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:
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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:
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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
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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:
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Urgent Care Access
Wexham Park – Patient Flow
Discharge and Out of Hospital Care
The three workstreams are tasked with:
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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.
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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.
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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
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Improved access to
emergency care
Seven day working
Enhanced patient
environment
Improved access to
elective surgical
care
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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
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Patients discharged
quickly, safely and
effectively
Patients able to
maintain
independence and
mobility in the
community
Seven day working
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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
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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.
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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
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