ITEM 10 Winter Resilience
North Lanarkshire Council · 21 February 2024
Back to IJB Performance, Finance and Audit Committee — 21 February 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: 10 SUBJECT: Winter Resilience TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NLHSCP Author(s) of Report Ross McGuffie, Chief Officer NL HSCP DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ The HSCP Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: (1) Note the progress made through Operation Flow and the impact so far over the winter period. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required Yes ☐ No ☒ N/A ☐
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Operation Flow commenced in early 2023, with a 9-day Firebreak taking place that reduced site occupancy by around 15% and supported NHS Lanarkshire to move from black to red status on 6th March 2023. 5.1.2 Since then, learning from this intervention has led to the Operation Flow 2 action plan and developments that commenced in summer 2023 with the aim of having the whole system better prepared for winter 23/24. 5.2 Operation Flow 2 – January Firebreak 5.2.1 One of the key areas of learning from Operation Flow has been the positive impact of targeted and intensive firebreaks. Early January is always a significant pressure point across the health and social care system following two four-day weekends, so a proactive Firebreak took place from Wednesday 3rd – Friday 12th January 2024. 5.2.2 The 3 acute sites and 2 HSCPs developed plans with a range of actions which included: • Increased Hospital @ Home capacity to reduce admission • Enhanced use of Hospital Assessment Team and Home First to support earlier discharges • Length of stay reviews of patients to support discharge planning • Increased use of discharge lounge • Additional on-call support • Enhanced medical cover and additional nursing staff • Senior staff supported Board Rounds • Maximised Senior Decision within the Flow Navigation Centre (FNC) to ensure patients access the most suitable treatment pathways and/or clinical advice 5.2.3 All non-essential meetings were stood down to free up members of the senior team to support flow enhancing activities across the whole system. 5.3 System Learning 5.3.1 Following the January firebreak, a learning review was undertaken, with a number of highlights noted: Structured, organised and robust processes Team working and MDT collaboration Timely discharge planning Real time solutions found for challenges Focus on patient safety and getting the right care in the right place at the right time Occupancy reduced Ward beat achievement improved Increased discharges Improved weekly performance
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3 Frailty team at front door – 25% avoided downstream moves 5.3.2 A number of challenges were also noted that require further exploration and development: Weekend Care Home discharges Reduced referrals and discharges during Christmas week Off-site bed purpose – need clear expectations with staff, patients and families Side room demand due to flu/covid impacting both 8hr and 12hr performance Referral rates, unplanned referrals and cancelled discharges remain high Admin capacity to keep Trak updated 5.4 Impact on site performance 5.4.1 While the January firebreak provided a comparative boost in performance from the previous year (4hr performance 62% for week ending 14th January), performance overall was still lower than before the Christmas period, with both 12hr waits and occupancy increased. 5.4.2 At week ending 14th January, site occupancy was 102%, up from 98% pre- Christmas. 5.43 While performance is not yet at the levels being aimed for, winter performance has been much more stable in 2023/24. When comparing daily performance from mid-December to mid-January 22/23 and the corresponding days in 23/24, performance was better in 23/24 in all but 6 instances (2 equal, 4 worse, 22 improved). 5.4.4 Comparative performance with neighbouring Boards highlights NHS Lanarkshire’s comparative improvements in ED performance from 2022/23 to 2023/24, though still significantly short of where we aspire to be.
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4 5.5 Delayed Discharge 5.5.1 Delayed Discharge performance has remained much more stable than in previous winter periods, with strong and consistent discharge rates of over 100 per week being maintained since October and throughout December and January. 5.5.2 While dips in both referrals for supported discharge and discharges from delay were noted in both the Christmas and New Year weeks, discharge performance recovered to normal levels on week beginning 8th January. 5.5.3 At 15th January, the national Delayed Discharge census shows the positive performance improvements: 5.5.4 Weekly management data highlights the much greater stability in delay numbers and the consistently high volume of discharges being supported. For context, during peak winter pressures in 2019/20, North Lanarkshire supported on average 77 supported discharges per week, but now consistently supports well beyond 100.
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5 5.6 Measures of Success 5.6.1 Revised governance arrangements have been established to support the operational delivery, underpinned by a robust performance management framework. 5.6.2 Flow Oversight Boards have been set up for each acute site, supported by representatives from the HSCPs and Scottish Ambulance Service. A joint HSCP Flow Oversight Board has also been established between the North and South HSCPs. 5.6.3 The key objective of each Flow Oversight Board will be to improve performance at a site/sector level, as set out in the Whole System Key Performance Indicators: Reducing Demand by redirection and streaming of patients via REACT Reduce Admission Conversion to <25% Reduce Occupancy <95% Reduce LOS in Wards Improve Daily Ward Beat > 90% Increase am Discharges > 40% Improve 4 Hour to >70% Reduce 12 Hour Waits > 10/day Reduce Delayed Discharges 5.7 Next Steps 5.7.1 A number of new posts commence in January 2024, completing the recruitment as planned for Operation Flow 2, supporting the full roll out of the new planned model.
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6 5.7.2 The new hospital site Flow Oversight Boards will support a whole system and integrated approach to full implementation of the plan and ongoing service improvement, particularly around the area of integrated discharge planning. 6. CONCLUSIONS 6.1 While winter has remained challenging and performance has still not recovered to where we aspire, there are some positive signs of improvement from last year. 6.2 Through Operation Flow, there is now a much deeper understanding of the how the system works as a whole, with collaborative structures in place to continue developments. The commencement of Site Flow Boards that bring the hospitals and HSCP sectors together is a particularly positive step towards supporting positive change. 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 ☒ 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) 7.2.1 New whole system KPIs are currently under development, as outlined in 5.6.3. 7.3 FINANCIAL Any financial impact will be highlighted at the end of the review This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT
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7 Relevant Risk Register Details Current Risk Level Risk Owner IJB 17/22 Very High Chief Officer Risk IJB 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Significant staff engagement through the Operation Flow process ☒ 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 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A
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8 EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.