ITEM 5 Whole System Winter Planning 2023-24
North Lanarkshire Council · 24 January 2024
Back to Health and Social Care Integration Joint Board — 24 January 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 5 SUBJECT: Whole System Winter Planning 2023/24 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Author(s) of Report Report content was developed by Craig Cunningham, Head of Commissioning and Performance, South Lanarkshire Health and Social Care Partnership and Kirsty Orr Head of Planning and development, NHS Lanarkshire. . Refreshed for North Lanarkshire IJB by Stacey Anderson DATE: 24 January 2024 1. PURPOSE OF REPORT For approval ☐ For endorsement ☐ To note ☒ This paper is coming to the IJB to provide an update on and confirm support for the planning arrangements being put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months – with particular recognition of the uncertainties and potential impacts that still remain relating to inclement weather, Covid 19, influenza, financial pressures, cost of living issues and other concurrent risks against the backdrop of major pre- existing system-wide pressures 2. ROUTE TO THE BOARD This paper has been:
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2 Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ This paper has been prepared by the multi-agency, multi-disciplinary winter planning group alongside the key action areas of Operation Flow 2 and reviewed by PPRC and NL H&SCP SLT. 3. RECOMMENDATIONS 3.1 The IJB is asked to: note the extensive planning undertaken to date; the range of ‘early warning systems’ in place to seek to identify any issues and mitigate accordingly; and the variability of a series of scenarios which mean that the winter plan will require to be constantly reviewed and flexed to meet any emergent issues. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Annual ‘whole system’ planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Lanarkshire Health and Social Care system – in common with that across Scotland - continues to face significant challenges. Last winter, health and social care services and staff had to contend with some of the most extreme winter pressures ever known, many of which continue to be issues for the system. 5.1.1 Planning for Winter 2023/24 commenced in August 2023 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24).
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3 5.1.2 Given the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as – and should be understood to be - a dynamic plan and one that is highly likely to be subject to change over the coming months. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific exercise was undertaken on 9 November 2023 to test system-wide planning. 5.1.3 Additionally, work undertaken last year by NHS Lanarkshire to take account of the increasingly likely eventuality of a number of concurrent risks which may well align to create increased system pressure has also been utilised as part of the wider winter planning process. These risks include, inter alia, further waves of Covid 19; increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages in all sectors and grades across the Health and Social Care sector; public health impact of cost of living crisis/fuel costs and subsequent demand on health and care services; inclement weather and available finances. 5.2 National Guidance / Scottish Government Correspondence 5.2.1 On 22 August 2023, Scottish Government hosted a national Winter Resilience event which highlighted a range of examples of good practice that could be considered as part of winter planning. The vast majority of these examples related to supporting good system flow all year round and many are already in place in a Lanarkshire context. There was however learning from the event which has been built into the Lanarkshire plan for 2023/24, including areas of work associated with system flow and support for additional care in a community context, thereby reducing reliance on hospital care. 5.2.2 A self-assessment relating to preparing for winter was also undertaken by the multi-agency group and duly submitted to Scottish Government on 22 September 2023. 5.2.3 National guidance was subsequently published on 24 October 2023 which set out the national expectations for those areas that local winter plans would be expected to address. 5.2.4 At the winter planning meeting of 17 November 2023, colleagues from Public Health Scotland shared a set of data on anticipated additional bed pressures on the basis of current/anticipated demand associated with prevalence of influenza, Covid and other respiratory illness as currently predicted. In turn, this will be monitored to capture any revisions and also sets a useful indication of the additional beds that may be required to support the system at peak periods. 5.2.5 Some funding has been made available centrally in 2023/24 to support winter planning as well as some monies managed internally as part of the respective financial plans to anticipate winter pressures. Following discussion between the NHS Lanarkshire Director of Finance, the two Chief Financial Officers of the IJBs and Council Finance colleagues, funding to manage the impact of winter
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4 and ongoing pressures has been identified and further detail is set out at item 7 below. 5.3 Approach to Winter Planning 2023/24 5.3.1 Whilst the winter plan will be a Lanarkshire wide plan, it is being structured in two main parts for 2023/24. This is to recognise the significant work underway currently as part of Operation Flow 2 – which is aimed at maximising flow through acute hospitals and associated care pathways. Continuation and emphasis of particular aspects of this work will form the basis of the winter planning for acute hospital services. 5.3.2 All other aspects of the Lanarkshire wide winter plan will be undertaken in the normal way via the multi-sectorial/multi-agency winter planning group. Representation from acute services/Operation Flow forms part of the wider group to ensure all necessary synergies are recognised and planning is appropriately integrated. 5.3.3 As well as the national guidance referred to at 3.4, there was also a debrief of the winter plan for 2022/23 and this also features as part of the planning for winter 2023/24. 5.4 Acute Services/Unscheduled Care Winter Planning through Operation Flow 2 – including ‘power up’ 5.4.1 As reported to the Health Board at its October meeting, a system wide Operation Flow Pause Event was held on 29 September 2023 with managerial, operational and clinical leaders from across the system. The objective of the session was to provide space and time to consider if the plan aligned with needs, informed by learning from the peer review visit from colleagues from NHS Tayside. This included reassessing and confirming that the plan has the capability to deliver a better Winter for both patients and staff. 5.4.2 To enhance patient safety and staff well-being, the three priority areas agreed as continuing to underpin Operation Flow were noted to be: Managing Demand across our system Maintaining a positive admission and discharge balance Maximising Outflow 5.4.3 Creating the right conditions for the success of the winter plan is essential. Consequently, preparation has included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation. System readiness is also underpinned by the delivery and implementation of the detail of the site and HSCP level improvement plans. This focused preparation period – ‘Power up’ – has ran through the month of October. 5.4.4 The actions that have been progressed to support Power up have included:
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5 Testing the REACT processes as part of the new Front Door Target Operating Model to increase streaming of patients to the right part of the system in UHH and UHW. The testing has helped to ensure that processes are tested and staff confidence is increased prior to Go Live Maximise the availability of Senior Clinical Decision Maker in the Flow Navigation Centre as part of the new care model to support direction of patients to the right place and at the right time. The new care model was launched on 1 November 2023 Increase ‘Near me’ consultation and ‘Call before you Convey’ between Hospital @ Home and SAS to increase efficiency and capacity within the service Completing the bed base modelling for UHW and UHH sites to inform future planning and consideration of reconfiguration of the bed base to manage demand Undertaking focused improvement work within Medicine for Older Adults – UHW to maximise flow across the acute site and offsite beds Fast tracking access to interim care beds at Cumbernauld Care Home to create acute capacity Undertaking a review of all inpatients categorised as Hospital Based Complex Clinical Care (HBCCC) to determine if appropriately coded and placed or if another care location is more appropriate to meet their needs 5.4.5 The actions outlined above are aligned to the Acute sites and HSCP based improvement delivery plans and the remaining actions being progressed through the task and finish group structures. 5.4.6 As part of the ‘Power up’ plan, all patients who have been inpatient beyond, seven, 14 and 21 days will be reviewed to assess if alternative care options could be provided and, in turn, to assist in decompressing the respective hospital sites by accelerating discharge when safe to do so. 5.4.7 There will be continual oversight of flow through the Executive Flow Oversight Board on a weekly basis, utilising all appropriate data as well as multiple daily reviews of system operating issues and the necessary actions being agreed. 5.5 Discharge Without Delay 5.5.1 Work continues in the enactment of the Discharge Without Delay programme and its related aspects, e.g. embedding of Planned Date of Discharge; consistent roll out of Home Assessment Team (North) and Home First (South); increased numbers of people being supported to die at home via ‘pathway 4’ and further work with third sector providers. 5.5.2 In particular, work being undertaken by the Home Assessment Team in North Lanarkshire has also made significant improvements in the number of people able to be supported out of hospital with no/little delay.
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6 5.5.3 Similarly, through the development and embedding of the ‘Home First’ model in South Lanarkshire HSCP, additional capacity is being created to support the review of the Care at Home service. 5.5.4 Both of these services are now seeing an increase in the number of people who are being supported to be rehabilitated to a level of being able to manage their own care independently or, in some instances, with a reduced level of care than may have been originally assessed when in the hospital or first referred. 5.6 Social Care Provider Sustainability 5.6.1 Independent providers of social care in Scotland – notably care homes and care at home providers – have highlighted the extremely difficult operating environment. As well as the cost-of-living-crisis and the lasting impact of measures introduced during the management of the pandemic, vacancy pressures also continue to be a concern for a number of providers. 5.6.2 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider environment and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care workforce challenges) and statutory/legal parameters. On a Lanarkshire-wide basis, support and quality assurance for Care Homes continues on a whole system basis to be overseen by the Pan-Lanarkshire Care Home Assurance Tactical (CHAT) Group; and for Care at Home Services through the equivalent Care at Home Oversight Group. The Care Inspectorate participate in both of these meetings. 5.7 General Practice and pharmacy opening 5.7.1 As in previous years, a local enhanced service to support general practices opening on the fourth day of the weekend/public holidays – that is, on 26 December and 2 January, as well as the Saturdays through January 2024 - has been offered and around 60% of practices are participating in this at one time or another throughout the period. There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, the Primary Care Out of Hours (PCOOH) Service, Emergency Departments and the FNC where possible. 5.8 General Practice sustainability 5.8.1 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. 5.8.2 This was the subject of previous presentations to the Board which included describing the work ongoing to address capacity and demand – most notably, through the Primary Care Improvement Plan (PCIP) that is reported through to the NHS Lanarkshire Board and IJB(s) as per the expectations within the General Medical Services (GMS) Contract.
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7 5.8.3 As part of the regular reporting to Government on system pressures through the winter period, there will be weekly updates on the numbers of practices where they believe they are unable to provide the full range of services that they would under ‘normal’ working conditions. This reporting process commenced on 13 November 2023. 5.9 Primary Care Out of Hours 5.9.1 For a considerable period, and similar to most Scottish ‘out of hours’ services, the NHS Lanarkshire PCOOH Service has had to manage workforce availability challenges (notably in relation to GPs); and has regularly had to contend with escalating levels of demand. 5.9.2 The new clinical model has assisted the PCOOH Service to move to a more multi-disciplinary workforce and competency-based model of care, thereby reducing the number of occasions when alternative arrangements have been introduced. This will also be enhanced over the winter period to ensure additional staff are available to manage the additional demand that can be anticipated across the peak activity periods in winter. 5.10 Contingency Arrangements for Additional Deaths 5.10.1 As set out within national guidance and is the case every year, work is underway – including with local undertakers - to ensure that there is sufficient ‘pace’ of funeral services (both burials and cremations) to support the eventuality of a significant excess of deaths over the winter period. Additional mortuary capacity identified for Covid 19 is still in place and will continue to be available over this winter period if required. 5.11 Covid 19 and Flu Vaccine Programme 5.11.1 Following final advice on the winter Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), the following groups are being offered an additional Covid 19 booster: Residents in a care home for older adults and staff working in care homes for older adults. Frontline Health and Social Care workers. All adults aged 65 years and over. Those aged 5 to 49 years in a clinical risk group, including those who are pregnant. Those aged 5 to 49 years who are household contacts of people with immunosuppression. Flu vaccines will be available to a wider range of individuals, including all >50 year olds. 5.11.2 The programme is well advanced and take up of vaccines is on target to be consistent with national performance. In addition to this, there is a range of services designed to offer vaccines to any who are in geographical areas or part of a thematic/ethnic group where take up of vaccine is less than hoped for.
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8 5.12 Carers Support 5.12.1 Funding from the Carers (Scotland) Act 2016 allocation 2023/2024 has been used to enhance operational services for carers across both Partnerships. This included monies from this funding being directed to support ongoing work with carers, with a particular emphasis on the Self-Directed Support (SDS) agenda; and a strengthened internal capacity within the HSCPs to enable frontline staff in managing increasing demand with regards to supporting carers. 5.13 Staff Wellbeing 5.13.1 NHS Lanarkshire’s Health and Wellbeing Strategy will form an integral part of the system wide winter plan, with the emphasis on providing a working environment in all areas across Health and Social Care where staff are able to enhance and maintain their personal and professional wellbeing and to reach their full potential in a culture that provides space, time and support for self- care. 5.13.2 The Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded fully and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to manage the dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 5.13.3 Council employees can also access a range of materials to support health and wellbeing through the respective employee programmes. 5.14 Adverse Weather 5.14.1 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both North and South Lanarkshire Councils have policies in place in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 5.14.2 A series of actions is open to the organisations – individually and in collaboration - in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations.
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9 6. CONCLUSIONS A range of implementations and reviews have taken place to ensure the right conditions for the success of the winter plan. Preparation have included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation to support continuous patient flow and care. 7. IMPLICATIONS 7.1 Concurrent Resilience Planning and Risks 7.1.1 As highlighted above, there is a potential of concurrent risks aligning to have a significant impact on the wider health and social care services. 7.1.2 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. A very well attended ‘Winter Breach’ event was held on 9 November 2023, organised by the Lanarkshire LRP and focussing on the potential disruption caused by severe flooding. 7.1.3 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒
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10 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL 7.3.1 A number of funding sources are being utilised to cover the cost of the additional services being introduced to support enhanced staffing and services across the peak winter period. For the majority of services, they will operate from mid-December through to mid-March. 7.3.2 Funding sources include nationally provided Unscheduled Care monies; monies announced on 24 October to support additional winter planning; financial plans of both the NHS Board and the two H&SCPs as well as the potential use of some of the funding associated with Operation Flow and the attendant aspects which will be enhanced over the winter months. 7.3.3 In total, it is anticipated that circa £4.0m will be utilised in funding all the additional services which will be provided and this can be funded from the available budgets. This paper has been reviewed by Finance: Yes ☒ No ☐ N/A ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 As highlighted above, there is a potential of concurrent risks aligning to have a significant impact on the wider health and social care services. 7.4.2 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. A very well attended ‘Winter Breach’ event was held on 9 November 2023, organised by
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11 the Lanarkshire LRP and focussing on the potential disruption caused by severe flooding. 7.4.3 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. Relevant Risk Register Details Current Risk Level Risk Owner IJB – Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. High Ross McGuffie 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken.
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12 Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff □ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.5.1 Work is underway at both local and national levels on the public messaging in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. South and North Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. 7.5.2 The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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13 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS Appendix 1 Health and Social Care Winter Preparedness Plan 2023-24. 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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14 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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15 Appendix 1 Health & Social Care Winter Preparedness Plan 2023/24
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16 Contents Joint Foreword by Cabinet Secretary and Councillor Kelly .......................................... 3 Introduction ................................................................................................................ 5 Our Principles and Priorities for Winter 2023/24 .......................................................... 6 Learning from Last Winter ............................................................................................ 7 A Different Approach ..................................................................................................... 8 Working in Partnership ............................................................................................. 8 Improved data collection and reporting..................................................................... 8 Winter Summit ........................................................................................................ 9 Winter Preparedness Checklist ............................................................................... 9 Priority One. Ensure people receive care at home, or as close to home as possible, where clinically appropriate ........................................................................................ 10 Priority Two. Consistent messaging to the public and our staff that supports access to the right care, in the right place, at the right time ................................................... 12 Priority Three. Focus on recruitment, retention and wellbeing of our health and social care workforce .......................................................................................................... 13 Priority Four. Maximise capacity to meet demand and maintain integrated health and social care services throughout autumn and winter .................................................... 15 Priority Five. Support the delivery of health and social care services that are as safe as possible throughout the autumn and winter period, including delivery of a winter vaccination programme for Covid-19 and flu .............................................................. 17 Priority Six. Work in partnership across health and social care, and with other partners, to deliver this Plan ....................................................................................... 19 Priority Seven. Protect planned care with a focus on continuing to reduce long waits. ..................................................................................................................................... 20 Priority Eight. Prioritise care for the people in our communities who need it most. .. 21 Summary and Escalations .......................................................................................... 23
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17 Joint Foreword by Cabinet Secretary and Councillor Kelly There is no doubt that this winter will present considerable challenges to people who need to access our health and social care system, which is why the planning cycle for this winter has started earlier than ever before. The Scottish Government and COSLA have been supporting the system to be as ready as possible for the pressures it will face since the end of last winter, so that people can continue to access health and social care services and support when they need it most. We expect an extremely pressurised winter, and local systems are preparing to work flexibly and responsively to prevent issues and address them as they arise, working across boundaries with the voluntary and independent sectors, and, vitally, with individuals, their families, carers and communities, to meet need and maximise impact. We continue to see a change in the demand for health and care services: our population’s needs are increasingly complex, and more complex personalised care is required at the point of discharge from hospital and onwards to a care home or their own home with support. This sits alongside the increase in patients we see every winter with respiratory illnesses such as flu and RSV, and weather-related injuries from falls and accidents. We are experiencing significant recruitment and retention challenges across the health and social care workforce. And of course, the potential for a rise in Covid-19 cases informs our thinking and scenario planning. This plan recognises the interdependence and integration of health and care services and seeks to ensure that people in Scotland receive safe and timely access to health and social care services and supports over winter. We have significantly strengthened our efforts to support the system in its planning and preparations for the inevitable challenges this coming winter will bring. Local systems are assessing their own readiness and will take decisions both to prevent and to address pressures as they arise. This plan aims to support local systems to, when needed, make changes, at pace, to relieve pressure and drive improvement, to provide the best levels of care possible for the people we serve. However, there is also a recognition that at times, we will need to prioritise care and support for those most in need, particularly when levels of demand and need rise. This Winter Plan sets out the actions we know from previous winters work to help relieve pressure points across the system. We believe the principles and measures set out in this Winter Plan are the right ones. Critically, we are encouraging the system to adopt a ‘home first’ approach when it is clinically appropriate to do so. Providing care in a home setting is better for people, and better for their families and carers and also frees up capacity in our hospitals. We are providing the conditions for the system to do this. For example, the Scottish Government is significantly increasing investment in hospital at home, an initiative providing acute care at home which has consistently delivered improved levels of patient satisfaction compared to in-hospital care. We are united in our resolve to deliver for our citizens, and the Scottish Government and COSLA have been working tirelessly to create the conditions needed for the whole system to deliver. This Winter Plan forms the basis of a joined-up and collegiate approach to increase resilience, reduce pressure and improve outcomes for our citizens across the complex landscape of health and social care.
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18 Michael Mathieson Councillor Paul Kelly Cabinet Secretary for NHS Recovery, COSLA, Health and Social Care Health and Social Care Spokesperson
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19 Introduction This Winter Plan represents a whole system approach to responding to a surge in demand for health and social care services. While the focus of this plan is on the winter months, the measures outlined are applicable to other times of the year when our health and social care system faces increased pressures. We are encouraging systems to adopt a preventative approach as far as possible to mitigate and reduce harm by ensuring people who need health and social care services are receiving the right care, at the right time and in the right place. Whilst this plan provides a national overview, in developing this plan we recognise the important contribution of the voluntary and independent sector locally in delivering care and acknowledge that these services are commissioned through local arrangements. This Plan seeks to address the specific operational pressures experienced across the health and social care system over winter. We have engaged with the independent and voluntary sector as partners and leaders in the delivery of social care across Scotland. Alongside partners, the Scottish Government and COSLA continue to discuss the creation of a National Care Service which will deliver improvements for people accessing community health and social care support. Although the health and social care system is well-used to planning, preparing and delivering care ahead of and throughout winter, we have strengthened our approach this year to reflect our experiences over the last few years. In doing so, we are embedding the following key components to support a more resilient health and care system better aligned to meeting people’s needs by: Whole system focus and oversight, recognising the critical interdependencies across the system. Earlier engagement and planning for winter than ever before. Having an approach that acknowledges and responds to pressures across the whole system. Implementing lessons learned from 2022/23 and previously. Supporting local systems to develop their demand and capacity plans to identify current and future requirements to support surge response. Developing a national target operating model with key resilience measures and a clear understanding of the impact that improvement work will have to achieve our targets. Taking action on returns from a preparedness checklist for local systems, ensuring we have a clear understanding of risks to the system both locally and nationally Improving data quality and reporting to support local and national assurance and understand when escalation is appropriate. Targeting interventions where there is greatest need. Utilising proven digital tools to maximise capacity. Providing the conditions needed for a ‘home first’ approach.
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20 Our Principles and Priorities for Winter 2023/24 We have developed a set of planning principles and priorities to guide our health and social care services as we put people at the heart of what we do, whilst we build our resilience to meet changing demand, recognising that surges can occur at any time of the year and not just winter. In developing our priorities, we have reflected on our approach in previous years and sought to build on what we know works, and stopped what has failed to have the desired impact, whilst strengthening our approach to both planning and delivery of the plan at a national level. In particular it is important for us to maintain a whole system focus given that people do not differentiate between the organisational boundaries in which each individual system operates, and given the knock-on impacts pressure in one part of the system has on others. By ‘whole system’, we mean every interface between an individual and the health and social care system: from pharmacy, primary care, NHS Inform, NHS 24, the Scottish Ambulance Service, to A&E and acute and community hospital settings, and on into care provided at home or in a care home setting. Carers and the voluntary sectors have a key role to play within the system. A whole system approach recognises that pressures within any area of the health and care system will impact other areas, and that any actions taken must consider this interdependency. The seven winter planning priorities, which we are empowering local systems to adopt, coalesce under three critical principles: Right care, right time, right place A partnership approach across the whole system Local and national actions we know work
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21 Learning from Last Winter Our approach this year has built on our response to previous winters, including the most recent, where we adopted a whole system approach to managing the extreme and unprecedented pressures we experienced. Last winter, we saw unacceptable waits for ambulances, queues of ambulances outside A&E, long delays in A&E departments, high levels of hospital occupancy, high levels of delayed discharge, high levels of unmet need within our communities, increased demand for GP appointments and increased demand for social care packages and assessment. Local systems, and the individuals and organisations that work within it to deliver health and care to our most vulnerable individuals – worked hard to meet high levels of demand and ensure people received care when they needed it most. However, we know that complex challenges remain and there is still work to be done to ensure people can access the care they need. To inform our approach moving forwards, we undertook a comprehensive exercise to understand the lessons learned from last winter which focused on the development, delivery, and governance of the published actions. The report makes several recommendations which have been considered and incorporated into the current winter planning work. The report highlighted that some actions and interventions had greater impact than others. However, even those with lower impact were still instrumental in building the resilience of the system to respond to surges in demand so should not be discounted. For example, Scottish Government made additional funding available for international recruitment in October 2022. We have learned that earlier communication of this intervention may have allowed local Boards and Partnerships to begin recruitment so that this could provide additional capacity in time for winter. For this year, we have worked with partners to bring forward recruitment campaigns. Critically, the report highlighted that to be effective, planning should begin much earlier and that is why this year, work began across the health and social care system in early Spring 2023. This included the launch of our Delayed Discharge and Hospital Occupancy Action Plan in March 2023, which set out a series of actions to be implemented and delivered throughout the year to build resilience and capacity in our systems.
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22 A Different Approach There are a number of critical areas where we have built upon the lessons learned from previous winters and taken a different approach to planning. Most notable of these are: Working in Partnership We have brought integrated planning into the core of preparations and have developed an extensive joint governance and assurance mechanism between the Scottish Government and COSLA. As part of this, a Whole System Planning and Oversight Group, which is chaired by Chief Executives from health boards, local authorities and a Chief Officer on behalf of Health and Social Care Scotland, has been overseeing and seeking assurance on the implementation of the Delayed Discharge and Hospital Occupancy Action Plan which sets out the interventions we know improve flow through the hospital and, vitally, improve the experience for people. We continue to support local systems to make the necessary changes to drive these improvements and to monitor the resulting impact as the actions set out in that plan are vital in reducing occupancy and delayed discharge, ultimately freeing up capacity as we head towards a period of higher demand, ensuring people and families are seen to when they need it most. The Whole System Oversight Group ensures alignment with other groups with the overall aim of improving the experience and resilience of the health and social care system. Where further assurance and escalation for joint decisions between Scottish Ministers, COSLA and the Co-Chairs of the Whole System Oversight and Planning Group on the deployment of options that support the resilience of Health and Social Care are required, a Collaborative Response and Assurance Group (CRAG), co- chaired by the Cabinet Secretary and COSLA Health and Social Care Spokesperson, will be stood up. Improved data collection and reporting We have supported local systems in the development and utilisation of data to help us better understand and respond to the challenges being experienced. As part of this, demand and capacity modelling, supported by Public Health Scotland (PHS), provides a set of resilience indicators at Board and HSCP level to enable local services to target interventions during surge responses. PHS are producing a number of scenarios for winter 2023/24 based on Covid-19, flu and additional hospital occupancy to help understand the potential scale and shape of the demand that Covid and flu may present this winter, particularly in acute hospital settings. These scenarios will be adjusted to incorporate emerging data and evidence throughout the winter. We have developed and launched two new dashboards ahead of this winter which collate data from across the whole system to give Scottish Government, COSLA and the system itself the intelligence required to inform decision-making and action. The Social Care Response and Delayed Discharge dashboard and the Whole System and Winter dashboard provide national and local level data across 25 and 35
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23 indicators respectively. Where these begin to move into below-optimal rates due to increased demand, early responses can be co-ordinated across systems and targeted interventions deployed as necessary. Winter Summit The first NHS and Social Care Winter Planning Summit, co-chaired by the Cabinet Secretary for NHS Recovery, Health and Social Care and COSLAs Health and Social Spokesperson, was held in August 2023. This Summit brought together more than 300 leaders from across the country to share best practice and local plans for this winter. Crucial to this summit was ensuring people who use our services were at the centre of our preparations. Social care providers, local government leaders and the independent sector were represented alongside NHS colleagues. The Summit generated key expert, stakeholder, and system-wide input into decisions on winter planning and preparedness in advance of responding to surges, including winter 23/24. Winter Preparedness Checklist Ahead of finalisation of this Winter Plan, we asked local systems to undertake a state of readiness check. The Winter Preparedness Checklist sets out four key areas against which we asked Health Boards and HSCPs to provide an assessment of preparedness for their local systems: Section 1: Overview of Preparedness and Business Continuity Section 2: Urgent and Unscheduled Health and Social Care, and Planned Care Section 3: Primary Care, Mental Health and Social Care Section 4: Health and Social Care Workforce and Staff Wellbeing We are now using the outputs of this checklist along with the Delayed Discharge and Hospital Occupancy Action Plan self-assessment returns and dashboard data to create a holistic system overview and provide targeted and tailored support to those areas identified as having scope to improve and increase resilience. This approach also encourages benchmarking across and within the system, and identification and sharing of best practice between areas.
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24 Priority One. Ensure people receive care at home, or as close to home as possible, where clinically appropriate Primary and community care is, for many people, the front door to the health service, where their needs are first raised. Each week in Scotland, there are around 680,000 GP consultations, with 28,000 people being seen in our hospital Emergency Departments. The Scottish Government is supporting primary care to provide essential care where it is needed most – in our local communities - with funding for multi-disciplinary teams which has been increased to £170 million this year. For many, A&E may not be the best place for their healthcare needs and our Urgent and Unscheduled Care Collaborative improvement programme offers patients alternative routes to urgent care. The ‘home first’ approach is not only better for people, but supports acute and primary care services too. This includes expanding Hospital at Home services. The Scottish Government is investing over £15 million in 2023/24 to deliver additional virtual beds this winter, significantly increasing capacity in our system and reducing the need for emergency admissions every week, and of course better for people who need acute care. Unpaid carers and social care services, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated health and social care approach will be critical year-round but particularly over winter. The use of telecare and digital technology to detect and alert health professionals when a person is needing support is a crucial tool, as is the ability to maximise existing community and third sector supports. Everyone in need of emergency mental health care must receive that support quickly, and wherever possible, close to home. People presenting with stress and/or distress are often conveyed to hospital when there can be community-based alternatives that support the patient as well as the system as a whole. This will also ensure that people seeking mental health support receive the right care, in the right place, at the right time, regardless of where, or what time of day they present – there should be no wrong door. The Scottish Government and local government are also continuing to maximise the use of digital tools such as increased use of Near Me in Flow Navigation Centres, Connect Me. Telecare and M365 collaboration to improve our systems and widen access, investing in Pharmacy First and community nursing teams to support people in their communities, and actively managing demand for urgent and unscheduled care to ensure that patients are triaged appropriately and directly. How we will jointly deliver this priority: Proactively support people at highest risk of hospital admission within our communities. Critical to this is the strong partnership working between Integration Authorities and local partner providers and third sector interface, as well as nationally through our engagement with sector leaders which helps us better understand and respond to the pressures and challenges facing the sector.
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25 Through the actions underway in the Urgent and Unscheduled Care Collaborative Programme, we will improve urgent care pathways in the community including enhanced links across the primary and secondary care interface. Work with NHS 24 and Boards to review alternative pathways for people with urgent care needs both in and out of hours. This could include opportunities for Primary Care Multi-Disciplinary Teams (MDTs) to provide resilience to Primary Care OOH teams to address capacity issues and divert care from A&Es, though it is important that community MDTs function both in and out of hours, to reduce unnecessary conveyance to hospital. Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and out of hours. Increase the use of Flow Navigation Centres to reduce avoidable visits to A&E, optimising use of Call Before You Convey and Near Me video consultations. Continue to optimise the roll-out of Near Me for social work and out of hours services. Through the SAS Integrated Clinical Hub multi-disciplinary team, undertake a remote clinical assessment of patients to care for people closer to home through self-care advice or referral to other pathways. Further expand the Hospital at Home service with an additional £3.6 million of funding to enable people to be treated at home, where appropriate, and to expand access to acute care at home with expansion of Hospital at Home to other specialty areas such as Respiratory, Heart Failure, Paediatrics and OPAT services. Involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, this means engaging with the patient, their families, and carers in hospital discharge discussions to ensure their needs and wants are central to decision-making. Develop a data-based understanding of people who return to hospital upon discharge with a care package. Drive improvement through the Mental Health Unscheduled Care Network to allow people to access care in the most accessible setting.
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26 Priority Two. Consistent messaging to the public and our staff that supports access to the right care, in the right place, at the right time. To ensure that people receive the most appropriate care and are empowered to support themselves and those they care for, the Scottish Government is continuing to invest in making high quality healthcare information accessible. A multi-agency communications group provides an expert forum to agree key messages and develop national and local communications plans to ensure the public is well- informed. How we will jointly deliver this priority: All Boards, Local Authorities, Primary Care Contractors, and Partnerships to redirect and signpost people to the appropriate service for their needs, through national and local communications. Ensure the public are aware of key sources of information that will support them with their care needs, whether that information is delivered in person (for example, through social workers, community pharmacy or their local General Practice), via the telephone (NHS 24 on 111 for physical or mental health concerns) or digitally (nhsinform.scot, the NHS 24 online app, Care Information Scotland or local council websites). Messaging will focus on what a service is for rather than seeking to direct people away from a particular service. Self-management and self-care using the guides on nhsinform provide the public with an accessible resource to treat many of the common winter illnesses without the need to interact with a health professional. Communications will aim to increase awareness of these resources. Communications activity will be based on insight that has been gathered from evaluation of campaigns from previous years. Continue to build preventative messaging into health and social care communications activity for Winter (eg the vaccination programme, Mind to Mind, Healthy Know How) and throughout the year. Collaboration across national and local messaging by all stakeholders to ensure consistent messaging. Resources will be developed by Scottish Government, Public Health Scotland and NHS 24 that will be available online for any stakeholders to use through their own communications channels such as social media accounts, e-newsletters or in-venue signage to support local activation. Undertake scenario planning to identify the communication actions which can be implemented based on the level of system pressure being faced in order that appropriate messaging can be activated nationally or locally. Raise awareness nationally of the technology hubs that are located throughout Scotland where people accessing and delivering services can go to see technology in a home setting. Raise awareness that assessments for longer-term care needs should be undertaken at home whenever possible to ensure individuals get the correct level of support to maintain independence and reduce unintended harm.
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27 Priority Three. Focus on recruitment, retention and wellbeing of our health and social care workforce. Our highly skilled and committed workforce is the cornerstone of our response every winter. In order to meet demand, we must continue to focus on recruitment and retention of our workforce, ensuring that we support the wellbeing of our staff through challenging periods of high demand. We are pursuing a range of different strategies to nurture and grow the workforce in both health and social care over the long term. Within our health workforce, for example, this includes continuing to grow controlled healthcare subjects intake in line with evolving demand projections and supporting the expansion of trainee doctor posts, to reflect the changing demands on our health and social care system. Between 700,000 and 800,000 people provide unpaid care for a relative or friend at home and within other community or residential supports, and so we must also consider and respond to the wellbeing and support needs of Scotland’s hugely valued unpaid carers, as well as supporting flexible access to Self-Directed Support for people who access support and their carers. How we will jointly deliver this priority: Invest in recruitment utilising the full range of potential activity and interventions across health and social care in order to protect and maintain high quality services, including international and domestic social care marketing and recruitment campaigns. In support of retention and recruitment of the social care workforce, we will work with partners to ensure system readiness for the implementation of the commitment to enable a minimum rate of £12 per hour for those providing direct care in commissioned services from April 2024. While this commitment may not address immediate workforce pressures, it seeks to recognise the valuable efforts of our social care workforce during extremely challenging circumstances. We have also established a joint social services and social care taskforce, co- chaired by the Scottish Government and COSLA, supporting delivery and acceleration of workforce improvement activity across the social care and social work workforces. Have confirmed contingency plans in place to cover NHS staff disruption to manage the impacts, ensuring staff are fully aware of plans. Invest in local, third and independent sector organisations to support care at home teams and the wellbeing for those who provide practical support to people who are ready for discharge, and across the wider community. Raise staff awareness of digital tools available to staff that can increase capacity such as use of Near Me, use of M365 platform to safely and easily communicate, collaborate and share information, the technology hubs that are located throughout Scotland, and maximising the use of telecare devices. Continue to explore how volunteers can provide support in discharge and consider appropriate use of established local and national volunteer partnerships. Ensure people who provide unpaid care are supported in their caring roles and supported to look after their own health and wellbeing. Last winter we published the National Carers Strategy which set out the actions underway to ensure carers are supported fully in a joined up and cohesive way. It brings together existing
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28 initiatives and new approaches, and proposes new and better ways to support carers. Continue to support Boards and HSCPs to work with students and with retirees who may wish to return to work on a part-time basis to build short-term capacity as required. Support all health and social care staff appropriately in accessing the range of available local and national staff wellbeing resources and raise awareness of the mental health and wellbeing resources available on the Mind to Mind website.
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29 Priority Four. Maximise capacity to meet demand and maintain integrated health and social care services throughout autumn and winter. Both COSLA and Scottish Government recognise that actions and improvements to maximise capacity are best and most sustainably delivered in an integrated and co- ordinated way across the whole system. Local Authorities, Boards and Integration Authorities together with the voluntary and independent sectors, and indeed with communities, lead the way on integration of health and social care to deliver better experiences and outcomes for the people who access services. How we will jointly deliver this priority: Ensure consistent and effective discharge planning takes place over seven days and the holidays. Reduce the time people need to spend in hospital by promoting early and effective discharge planning deploying the basics set out in the Delayed Discharge and Hospital Occupancy Plan sent in March 2023 and robust and responsive operational management, and by recognising and meeting the challenges of unmet need in communities. The basics identified within the March Plan include: Admission avoidance. Social work input on every ward. Implementation of Discharge without Delay and Planned Date of Discharge. Early identification of complex discharges. Early engagement with people, families and carers. Implementation of discharge to assess and intermediate models of care. Daily multi-disciplinary reviews of all patients to ensure understanding of criteria to reside, planned date of discharge and early referrals for supported discharge ahead of clinical readiness date. Use of home-based assessments for all Home Support packages to ensure accurate person-centred assessments, in familiar and homely environments. This also results in more efficient use of scarce resources. Work intensively with HSCPs and Boards across the country to reduce delayed discharges for patients with learning disabilities and complex care needs moving from inpatient treatment to the community, including through supporting the use of the Dynamic Support Register, a consistent process for regularly reviewing and taking action to support individuals with complex needs. Continue to work with and support systems to ensure that suitable accommodation and support packages are in place to address delayed discharge of forensic mental health patients. Support telecare providers to increase the use of proactive outbound calling to support people who have been identified as being at risk or more vulnerable and directing them to community-based support earlier to keep them at home longer and prevent unnecessary admissions to hospital. Reduce time spent in the Emergency Department by working with Boards to deliver rapid assessment and care, enhanced triage and signposting or redirection and reduce length of stay.
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30 Make improvements to reporting and performance dashboards that will support visibility of capacity in social care, including levels of unmet need within the community and people awaiting community care assessments – and how this data impacts on the wider system. Embed use of the new dashboards to support benchmarking between systems and sharing of best practice. Work with Boards to ensure sufficient Dentistry and Optometry capacity to support referrals from NHS 24 and OOH/unregistered patient care and holiday cover. Run a mental health bed occupancy survey throughout the winter to ensure we have an understanding of service pressures and can offer support as required. Continue to support Boards to increase the use of Hospital at Home to enable people to be safely cared for in their own homes. Continue to maximise the use of Planned Day of Discharge, Discharge to Assess, Hospital to Home teams, community rehabilitation and other discharge support services.
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31 Priority Five. Support the delivery of health and social care services that are as safe as possible throughout the autumn and winter period, including delivery of a winter vaccination programme for Covid-19 and flu. Protecting people who may be most impacted by severe illness, hospitalisation or death from Covid-19 and flu, through vaccination, is a key means of protecting individuals from illness and reducing demand on our health and social care systems. We want to see as many people protected from Covid-19 and flu as possible this winter to help protect people’s health and alleviate pressure on the health and social care system. The winter vaccinations programme started on 4 September and the majority of vaccinations will be complete by 11 December to ensure protection before the main winter pressures begin (the programme will run until 31 March 2024). Scotland is the only nation offering a free flu vaccine this winter to everyone aged 50- 64 and deployment of both Covid-19 and flu vaccinations continues to be guided by advice from the JCVI. This winter programme focuses on those at greater risk of severe illness from Covid and flu; namely those aged 65 and over and those aged 6 months to 64 years at clinical risk. Priority is also being given to those who are unpaid carers. Improved demand and capacity forecasting around Covid-19, flu and underlying winter pressure scenarios is informing thinking and scenario planning to help national and local partners better understand and respond to the challenges being experienced. These scenarios will be adjusted to incorporate emerging data and evidence throughout the winter. Alongside this it will be important for us to continue to closely monitoring rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. In addition to vaccination and infection prevention, social connections, exercise and meaningful activity are vital for the wellbeing and quality of life of everyone, but in particular those living in a care home. It therefore remains fundamentally important that people living in care homes remain connected to their loved ones even in infectious outbreak situations in line with Public Health Scotland Covid-19 Guidance. How we will jointly deliver this priority: Work with Boards to operationalise delivery of the winter vaccination programme, bringing this forward for those at highest risk where possible (care home residents, people aged 75 and over and people with weakened immune systems aged 12 and over) as a precautionary measure in light of the emergence of new variant BA.2.86. Work with partners to ensure all eligible health and social care workers, carers and household contacts of the immunosuppressed have access to their flu and Covid-19 vaccines to help build resilience within the health and social care system. Encouraging high vaccination uptake within care homes in particular is vital.
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32 Continue to work with Executive Board Nurse Directors, Chief Social Work Officers, and Care Homes to collaborate on the delivery of person-centred safe care and support to enable people to be looked after in their communities, where possible Offer children aged 2-5 years the flu vaccination from the outset of the programme to ensure they receive the earliest protection to help stop the virus spreading. To have maximum impact early completion of vaccination amongst this group is essential. Offer the flu vaccination to all school age children in Scotland. Offer seasonal flu vaccination to poultry and outbreak team workers. This is in response to the increased vigilance and monitoring of outbreaks associated with Avian Influenza. Work with Boards and wider partners to use data, along with local knowledge, to target outreach work and reduce barriers to vaccinations amongst under- served communities and where uptake continues to be lowest, including Polish, Gypsy/Traveller, African and Black/Caribbean ethnic groups and people in areas of highest SIMD. Work with Boards to vaccinate all cohorts as advised by JCVI, by 11 December. Continue to support and use demand and capacity forecasting around Covid- 19, flu and underlying winter pressure scenarios to inform thinking and scenario planning. With partners such as PHS, continue to closely monitor rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. Continue to work with local partners to ensure family/friend visits are supported in all care settings.
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33 Priority Six. Work in partnership across health and social care, and with other partners, to deliver this Plan. To deliver on our commitments, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures), maintain a flexible approach, and enable an effective response and support to whole-system winter pressures. How we will jointly deliver this priority: The Chief Operating Officer for NHS Scotland and Director for Social Care Resilience and Improvement, supported by Health and Social Care Directors and COSLA Officials, will report to Ministers and COSLA Leaders on progress of addressing whole-system pressures throughout the winter period. A Whole System Oversight and Planning Group (WSOPG) is in place and has strategic oversight of health and social care pressures through the winter period. Working on a subsidiarity basis, local monitoring will continue, and health and care organisations will utilise their established governance and response structures to manage pressures. In addition, established National Incident Management Plans will enable a multi-agency team including the Scottish Government and COSLA to assist Boards and HSCPs in responding to any emergencies or major incidents through established procedures. This will include a shared escalation plan between the Scottish Ambulance Service and NHS 24 for early identification and management of surge and risks. The third and voluntary sectors and organisations representing unpaid carers will be integral to these governance structures to assist with identification of issues and co-production of solutions.
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34 Priority Seven. Protect planned care with a focus on continuing to reduce long waits. Unfortunately, Boards have had to take the difficult decision over the last two winters to step down planned care in order to treat people requiring emergency treatment. Given the impact this has had on waiting lists, and on patients themselves, we are committed to protecting planned care throughout this winter. Following the recently set ambitious targets, Boards have made significant progress in reducing the number of people waiting more than two years for an outpatient appointment by end of August, and 10 out of 14 territorial Boards reported five patients or fewer waiting more than two years. We will continue to work closely with the Boards and HSCPs to maximise planned care capacity and where the majority of long waits in some specialities remain, ensure these are cleared as quickly as possible. How we will jointly deliver this priority: Strive to protect cancer care with a focus on continuing to prioritise new urgent suspicion of cancer patients and protect theatres for cancer operating. Work with Boards to maximise capacity through pooled lists: locally for high volume specialties (new and return patients) and regionally/nationally for longest waits/specific specialities. Maximise theatre capacity including National Treatment Centres through expanded sessions in evenings and weekends. Support Boards to maximise clinical validation of waiting lists to identify, where appropriate, alternative forms of treatment. Continue to support Boards in the adoption of Active Clinical Referral Triage (ACRT) and Patient Initiated Return (PIR) to improve patient care and reduce waiting times by eliminating unnecessary face to face attendances. Deliver the actions contained in the Endoscopy and Urology Diagnostic Plan. Encourage the optimisation of digital solutions, standardise pre-operative assessment to reduce the need for unnecessary appointments and cancellations releasing capacity. Protect planned care through maximising the use of day surgery units including increasing the proportion of procedures converted to day case surgery.
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35 Priority Eight. Prioritise care for the people in our communities who need it most. Some people are more vulnerable to the pressures and challenges brought about by winter, the colder weather, and Covid-19. We recognise the issue of poorly heated homes as a driver of poor health and almost £3bn has been allocated during the ongoing cost of living crisis to tackle poverty and protect people as far as possible. This includes £350 million this year for heat, energy efficiency and fuel poverty mitigations. Anticipatory, or Future, Care Planning aims to support people to think and plan for changes in their health and care that might happen when they are living with a serious illness, have a longer-term condition or disability that could get worse, or are getting older and frailer, focusing on what matters to them. There are a number of actions that can be taken within existing legislation and process to address pressures within health and social care services to ensure that adults with incapacity (AWI) can be discharged from hospital when medically fit and cared for in a setting more appropriate for their needs. Delays in the court system are often cited as a cause of unnecessary delay with the AWI guardianship process. The Scottish Courts and Tribunals Service (SCTS) has confirmed that there is currently no backlog in civil law cases, and that any cases relating to guardianships for AWI can be actively prioritised. This is particularly the case where input from the courts could help to facilitate moves that are of benefit to the patient. SCTS has highlighted that applying for interim guardianship orders where appropriate will enable cases to be expedited more quickly. How we will jointly deliver this priority: Relaunch the Warmer Homes Scotland scheme from October with more funding and more help for households at risk of fuel poverty to receive a climate-friendly heating system, insulation and increased energy efficiency. Direct people to the Scottish Government’s Cost Of Living website which has a range of resources including how to get in touch with your local council for help with energy and bills, and has specific advice for older people or those who are disabled. Continue to scope options for increasing creation and review of Anticipatory Care Plans (including renaming as Future Care Plans) focusing on specific population groups. Provide the Covid-19 booster for those at higher risk, as per the JCVI statement of August 2023, and explore access for older and frailer groups to receive their flu and Covid-19 vaccines in their home in partnership with local agencies and the independent sector. Continue to encourage close working with our valued partners in the independent sector, and with unpaid carers, to enable continued support for older and frailer people who may need practical help to keep them safe and well. Where necessary, local systems will prioritise social care and support services for those who need it most and are considered to be at a critical or substantial risk level.
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36 Continue to work together with Partnerships, Boards, and people with lived experience to reduce inappropriate out-of-area residential placements and inappropriate hospital stays for people with learning disabilities and complex care needs. Encourage the use of local authority applications for guardianship of Adults With Incapacity where appropriate (as opposed to private applications) and apply for interim guardianship orders where appropriate to expedite cases. We have updated the national best practice guidance for Adults With Incapacity, noting that it is and average of 91 bed days for a private guardianship application. The guidance draws on experiences of statutory partners and aims to set out for local systems models of good practice to support a reduction in delayed discharges where adults lack capacity Provide support to allow the timely discharge of Adults With Incapacity, including: o Targeted guidance for practitioners, using good practice examples, as referenced. o Proposals for reform of legal aid practice. o Ongoing training at basic, intermediate, and advanced levels for practitioners delivered on a joint basis with NES, MWC and the Law Society. o Targeted meetings with HSCPs with higher numbers of AWI delayed discharges to offer assistance and understand the local challenges to help inform any necessary national response. Increase public awareness and uptake of Power of Attorney, to ensure people continue to have their wishes and voice heard and to help enable people to be discharged from hospital as quickly as possible to the best setting for their ongoing care. Support the continued roll out of the Healthcare Framework for Care Homes that provide proactive and preventative multidisciplinary care to vulnerable individuals.
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37 Summary and Escalations This Winter Plan sets out the actions being implemented across the health and social care system in order to prepare for the increase in demand and pressure we expect to see over winter 2023/24. These actions are being adopted as part of a business as usual approach to local planning for surges in demand and complement local surge/escalation and capacity plans. To support this, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures) and maintain a flexible response covering whole-system winter pressures. Working on a subsidiarity basis, local monitoring will continue, and health and care organisations will utilise their established governance and response structures.
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38 © Crown copyright 2023 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-83521-434-3 (web only) Published by The Scottish Government, October 2023 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS1365422 (10/23) w w w . g o v . s c o t