient’s own home, rather than in an acute environment. To date, we have received 608 referrals from hospital, with 62% requiring no ongoing Home Support after the 2wks of support. The aim is to provide this service from community as well in future to prevent unnecessary admissions Additional Clinical Support Worker posts have been created in the District Nursing Teams to focus on those identified for Care Management (highest risk of admission) to support more proactive support of high risk patients in the community New choice protocol developed to more proactively manage Care Home related delays Lanarkshire is a demonstrator site for Discharge Without Delay. The graphs above highlight the improved understanding of our system and whole-system focus on improvement
Page 6
6 Home Support programme board in place to review the current service model and implement new ways of working 5.3.8 With a number of upcoming long weekends in May, the partnership will have a full presence on the acute sites over the long weekends, including our Home Assessment Teams, while Planned Dates of Discharge will continue to be set for over the long weekends with the aim of ensuring flow is maintained. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan Operation Flow and to enact the firebreak at scale and pace. 6.2 The reduction in occupancy levels across all three sites has allowed NHS Lanarkshire to move from black to red status on 6th March 2022, following over 6 months in black status. 6.3 Attention has now moved to make the most of the system decompression to move forwards with the ambitious change programme identified to ensure the positive performance improvements can be sustained and indeed further improved over time. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None.
Page 7
7 9. APPENDICES Appendix 1: Operation Flow 2 structure ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
Page 8
8 Appendix 1: Operation Flow 2 structure