Improved partnership working in winter 2009-2010
Acute and Community Hospitals, Community Health Partnerships
and Local Management Units
Alasdair Macleod
Service Manager
Older People Services (East)
Fife Council
Yvonne McCallion
Integrated Admission and Discharge Manager
NHS Fife
‘Winter pressures in NHS Scotland 2008-2009’ report
•
‘Health boards should ensure that their winter planning starts early and
that the process includes Community Health Partnerships and Social
Work Departments’
•
‘Integral to the winter plan should be the escalation plan. This should
involve all stakeholders including Community Health Partnerships’
•
‘Health boards should undertake more accurate modelling over the
festive period . . .’
•
‘The level of discharges over the holiday period should be improved’
Identified opportunities for improving partnership working
•
Part of the overall improvement in winter planning and partnership
working following the recommendations in the ‘Winter pressures in NHS
Scotland 2008-2009’ report
•
Early winter planning between health and social care
•
Improved communication
– Predictive information
– Escalation
Identified opportunities for improving partnership working
(cont.)
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Development of infrastructure for escalation
•
Modelling activity to identify the required capacity at key points across
the health and social care system
•
Increased discharge numbers of ‘complex’ patients over 2 week festive
period
– Restarting packages of care
– New home care packages
Improving the winter planning process
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Planning commenced August using Local Management Units leads
meeting as forum
•
Initial planning assumptions based on 7.9% increase in emergency
admissions across NHS Scotland in December 2008 (data from SMR01
dataset compared to the 5 year monthly mean)
Improving the winter planning process (cont.)
•
Challenging the system to identify how activity could be increased
by 7.9% across the following areas
–
–
–
–
–
–
–
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Social work allocation
Social work assessment
Home care assessment
Provision of home care packages
Provision of equipment
Delivery of equipment
Funding for care home placement
Intermediate care response to prevent admission and support early
discharge
Improving the winter planning process (cont.)
•
Discussions from August to December to agree how information should
be shared and what the escalation arrangements should be
– When?
– Why?
– Who?
Key Planning
•
Direct access to private home care providers during festive period for
patients requiring less than 10hours per week
•
Single point of access to social care over the festive period with
voluntary cover from senior social care staff
•
Home care assessment and provision availability to both acute sites on
29th, 30th and 31st December
Key Planning (cont.)
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Daily teleconferencing commencing 21st December – end of January
including social care and NHS staff (acute and community)
– Daily SITREP’s from Operational Division detailing acute capacity /
patients in delay and 4 hour performance
– Weekly SITREP’s from CHP detailing community capacity
•
Direct access by NHS staff to available respite beds for patients
awaiting complex care packages
•
Flexible use of community hospital beds including GP beds
•
Direct access by NHS staff to choice of care home if vacancies arise
over festive period
Impact of improved partnership working
•
18 patients discharged over the festive period using resources not
previously available
QMH and VHK 4 Hour Performance
December - January 2008/09 and 2009/10
100%
95%
90%
2008/2009
85%
2009/2010
80%
75%
70%
01/12 - 07/12
08/12 - 14/12
15/12 - 21/12
22/12 - 28/12
29/12 - 04/01
05/01 - 11/01
12/01 - 18/01
19/01 - 25/01
26/01 - 01/02
Lessons learned
•
Time taken to plan supported the development of improved
relationships
•
Requirement for year round whole system escalation plan – not just 2
weeks
•
Need to focus on improving partnership working all year round – not
just for 2 weeks
•
Review use of teleconferencing – improved structure of calls
•
Importance of continuing to build on the success of 2009-2010 to agree
and develop new pathways and models of care