WINTER PLAN – ADDITIONAL SUPPORT FOR THE HEATHERWOOD AND WEXHAM PARK HEALTH SYSTEM 1. BACKGROUND The East Berkshire health and social care system has received £6.644m from NHS England to enhance capacity in the urgent and emergency care system over the 2013 winter period. The local health system has been under considerable strain since September 2013 with rising ambulance and A&E attendances and hospital admissions and a shortfall in acute and community capacity. As a result, Wexham Park Hospital has failed to achieve the NHS Constitution standard of 95% of patients seen within four hours of arrival in A&E. In June 2013 an Urgent Care Programme Group with representation across CCGs, community, ambulance and unitary authority approved an A&E Recovery and Improvement Plan to improve performance and is continuing to monitor delivery. In July 2013 Wexham Park achieved the 95% standard for the first time since September 2012. It has been acknowledged that additional community and acute capacity for the winter period is required to ensure effective, safe, quality services for patients. Subsequently, the CCGs in East Berkshire received £6.644m following a bid for nonrecurrent resource to NHS England to support additional capacity. This paper outlines: Principles for using the non-recurrent resource A winter plan linked to the A&E Recovery and Improvement Plan Project management and system wide leadership to deliver safe, effective services over the winter period 2. PRINCIPLES The following principles are relevant for use of non-recurrent support: Achieves NHS constitution standards Supports actions agreed through the A&E Recovery Plan Targeted at short term capacity for swift delivery from October 2013 – March 2014 Tackles known ‘gaps’ in capacity and delivery Supports a simple, consistent delivery of an urgent care system across East Berkshire 1 Supports integrated care philosophy across organisations Tests out new innovative ways of delivering services for patients Distributive leadership across the whole system for delivery The initial bid was submitted on 25th July. It was shared at the Urgent Care Programme Group on 1st August and a revised bid was submitted with all partner signatories on 23rd August 2013 for consideration by NHS England. The Wexham Park system received funding on 10th September and have been working on detailed plans for implementation in conjunction with CCGs. 3. PROGRAMME GOVERNANCE AND LEADERSHIP The A&E Recovery Plan builds on best practice highlighted in the King’s Fund report; ‘Urgent and Emergency Care, A Review for the South of England’ and focussing on three distinct areas of patient care: Urgent Care Access Wexham Park – Patient Flow Discharge and Out of Hospital Care The three workstreams are tasked with: Implementing and monitoring the agreed A&E Recovery Plan Using the non-recurrent winter resources to effect increase in capacity, and resilience of the east Berkshire system through the winter using evidence of best practice Assessing and monitoring new ways of working An Operational Delivery Group consisting of the Programme Director, Programme Manager and the three Project Leads to meet on a weekly basis to drive implementation. These workstreams report on a monthly basis to the Urgent Care Programme Group which will monitor overall delivery and use of the resources allocated on behalf of CCGs. 2 Table 1 Governance structure Programme Urgent Care Programme Group Operational Delivery Group Project Workstreams Urgent Care Access Table 2 Wexham Park Patient Flow Discharge and Out of Hospital Programme and Project Leadership The overall Programme Director is David Williams, Director of Strategy and Development for the three CCGs with Programme Manager support from the CSU; Peter Loomes, Senior Strategic Planning and Redesign Manager. Workstream Organisation Sponsor Project Sponsor 1.Urgent Care Access Jim O’Donnell East Berkshire CCGs 2.Wexham Heatherwood Park- Patient and Wexham Flow Park NHS Foundation Trust 3.Discharge Berkshire and Out of Healthcare Hospital Foundation Care Trust Bracknell Project and Ascot Manager Leadership Monica Jacky Nuvoloni Walters Philippa Slinger Asif Ali (on behalf of the three CCGs) Andy Howlett Adrian Hayter Mira Haynes Peter Loomes Stakeholders CCGs Area team SCAS (inc. 111) Berkshire East Primary Care BHFT HWP BHFT CCG HWP Lead BHFT 4 Unitary Authorities CCGs Each project will use standard programme and project management templates and provide highlight reports for each monthly Urgent Care Programme Group. 3 4. KEY DELIVERABLES The winter plan submission will meet the following intended benefits for patients. Details of the full bid are available on request. Workstream Urgent Care Access Wexham Park – Patient Flow Intended Benefits KPIs Improve access to Increased 111 call GP services rates Consistent delivery Reduced 111 of alternatives to response time A&E (MIU,Urgent Dispositions from Care) 111 Increase access to Increased alternatives to A&E Attendance rates at Enhance 111 local alternatives to A&E Directory of Increased Number Services of additional weekend and Increase capacity of ambulance services evening GP especially at surgeries evenings and Increased Number weekends of patients reviewed Increase Integrated by ICT teams Care Team Number of patients capacity referred to the Reduction in RACC emergency Reduced A&E admissions for attendances paediatrics Reduce emergency Enhance seven day admissions working Improved performance in the Patient experience survey – perceptions of urgent care Improved access to emergency care Seven day working Enhanced patient environment Improved access to elective surgical care 4 Delivery of the A&E 4 hour target Delivery of the 18 week 90% target A&E to admission ratio Reduced Proportion of ambulance A&E attendances Number of beds A&E attendances Emergency Discharge and Out of Hospital Care Patients discharged quickly, safely and effectively Patients able to maintain independence and mobility in the community Seven day working Admissions Weekend and evening admissions and discharges Reduced Length of stay by UA and specialty Reduced Readmission Rate Increased Number of referrals to Intermediate Care Teams Increase in the Number of active Patients in Intermediate Care Services Discharge team dispositions Reduction in Delayed Transfers of Care Increased Community bed usage and reduced Length of stay Increased discharges over evenings and weekends 5. PROGRAMME MILESTONES Project Phase Milestone Tasks linked to UCPG Dates Initiation 10th September Establish programme and 2013 project structure including leadership and project support Agree non-recurrent funding and A&E Recovery Plan with NHS England Deployment 1st October Prepare implementation 5 Progress UCPG established Workstreams to finalise bids Final non-recurrent submission 23rd August NHS England approved funding Meetings of the workstreams 2013 including recruitment of key staff and resources, establish details of capital funding have drawn up detailed plans for each project including KPIs, milestones for implementation. Communication and consultation with CCGs and localities throughout the process. Delivery 1st November onwards Monthly monitoring via workstreams with exception reports to the UCPG UC dashboard linked to KPIs monitored on a monthly basis Transfer to recurrent Schemes 1st April 2014 CCGs to consider converting successful schemes into recurrent scheme for 2014/15 QIPP programme Schemes starting to put in place additional capacity and capability. 6. INTEGRATED CARE STRATEGY Whilst this project is focussed on achieving short term capacity and flexibility over the winter period linked to Wexham Park, the Urgent Care Programme Board will increasingly support the delivery of a longer term integrated care strategy across East Berkshire encompassing all parties. The innovations and project ideas highlighted here can feed into this process. 7. PROGRESS Early indications are that Heatherwood and Wexham Park hospital will achieve 95% standard of patients waiting less than four hours in A&E for the month of October. A full update on project progress is found as Appendix 1. 8. RECOMMENDATIONS The Bracknell and Ascot CCG is asked to :NOTE the additional winter plan resources available to support Heatherwood and Wexham Park NHS Foundation Trust to achieve the A&E target from October 2013 March 2014. 6 APPROVE the programme and project management approach to delivering improvements in urgent and emergency care NOTE the engagement and support from Bracknell and Ascot CCG in the different workstreams NOTE progress in delivering additional capacity and support so far this year. David Williams Director of Strategy and Development November 2013 7