ITEM 13 Resilience Response
North Lanarkshire Council · 18 October 2023
Back to IJB Performance, Finance and Audit Committee — 18 October 2023 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: 13 SUBJECT: Resilience Response TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Kirsty Orr, Head of Planning and Development, NHSL Ross McGuffie ,Chief Officer North HSCP DATE: 18th October 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Performance, Finance and Audit Committee: 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 BOARD 2.1 This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The PFA is asked to: (1) Recognise the whole system Operation Flow 2 plans and implementation structures set out in the report; (2) Request future updates on progress. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐
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2 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. 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 PFA received an update on Operation Flow at its meeting on 21st June 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 In the June update, officers set out the Operation Flow 2 plan and implementation structure for members, with the aim of having all elements completed by the end of October 2023, ahead of winter. 5.3 Operation Flow 2 Progress Update 5.3.1 Intensive work continues to embed best practice accountability and leadership to deliver our plan. However, we know that new ways of working and the resource additionally required will take some time to implement the changes and see the sustained unscheduled care performance that is required to improve patient safety and well-being, across our system. 5.3.2 It was disappointing that our performance against the 4-hour standard did not meet our August 2023 trajectory of 70% (65%) despite significant efforts. It should, however, be recognised that many of the additional resources identified through the plan will take some time to get in place, not least due to the current challenges around recruitment. 5.3.3 Consequently, in early September operational and clinical colleagues, from across the system, worked together to develop a recovery plan for with the objective of improving performance against some or indeed all of our metrics which are: Weekly 4-hour access performance Weekly number 8 hour waits Weekly number of 12 hour waits Acute site occupancy levels, Ward beat rate achieved / week Discharge lunge use Pre-noon discharge rate Delayed discharges / week (Acute and Community sites) 5.3.4 The recovery actions agreed to be progressed through September include:
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3 Enhanced duty manager support across our sites to support flow during our vulnerable times which includes the OOHs period and Monday mornings Increased Senior Clinical Decision Makers within the FNC to support direction of patients to the right service and reduce demand where appropriate Expansion of Hospital at Home capacity to increase admission avoidance Focused improvement work to embed the flow foundation bundles across acute and off site areas Focused communications by the FNC service team outlining the role and function to ensure shared understanding of the opportunities of this service across our system 5.3.5 Daily performance metrics for each site have also been implemented which will ensure that we can track day to day improvements or deterioration in performance and the required actions to sustain or improve our metrics. 5.3.6 Within the HSCP, significant progress has been made in creating a more efficient entry point to social care, with Reablement teams now fully ring-fenced to ensure their capacity and Home Assessment Teams expected to be at full capacity by the end of October. 5.3.7 Home Assessment Team capacity has been steadily improving, with the service supporting its 1000th discharge in August, with still over 60% of service users requiring no ongoing package of care after 2 weeks of wrap around support and assessment at home. 5.3.8 A test of change around Locality Response has commenced in Wishaw Locality, supporting a multi-disciplinary urgent response to individuals at risk of admission, with the aim of supporting them to remain at home. This has included tie ins with both the Emergency Department and Flow Navigation Centre. The aim is to continue to test the model before gradually rolling out across the five remaining Localities. 5.3.9 Hospital at Home service expansion continues ahead of winter, with the service roll out into Clydesdale Locality taking place in August 2023 and additional capacity being recruited to support extended working hours and increased capacity in the North Lanarkshire service. 5.3.10 Work continues with the development of a Frailty Strategy and the recruitment of Frailty interface teams on each of the three acute sites with the aim of supporting admission avoidance, improved pathways and earlier discharge for frail patients. 5.4 System Readiness – Operation Flow 2 Power Up 5.4.1 The primary objective of the task and finish groups in relation to scoping and developing proposals has now been achieved and we a transitioning to our delivery structures to support this work. Some task and finish groups will continue to operate until all our new models of care are developed. However, the majority of the work will be delivered through a hospital sector based structure to ensure that we maintain a whole system approach. However, we also recognise that there are some elements of our plan that are pan-Lanarkshire e.g. FNC development and Frailty Clinical Network which will require some flexibility in our approach to support delivery.
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4 5.4.2 We remain committed to launch and implement our Operation Flow 2 Winter Plan from the 1 November 2023. However, we know that creating the right conditions for launch is essential. Consequently, our preparation will include finalising our new care models and ensuring that our 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 sector level improvement plans. This focused preparation period - Power up - will run through the month of October. 5.4.3 As a system we agreed a number of actions that would support testing of new models as well as decompression during the duration of the Power up period, which includes: Testing of the Rapid Emergency Assessment Care Team (REACT) processes as part of our new Front Door Target Operating Model (see appendix 1) to increase streaming of patients to the right part of our system in UHH and UHW which will help to ensure that processes are tested and staff increase their confidence in initial assessment at the front door (REACT is a model already in place in Monklands and being rolled out across the other two acute sites) Maximise the availability of a senior clinical decision maker in the Flow Navigation Centre as part of our new care model to support direction of patients the right place and at the right time to ensure new care model is ready for launch on 1 November 2023 (see appendix 2) Increase Near me consultation and Call before you Convey between Hospital @ Home and the Scottish Ambulance Service to increase efficiency and capacity within the service Complete the bed base modelling for UHW and UHH sites to inform future planning and consideration of reconfiguration of our bed base to manage demand Undertake focused improvement work within Medicine for Older Adults – UHW to maximise flow across the acute site and off site beds Fast track access to interim care beds at Cumbernauld Care Home to create acute capacity Undertake 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 5.4.4 The actions outlined in section 3.1 and above are aligned to the site and sector based improvement delivery plans and the remaining actions being progressed through the task and finish group structures. 5.5 Learning from our NHS Tayside Colleagues 5.5.1 Throughout Operation Flow we have embraced learning from across our system to help inform our new models. We were delighted that colleagues from NHS Tayside provided a peer support visit to NHS Lanarkshire to review our new target operating models and winter plans to help determine if there are any further opportunities for improvement and shared learning. The visit took place over the 7 and 8 September 2023 and colleagues spent time on our sites and with teams from across our system. 5.5.2 We await a formal feedback report however the team provided some initial reflections during the visit and a high level summary is noted below:
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5 Extremely supportive of the Senior Clinical Decision Maker workforce model for Flow Navigation Centre to maximise increase direction of patients to the right place, first time. Opportunities exist to maximise the use of Near Me to reduce footfall to our front doors Investment in our Frailty Strategy is essential to respond to current and future demand Reconfiguration of our off site bed estate to maximise system flow for this Winter and beyond 5.5.3 We have a whole system Operation Flow – Pause Event scheduled for Friday 29 September where will use the time to reflect on what will be at risk to deliver for Winter 2023/24 and how as a system will be respond to this and what elements of our plan do we need to change based on the learning from the peer review visit by NHS Tayside colleagues. Therefore, further detail of this this learning will be available for a future report. 5.6 Evaluating Patient Experience and Staff Well-being 5.6.1 Understanding the impact of Operation Flow from a patient experience and staff welling-being perspective is key for NHS Lanarkshire’s learning. Therefore, formal evaluation of Operation Flow 2 will commence from the 1 November 2023 in collaboration with colleagues from Strathclyde University. Our findings will be shared with the committee as soon as they are available. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan and prepare for implementation Operation Flow 2 at scale and pace. 6.2 Performance remains challenged, however, a range of the identified supports including additional staffing capacity will take time to implement. 7. IMPLICATIONS 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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6 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) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Risk 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. Very High Chief Officer 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. 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 Yes ☒ No ☐ N/A ☐
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7 ☐ 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 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: An EQIA for Operation Flow has been completed by NHS Lanarkshire. EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1: target operating model Appendix 2: Flow Navigation Centre changes ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591. Yes ☒ No ☒ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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8 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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9 Appendix 1: Target Operating Model
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10 Appendix 2: Flow Navigation Centre
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