Item 8 - Resilience Update
North Lanarkshire Council · 19 April 2023
Back to IJB Performance, Finance and Audit Committee — 19 April 2023 and its agenda
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1 REPORT Item No: 8 SUBJECT: Resilience Response TO: IJB Performance, Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 19th April 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 taken to date during the pandemic response. 2. ROUTE TO THE IJB PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The PFA is asked to: (1) Note that NHS Lanarkshire stood down its Covid Live Incident down in January 2023, though command structures have been adapted to continue to focus on ongoing wider resilience challenges, specifically around service pressures (2) Note that NHS Lanarkshire was able to move from black to red status on 6th March 2023, following a successful ‘firebreak’ as part of Operation Flow 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. Yes No N/A
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2 5.1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 The IJB received an update on Operation Flow at its meeting on 22nd March 2023. 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 The planning exercise commenced with senior leaders from the three acute sites and two HSCPs coming together face to face to discuss the key areas of challenge and potential areas of gain for the system as a whole. This engagement approach set a positive tone of collective responsibility and whole system working, and it is positive that following the Firebreak, further whole system learning sessions have been arranged for 6th and 27th April to collectively develop the next phases of Operation Flow. 5.2.3 In preparation for these sessions, the North HSCP has held a feedback session based on the Firebreak activity and dedicated time at the Strategic Leadership Team to further review the learning so far. A number of key themes have emerged, including: Significant gains in whole system partnership working from the Firebreak The ever increasing role of Home Assessment Teams in supporting discharge and also controlling future demand into mainstream Home Support services The need to better steward referrals for equipment Hospital at Home’s extended hours (to 8pm) led to the safe management of a larger caseload of patients, with significant increases in referrals received Interim Care needs to continue as part of the Choices Protocol for Care Home admission and also to support any Localities struggling with Care at Home capacity The discharge process is complex, bureaucratic and time consuming and needs to be streamlined across the system We use multiple (largely paper based) systems to record the discharge journey, that means there is never one version of the truth and makes joined up working more challenging Trakcare isn’t updated frequently enough, with the example of 238 delayed discharge bed days being recorded on the system despite the patients already being discharged Further work required to consistently implement the Flow Bundle, including developments such as Planned Date of Discharge and Criteria Led Discharge 5.2.4 Staff directly involved in the operational delivery of the Firebreak will be in attendance at the learning sessions in April to ensure that we are able to get into the detail of the kind of issues noted above.
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3 5.3 Delayed Discharge 5.3.1 One of the key aims of the Firebreak was to utilise multi-agency teams to review all inpatients on a daily basis, with the aim of improving the flow of the 95% of patients who don’t need supported discharge, but also supporting earlier identification of the 5% who will require support. 5.3.2 Consequently, one of the anticipated outcomes of the firebreak was the identification of a significant number of referrals for Social Work/Social Care support. Over the nine-day firebreak, 180 referrals for supported discharge were received in North Lanarkshire, with a further 81 in the three days running up to the start. To put this into context, during peak winter pressures in 2019/20, North Lanarkshire averaged 77 referrals per week for supported discharge, which was the highest rate in Scotland. 5.6.3 However, despite the spike in demand, the recently improved performance in delayed discharge has been maintained. At the start of the firebreak, there were 84 delays in the system, with 40 of these on the acute sites, and at 31st March, this has reduced to 69 delays, with 26 on the acute sites. On 20th March, the HSCP had its lowest recorded number of delays since November 2021 at 59. 5.6.4 While delay numbers will continue to fluctuate day by day, overall performance since the Firebreak has been much improved with considerable efforts ongoing to ensure the changes made through the Firebreak activity can become sustainable across the system as a whole. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan Operation Flow and to enact the firebreak at scale and pace. 6.2 The reduction in occupancy levels across all three sites has allowed NHS Lanarkshire to move from black to red status on 6th March 2022, following over 6 months in black status. 6.3 Attention has now moved to make the most of the system decompression to move forwards with the ambitious change programme identified to ensure the positive performance improvements can be sustained and indeed further improved over time. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT
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4 Risk IJB 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.