Item 9 - Resilience
North Lanarkshire Council · 21 June 2023
Back to IJB Performance, Finance and Audit Committee — 21 June 2023 and its agenda
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1 REPORT Item No: 9 SUBJECT: Resilience Response TO: 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: 21st June 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 IJB PERFORMANCE, FINANCE & 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) 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 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. Yes No N/A
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2 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 The IJB received an update on Operation Flow at its meeting on 22nd March 2023 and again at the PFA meeting on 19th April 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 5.2.2 Following two further face to face planning sessions that brought together leaders from across the whole system, a Task and Finish structure has now been developed to take forward the key actions agreed for Operation Flow 2 (see appendix 1). 5.3 Developing and Implementing Operation Flow 2 5.3.1 As system we have been not able to sustain the improvements in the weeks following the Firebreak period. However, work does continue to support the culture and behaviour change required across our Acute sites to improve efficiency and effectiveness by embedding the flow foundation bundles and pathways 5.3.2 We know that establishing and maintaining good flow across our system is key to the success of Operation Flow 2. Consequently, we have established a task and finish group structure which is underpinned by our new 6 step Flow Model (outlined below and also in Appendix 2) to support delivery of Operation Flow 2. A project plan (appendix 3) which outlines the key objectives for Operation Flow 2 has been developed in collaboration with colleagues across the system and also takes account of the learning from Firebreak. 5.3.3 Operation FLOW 1 involved considerable whole-system development work undertaken jointly by NHS Lanarkshire, Health and Social Care North Lanarkshire, South Lanarkshire Health and Social Care Partnership and Scottish Ambulance Service and this will continue through the duration of Operation Flow 2. 5.3.4 Five Task and Finish Groups have been established to lead in the development and implementation of the key elements aligned to the new flow model. The Task and Finish Groups are accountable to the Executive Flow Oversight Board (EFOB) which reports to Corporate Management Team (CMT). 5.3.5 A summary of each of their key high level objectives is described below: Task and Finish Group 1: Core Group Provides overview and co-ordination for success Ensures Task and Finish Groups, 2, 3, 4 and 5 are on track for delivery Undertakes weekly performance review in relation to progress of attaining trajectory milestones across our 23 Acute sites and system Develop and describe the OOHs Flow Management / On call model Develop and describes the resource plan for Operation Flow 2 Ensures escalation to EFOB Task and Finish Group 2: Pre-Hospital / Avoiding Admission
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3 Describe the operational model required to reduce demand via the FNC Detail the workforce model required which supports admission avoidance and direction to other parts of our system Roll out and expansion of consultant connect for SAS to reduce conveyancing to hospital when it is safe to do so Implement the recommendations of the Strategic Review of Hospital @ Home which supports admission avoidance Development of community access pathways to support people in the community Task and Finish Group 3: Pan Lanarkshire Front Door Redesign Undertake a review of the current “as is” pathways across ED, Acute Receiving and Ambulatory Care to ensure that there is a shared understanding across the 3 sites Undertake a resource review of ED’s shift by shift and complete comparison with 2019 data Develop recommendations which details the Target Operating Model for Font Door Services across Lanarkshire Task and Finish Group 4: Ward and System Flows Establish and embed a NHS Lanarkshire standardised huddle approach and template which embeds ward, site and system level escalation processes to support flow Embed all elements of the Flow Foundation Bundle across all inpatient areas Embed ward beat as part of huddle and flow foundation bundle Develop a consistent and co-ordinated flow management model for NHS L Task and Finish Group 5: Frailty and Off site Beds Develop a Front Door Frailty Rapid Assessment Process Develop and describe the Frailty Model for NHS L Scope the “as is” offsite bed model Develop recommendations that outlines the Target Operating Model for offsite beds to support system flow 5.3.6 We have also established a Data Governance Group which oversees all aspects of system development and ensuring that NHS Lanarkshire is compliant with Public Health Scotland definitions in relation to Urgent and Unscheduled Care. 5.4 Embedding Best Practice, Accountability and Leadership 5.4.1 We know that to deliver the comprehensive plan we will need to work together to ensure that there is: Cohesive Leadership across the Lanarkshire system Ownership by all Operational Leaders in Acute, Community and Social Care, with improvement support, to deliver the pace of change required Clarified roles and responsibilities to develop and deliver the plan Clear measurable objectives across all elements of the plan to demonstrate the impact made and flexibility in our approach, if required, to deliver greater effect
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4 5.4.2 Progressing improvement work across our system is exceptionally challenging within our current resource profile, given that our system continues to be in escalation and full capacity protocols. However, we continue work together across our system to develop and implement change that will improve the efficiency and effectiveness of our system. These actions include: Implementation and embedding of the Flow Foundation Bundle to support good flow across our sectors Embedding structured Hospital Huddles to ensure situational awareness of flow, impact on patient safety and the actions required to respond to pressure Implementation of consistent Escalation triggers and processes ensuring that the is clarity in roles and responsibilities across our wards, sites, sectors and system when responded to blockages and barriers to good flow and safety Ensuring standardisation of patient flows and dispositions across our system Developing and implementing assertive and continuous flow across all our Acute sites. 5.5 Revising the Service Models to Build Capacity and Capability 5.5.1 Through learning from the Firebreak and from shared experiences from other Health Boards across Scotland, we know that there are a number of improvement actions that will require increased capacity and capability to improve flow and demonstrate a positive impact on our performance against the 4-hour target and these include: Reducing demand with Senior Clinical Decision Makers in the FNC and with the Hospital @ Home Service Increased functional site capacity with an expanded minors area in UHW and 7 day opening of Ambulatory Care units across all 3 sites supporting discharge planning co-ordination with additional administrative support to wards Increased service improvement support across the whole system Increased flow management teams within the Acute sites Tackling the blocks to flow by opening the discharge lounge over 7 days Augmented data support for Operation Flow 2 and Trakcare and ensuring that we have access to accurate real time data 5.5.2 Consequently, we are looking at opportunities for investment through internal prioritisation processes and working closely with Scottish Government colleagues around the opportunities for reinvestment to support the project deliverables but also within the context of a financially sustainable plan for NHS Lanarkshire. 5.6 Performance and Monitoring 5.6.1 We have established a robust monitoring process for Operation Flow 2. Each of the Task and Finish Group have developed project plans which outline the tasks that need to be accomplished to achieve the project goals and this detail is reported to Task and Finish Core Group each week. The overarching project plan for Operation Flow 2 provides an overview of progress against each of the high level objectives for the Task and Finish Groups which is reported to EFOB on a weekly basis. A copy of the Overarching Plan is in Appendix 3. 5.6.2 A performance management framework has been established for Operation Flow 2 which is underpinned by objectives and improvement milestones. Performance improvement trajectories have been developed for the Lanarkshire System and
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5 each of the Acute sites. We have established milestones for achievement by 30 June 2023, 31August 2023 and 31 March 2024 (see appendix 4). 5.6.3 Our key objective it to consistently improve NHS Lanarkshire’s performance against the 4-hour standard by achieving 70% against the 4-hour access performance by 31 August 2023 and 90% by 31 March 2024. Crucially, we know that this will significantly improve the clinical safety and experiences for our patients as well as health and well-being of our workforce. The impact of the project actions from each of the Task and Finish Groups will be measured against the: 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 sites) Delayed Discharge / Week (Community Hospitals) 5.6.4 A balanced scorecard has also been developed to monitor our progress against the objectives. In addition, Each of the Task and Finish Groups have developed a data measurement framework which details the process measures to deliver the outcome measures. 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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6 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 Appendix 1: Operation Flow 2 structure Appendix 2: Flow Model Appendix 3: Programme Plan Appendix 4: Performance Plan ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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7 Appendix 1: Operation Flow 2 structure
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8 Appendix 2: 6 Step Flow Model
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9 Appendix 3: Project Plan
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10 Appendix 4: Improvement Milestones