Agenda item

Dominic Blaydon, Head of Partnerships, Rotherham NHS, gave a powerpoint presentation of an analysis of winter pressures experienced between 5^th December, 2010 and 16^th January, 2011, focussing on activity at Accident and Emergency, Acute Care, GP admissions and the GP Out of Hours service:-

 

-        Rotherham Foundation Trust       Accident and Emergency

-        Rotherham Foundation Trust       GP Admission Data

-        Rotherham Foundation Trust       Acute Care

-        Care UK                                        Walk in Centre

-        Care UK                                        Out of Hours Service

-        Social Care Response

-        Mitigation Activity

-        Future Work

 

Summary

-        Severe weather event early December

-        Unprecedented pressure on health community after New Year

-        Caused by swine flu outbreak with norovirus

-        Local health and social care service worked in close partnership

-        Limited disruption to services

 

A&E

-        Attendances

-        Breaches

-        Summary

o       Unprecedented spike in demand during first 2 weeks of January

o       Large proportion of admissions during this period – up to 26%

o       GP outliers – either large practices or in areas of deprivation

o       57% of attendances with no follow up or referral to GP

o       64% attendances were self-referrals

 

Acute Summary

-        54% increase in GP admissions during surge period

-        RFT operating 50 extra beds above baseline

-        Electives cancelled for 3 days

-        Substantial pressure on critical care bed capacity

-        Patients diverted on 2 occasions

-        13 cases of confirmed swine flu

-        Outbreak of norovirus which took some beds out

 

-        Walk in Centre Activity

 

-        Out of Hours Activity

 

-        Walk in Centre/Out of Hours Summary

o       45% increase in demand from week 52 to week 2

o       Mitigation activity had an impact

o       Peak in out of hours activity was before the A&E surge

o       43% increase in out of hours activity from week 53 to 3

 

Mitigation Activity

-        Initiation of Surge Plan

o       Reduces threshold for admission to Intermediate Care and Breathing Space

o       Triggers interventions from community services to support discharge

o       Places Continuing Care Team on standby to fast track social care assessments

o       Triggers extra support from Rotherham MBC to support Social Work Team

 

-        Emergency Bed Management Meetings

• Daily reporting on bed status at Rotherham FT
• Face-to-face support of Community Health Services to support discharge
• Anticipate pressures on system such as staff sickness and infection control
• Identify patients who were fit for discharge

 

-        Daily Teleconferences

o       Inform stakeholders where pressures were in system

o       Enlist Community Services support on maintaining secondary care services

o       Daily reports from each health agency

 

-        Local Sitrep Report

• Bed availability for RFT, Breathing Space and Intermediate Care
• Daily activity figures for A&E, YAS, WIC and OOH

 

Social Care Response

-        Strong support on hospital discharge from intermediate care

-        Additional social work support within the hospital

-        Discharges to residential/nursing care expedited effectively

-        Availability of home care packages on discharge

-        No delays in social care assessments

 

Future Work

-        Internet site which staff can access during severe weather

-        Establish a list of organisations who can provide 4x4 vehicles

-        Formal approval of the Surge Plan through RMBC

-        WIC to introduce an appointment system to spread demand

-        Communication Strategy to explain role of WIC

-        Ensure plans are in place for the Easter Bank Holiday period

-        Notify GP practices who undergo accelerated discharge

 

Discussion ensued on the presentation with the following issues raised:-

 

§         Appointment system at the Walk in Centre – during the period there had been patients waiting for extended periods of time resulting in health and safety issues due to the number of people in the waiting area.  There were 2 ways of dealing with this.  Firstly, to get the GPs to process the patients quicker and secondly the introduction of an appointment system during periods of pressure.  A trial would be conducted

 

§         Analysis was still being carried out of the illnesses over the 5 week period but it was thought mainly to be flu like symptoms.  There had not been many falls/fractures

 

§         Luckily there had been relatively low levels of staff sickness.  There had been an immunisation campaign in the hospital/community nurses which had had a positive impact

 

§         There was no specific Government guidance on what weeks to cover.  There was a requirement to submit, as a Strategic Health Authority, a Winter Plan by November until the end of March.  The Plan should set out the inter-agency arrangements and each of the health organisations’ effective continuity plans

 

§         There were major issues with regard to the budget cuts and the resultant reduction in backroom staff.  It was the effect of how to cover and maintain the support required between the different agencies.  There would also be a reduction in front line staff both in Social Care and probably Health which would have an impact in the 2011/12 financial year.  This could only be managed by addressing the issue of expectation by the public and understanding what the A&E and Walk in Clinic could achieve

 

§         So many people used in the Walk in Clinic because of their inability to get an appointment at their GP surgery.  Discussions were taking place with the GP Shadow Executive about how that situation was managed and address some of the conflicts with the Walk in Centre

 

§         The Health Centre housed both the Walk in Clinic, the GP Out of Hours Service and a separate GP practice.  In periods of high demand there would be some cross over and the GPs from the practice would be used.  There were discussions taking place with UK Care with regard to the number of patients processed by the GPs

 

§         An appointment system would not mean patients would not be seen but just spread the demand.  It may not be necessary to continue with an appointment system if the other strategies for increasing the volume of patients being processed by GPs worked

 

Resolved:-  (1)  That the presentation be noted.

 

(2)  That the NHS be informed that the Scrutiny Panel was not in favour of an appointment system at the Walk in Centre and be requested to reconsider the proposal.