Pan-Oxfordshire System Resilience Plan 2013-14
Introduction
This document will demonstrate organisational resilience across Oxfordshire against the anticipated winter priorities identified by NHS England
(as provided at the Winter planning workshop on 12th August). The resilience plan will focus on the management structures within and between
organisations and is intended to provide evidence of the rigorous processes in place to manage increased demand and ensure maintenance of
high quality care in times of system challenge.
The intention of Oxfordshire is for system resilience to be embedded in every day practice of staff, to bring identifiable benefit to patients even
when systems are challenged by increased demand or reduced capacity. The CCG leads a system-wide urgent care strategy including a wellestablished online escalation dashboard and daily teleconference call to enable rapid resolution of issues, as well as leading the reduction of
delayed transfers of care, reducing unnecessary admissions and improving early supported discharge in partnership with health and social care
organisations within the county.
The Urgent Care Working Group is well established with strong links across organisations at Director and Chief Operating Officer level and
downwards to operational level via the Urgent Care Taskforce. These groups will drive the system’s response to managing Winter, appraising
these plans to ensure they remain fit for purpose
This document will specifically demonstrate preparedness in the following areas:
• Ambulance handover
• Operational readiness (including bed management, capacity, staffing and New Year elective ‘re-start’)
• Capacity / availability of services during out of hours periods
• NHS / Social care joint arrangements, including work with Local Authorities to prevent admission and speed discharge
• Links between Primary care / Ambulance / A&E
• Critical care capacity
• Preventative measures, including flu campaigns and pneumococcal immunisation programmes for patients and staff
• Communications
• 111
The Director on call rota is provided on the next page
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Pan-Oxfordshire System Resilience Plan 2013-14
OCCG
W/C
04-Nov
11-Nov
18-Nov
25-Nov
02-Dec
09-Dec
16-Dec
23-Dec
30-Dec
06-Jan
13-Jan
20-Jan
27-Jan
03-Feb
10-Feb
17-Feb
24-Feb
03-Mar
10-Mar
17-Mar
24-Mar
31-Mar
Contact
no.
On-call
Gareth Kenworthy
Lorraine Foley
Sula Wiltshire
Catherine Mountford
Julie Dandridge
Fenella Trevillion
Jenny Simpson
Back up
Lorraine Foley
Sula Wiltshire
Catherine Mountford
Julie Dandridge
Fenella Trevillion
Jenny Simpson
Gareth Kenworthy
Lorraine Foley (24/25) ; Sula
Mary Keenan (24/25) ; Lorraine Wiltshire (26) ; Gareth Kenworthy
Foley (26) ; Sula Wiltshire (27-30)
(27-30)
Gareth Kenworthy (31 / 1st) ;
Fenella Trevillion (31 / 1st) ; Jenny
Fenella Trevillion
Simpson
Lorraine Foley
Sula Wiltshire
Mary Keenan
Lorraine Foley
Gareth Kenworthy
Mary Keenan
Rota not compiled yet
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Emergency on call pager number: 0765 9108 439. OCCG on call week
starts on a Tuesday
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Oxfordshire resilience plan 7.10.13 – Version 7
Oxfordshire University Hospitals
In Hours (8am to 6pm)
Out of Hours (6pm to 8am)
Sara Randall
Eileen Walsh
Sara Randall
Mark Mansfield
Sara Randall
Andrew Stevens
Sara Randall
Mark Trumper
Sara Randall
Ted Baker
Sara Randall
Mark Mansfield
Sara Randall
Eileen Walsh
Oxford Health
SCAS
111
Lynda Lambourne
Diane Baynham
Paul Tattam
Tim Churchill
Mark Rowell
Lynda Lambourne
Diane Baynham
Ox CC
999
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
Sara Randall
Paul Brennan
Paul Tattam
Lucy Butler
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
Sara Randall
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Paul Tattam
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Sara Livadeas
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
Lucy Butler
Sara Livadeas
John Jackson
All Duty Executives contactable via the JR Switchboard
01865 741166
On-call director rota is
compiled on a “monthby-month” basis and so
it is not possible to
project forward to the
end of March
01865 741717
On-call
director rota is
compiled on a
“month-bymonth” basis
and so it is not
possible to
project
forward to the
end of March
Via
Emergency
0300 303 8690. Please Operations
note the SCAS 111 Centre (EOC)
'oncall' week starts on on
a Wednesday.
01844267840
John Jackson- 07771
942838 ; Lucy Butler07540 944794 ; Sara
Livadeas- 07812
403375
Pan-Oxfordshire System Resilience Plan 2013-14
Winter Planning Self-Assessment
1.Handover of patient care from ambulance to acute trust
Are Urgent Care Boards focussed on securing continued improvements in
handover delays and do local plans aim to deliver or improve upon best practice as
set out in the NHS IMAS paper “Improving Ambulance Handover – Practical
Approaches”?
2. Operational Readiness
Y/N
Reference within Winter Plan
Y
2.19
Y/N
Reference within Winter Plan
Are there winter/surge and escalation leads are in each partner organisation?
Y
2.13
Is there a social service’s senior officer nominated in each area to coordinate
social service’s department planning and escalation?
Y
2.13
Have influenza immunisation co-ordinators at an appropriate level been identified
by NHS England?
Networks Are Urgent Care Boards fully established with clear terms of reference in line with
National Guidance.
Joint arrangements Are joint arrangements in place covering primary care, ambulance and acute
hospital services (A&E departments, critical care services, medical specialty
inpatient beds, social services, NHS 111 etc) including key risks and robust
contingency strategies?
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Thames Valley Area Team to answer
Y
2.19
Y
Section 2
Pan-Oxfordshire System Resilience Plan 2013-14
Are there agreed escalation measures in place if pressure rises above expected
levels for all areas? i.e. acute care (particularly critical care), primary care, social
care etc.
Capacity Have the community undertaken a demand and capacity exercise (Elective &
Emergency) and is there enough capacity in the system to deliver (including winter
surge)?
Y
2.13
Y
2.4
Y
2.14
Y
2.3
Y
2.4
Y
2.4
Y
4.1, 4.3
Are planned levels of capacity within intermediate care schemes sufficient to meet
forecast demand for the winter period and any unexpected peaks in demand
possible during the extended overall winter period?
Y
4.1, 4.3
Is there a single point of access for the full range of intermediate care services to
ensure simplicity and clarity for users?
Y
4.3
Are there robust arrangements are in place in Trusts to ensure the availability of
additional staffing resources that can work flexibly across disciplines to support
during peak pressures?
Are acute and community trusts able to operate 7 days a week during winter
periods? E.g. consultant ward rounds, physiotherapy and diagnostics.
Is the capacity in the health and social care system in terms of beds and services
at an equivalent level to last year?
Has any learning from previous winter or spikes in demand been factored into the
2013/14 winter plan?
Intermediate care - Are there robust multi-agency arrangements for planning, coordination and review of intermediate care services before and throughout the
winter period?
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Learning Disabilities Are there mechanisms are in place between health and social services to complete
a pre-admission assessment to influence the health care process for people with a
learning disability who require hospital admission?
Y
2.10
Is there specific additional support available to people with a learning disability who
are admitted to hospital and may present challenges to health services?
Y
2.10
What are the plans for people with a learning disability to allow appropriate and
timely discharge from hospital with an accurate discharge summary/plan?
Y
2.10
Mental Health Have arrangements been agreed to ensure access to services and primary care
cover for the Christmas/New Year holiday period and to identify and maintain
vulnerable people in the community?
Y
2.10
Are their psychiatric liaison and rapid response arrangements in place?
Y
2.10
Y
2.10
Y
2.15
Y
2.15
Y
3.4
Is there specific additional support for mental health clients (including alcohol and
substance mis-users) to support them in the community over the Christmas/New
Year holiday period are?
Management of infectious diseases including norovirus outbreaks Is the infection control toolkit being used by relevant healthcare providers?
Are all healthcare providers taking proactive whole health economy approach to
the management of infectious diseases including norovirus?
Home Oxygen Services Are there robust arrangements are in place to support patients that require home
oxygen services?
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3. Out of hours arrangements including NHS 111
Y/N
Reference within Winter Plan
Y
3.2
Intermediate care Are services organised on a 24-hour/7day-a-week basis? If not, can it be shown
what alternatives are available?
Y
4.3
Social Care Do social service’s department plans include provision for extended out-of-hours
cover over Christmas/New Year holiday period?
Y
3.2
Is this being done within a wider overall strategy for meeting demand on
holidays/out-of-hours year round?
Y
3.2
Can it be demonstrated what the Out-Of-Hours services in place to support people
in their own homes are?
Y
3.2
Y
2.4, 2.11
Y/N
Reference within Winter Plan
Out of hours including NHS 111 Are there robust business continuity plans in place to make sure the out of hours
service can be maintained and meet expected increases in demand even if winter
pressure exceed expectations?
Ambulance Can Trusts and Ambulance services demonstrate robust and flexible discharge
transport arrangements both in and out-of-hours that have been agreed with each
hospital and contingency plans in place to ensure discharge arrangements can be
maintained at times of peak pressure?
4. NHS and social care joint arrangements
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Are there mechanisms between health and social care for the quick resolution of
any issues arising from agreeing care packages?
Y
2.20
Y
3.2
Y
3.4
Does planning include contingency plans should a private sector home become at
short notice unable to provide ongoing care for residents?
Y
3.4
Are service standards agreed by all for monitoring performance?
Y
4.1
Have social services ensured that all residential and nursing homes have effective
protocols and schemes in place with primary care to avoid unnecessary
admissions to hospital and facilitate timely return after an admission?
Y
3.4
Are there robust mechanisms in place between social services and health services
to allow appropriate and timely discharge of patients from hospital care?
Y
2.11
Y/N
Reference within Winter Plan
Y
5.4
Have social service’s departments agreed their HR policies to ensure staff cover
over the extended holiday period and are their rotas and contacts available to the
whole system?
Have effective liaison and support systems been established with local
nursing/residential homeowners for Christmas/New Year holiday period including
provision to identify and maintain vulnerable people in the community?
5. Links between primary care services, ambulance trusts and A&E
departments
Have arrangements been agreed with local GPs, Dentists and pharmacies to
ensure access to services and primary care cover for the Christmas/New Year
holiday period including access to emergency contraception?
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Are plans in place for GPs, in liaison with other primary care and social service
colleagues, to ensure the identification of high risk community based patients and
to profile their care management over the extended holiday period appropriately?
Y
5.3
Have Ambulance Trusts had discussions with local general practitioners to spread
peaks of urgent demand? Are protocols in place to prioritise 999 and urgent calls
including links with NHS 111 where appropriate?
Y
5.3
Have Ambulance services demonstrated that they can meet sustained increase in
emergency and urgent demand and cope with demand increases of up to 50%
over short peak period and Patient Transport Services be sustained under
pressure?
Y
2.4
Are there agreed protocols in place for taking patients to sources of treatment/care
other than A&E if this is most appropriate to the patient’s needs? Are links
established with local minor injuries units, out-of-hours’ primary care or other
intervention teams to support this?
Y
4.4
Y
2.4, 2.14
Y
2.14, 2.18
Y/N
Reference within Winter Plan
Y
2.12
Can the local NHS 111 service meet a sustained increase in demand over the
winter period, specifically on Boxing day without the need to transfer calls to other
NHS 111 service call centres?
Are local NHS 111 contingency and business continuity arrangements are in place
for the winter period?
6. Critical Services
Are critical care / trauma networks in place and working with their relevant (acute)
providers and linked into the wider networks and support services identifying the
escalation capacity available to ensure that patients have access to the nearest,
appropriate level of care at all times including paediatric services?
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Is bed capacity the same as last year? If not, can it be demonstrated what
contingency arrangements have been made?
Y
2.12
Are there agreed transport protocols?
Y
2.12
Y/N
Reference within Winter Plan
Y
6.2
Y/N
Reference within Winter Plan
Y
6.2
Y
6.2
Y
7.1-7.4, 7.6
7. Preventative measures, including flu immunisation campaigns and
pneumococcal immunisation programmes
Are plans in place to encourage uptake of the flu vaccination, particularly among at
risk groups.
8. Communications
Flu vaccination Is there a plan setting out how the public, particularly those in at risk groups, will be
encouraged to take up the flu vaccination? The plan should include different ways
of communicating the key messages up until the end of January.
Is there evidence of involvement with the national Flu Fighters campaign run by
NHS Employers for NHS staff and a clear plan as to how local NHS organisations
are going to encourage staff to have the vaccination?
Appropriate use of health services Can is be demonstrated that there is a communications plan setting out how the
public will be encouraged to make appropriate use of health services and to selfcare where possible.
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Urgent communications Are tried and tested arrangements are in place to ensure urgent messages can be
communicated to the public when necessary e.g. if GP surgeries have to close due
to bad weather; elective operations are cancelled etc.
Are there are arrangements in place to ensure operational staff are fully informed
about preparations for winter and know what support is available from other
departments and agencies.
Are there are arrangements in place for communicating with NHS and social care
staff during severe weather conditions e.g. to advise staff how best to get to work
or to advise staff to stay at home.
Norovirus Is there a communications plan in place for dealing with norovirus which includes
mechanisms and methods for communicating the importance of the whole of the
local community taking action to eradicate the virus.
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Y
7.7, 7.8
Y
7.5
Y
7.5
Y
2.15
Pan-Oxfordshire System Resilience Plan 2013-14
1. Handover of patient care from ambulance to acute trust
1.1 Queue management
OUH
 Horton and JR Emergency Departments have additional nursing resources to provide additional capacity to prevent
ambulance delays. SCAS in-bound screens available in both Emergency Departments and EAUs to allow capacity to be
matched to demand.
 As a contingency a queue nurse is funded for both JR & HGH sites.
 Additional trolleys are available in the JR ED to minimise SCAS delays.
 In addition to this, a Rapid Nurse Assessment model of care for major’s patients has been implemented on 16/9/13 with a
phased approach to paediatrics and minor patient areas. This increases the ability of the nurse co-ordinator to review,
initiate investigation’s, support and promote early decision making of majors patient, minimising queuing.
 Work has commenced with the SCAS team to increase the use of the Ambulatory pathways across ED/EAU, this will
demand greater use of wheelchairs (where appropriate) by the SCAS crews.
SCAS
 Winter monies will fund two additional clinical manager to undertake a hospital liaison role at OUH to manage queues and
support capacity planning
1.2 Verification of handover
OUH
 A 1 week pilot of dual verification was undertaken between SCAS/OUH teams during the week commencing 16th September
2013. The results of the pilot were considered at a joint SCAS/OUH meeting on the 23rd September 2013.
Recommendations are being implemented during October whilst double verification continues with a further meeting at the
end of October 2013.
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1.3 Stretcher / cubicle capacity (including multiple ambulance queue arrangements)
OUH
 JR – 26 (including 3 Rapid Nurse Assessment Cubicles) plus an additional 5/6 nursed trolleys. Additional trolleys are
available, but these are not supported by OUH staffing.
 HG – 17 plus 3 additional trolleys.
1.4 Escalation procedures (inc. Director-on-call and Bronze / Silver / Gold arrangements)
OUH
 The OUH has on site 24/7 Operational Management (Operational) cover for both EDs. This role is supported by 24/7 Duty
Manager (Tactical) and Duty Executive (Strategic) (in hours based at JR, OOHs on call Duty Manager and Executive
Directors).
1.5 Governance and accountability (inc. reporting mechanisms)
OUH
 Queue management and validation of handover times will be monitored at the weekly OUH ED performance meeting, week
commencing 23/09/13. Bi weekly SCAS/OUH operational meetings are attended by managerial leads to discuss handover
management, clinical issues and real-time capacity and demand fluctuations. Handover and queue management data is
scrutinised at the monthly EMTA Directorate Executive and EMTA Divisional Executive meetings.
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2. Operational readiness
2.1 Bed management (including escalation bed and private provider capacity)
Oxford Health
 Within community hospitals 12 currently mothballed beds with plans to proactively escalate in Didcot and Wallingford (to be
funded via Winter monies)
 Integration programme is intending to provide greater flexibility around bed stock in the future.
 Joint Senior clinical role and Director on call
 Senior clinical lead for DPT / SPA immediate escalation to resolve "snags" in supported discharge pathway
OUH
 Capacity is managed through twice daily capacity meetings on all sites with 24/7 Operational Management on all sites. The
option to reconvene for additional meeting(s) is maintained. In addition the trust-wide bed state is circulated four times a day
to Divisional clinical teams, duty managers and executive directors. This is coordinated corporately by the Duty Manager
with escalation to the Duty Executive as required – with escalation to additional capacity meetings as required. Plus internal
teleconference calls at the weekend. This ensures that capacity across all sites is utilised to equalise pressures, i.e. timely
use of divert from one emergency department to the other; including balancing ambulance pressures in conjunction with
SCAS.
 Long standing arrangements for direct GP admissions to specialist beds i.e. Respiratory Medicine on the Churchill site to
avoid ED/EAU attendance. The OUH Corporate Bed Management Policy details the operational escalation process. The
NHS England South Escalation Framework (May 2013) will be utilised as appropriate should the need arise.
 Capacity status updated daily at whole-system teleconferences to promote proactive management of resources across the
system.
 The OUH is working with DGH partners to ensure a rapid turnaround for repatriations following tertiary level care. A new
repatriation policy has been circulated to surrounding DGHs outlining the OUH and receiving Hospitals’ responsibilities.
 Daily teleconferences (whole-system) ensure that all Oxfordshire partners are informed of pressures across the system.
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Additionally, weekend OUH teleconferences ensure tactical level managers are informed of pressures.
OUH inpatient bed stock and escalation capacity as at 21/8/13:
Division
Cardiac, Vascular &
Thoracic
Day Case
Inpatient
Children's & Women's
Physical
Bed
Capacity
Funded Open
Beds at
01/08/2013
Physical
Capacity
131
131
0
0
20
111
233
20
111
213
0
0
20
10
Day Case
39
37
2
Inpatient
194
176
18
32
26
6
Critical Care, Theatres,
Diagnostics & Pharmacy
Inpatient
Emergency Medicine,
Therapies & Ambulatory
Day Case
Inpatient
Unfunded
Inpatient
Escalation
Capacity
32
26
6
493
479
14
39
39
0
454
440
14
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Notes
2 x Gynae Day Case JR used for
TDA.
Adjusted Total Escalation
Capacity: 0
Of these beds 8 used (2 x CDU
and 6 x TDA).
Unused capacity: 2 x PICU, 2 x
SCBU, 2 x Tom’s, 4 x Gynae
Ward.
Adjusted Total Escalation
Capacity: 10
6
6 flex beds used to flex ICU
capacity between JR and CH
units.
Adjusted Total Escalation
Capacity: 6
10
Used capacity: 1 x Stroke Unit
TPA bed, 3 x Geratology flex
beds for Stroke/PPs.
Pan-Oxfordshire System Resilience Plan 2013-14
Unused capacity: 4 x unfunded
ambulatory area HG EAU, 6 x
JWW.
Adjusted Total Escalation
Capacity: 10.
MARS
142
138
4
Day Case
10
10
0
Inpatient
132
128
4
258
247
11
34
34
0
Neurosciences, Trauma &
Specialist Surgery
Day Case
Inpatient
Surgery & Oncology
224
213
11
466
453
13
Day Case
161
148
13
Inpatient
305
305
0
Grand Total
1755
1687
68
4
Unused capacity 4 x OCE beds.
Adjusted Total Escalation
Capacity: 4.
3
Used capacity: 5 x Neurosciences
– planned to open to 74 31/10/13.
Unused capacity: 3 x NICU (area
not commissioned). 3 x F Ward
HG.
Adjusted Total Escalation
Capacity: 3.
0
Unused capacity: 4 x Brodey
Centre, 4 x Chemo Suite, 4 x Day
Surgery HG, 1 x Day Surgery CH.
Adjusted Total Escalation
Capacity: 13.
33
Adjusted Total Escalation
Capacity:
Day Case: 131
Inpatient: 33
Notes:
1 – The opening of day case capacity for surge demand would be at an
operational impact.
Table includes the following bed stock increases in the physical bed capacity/unfunded escalation capacity totals (with the
exception of the JR Emergency Assessment Unit (EAU) planned increases).
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Planned bed stock increases:
 HG EAU opening additional 5 spaces (End Sept).
 Neurosciences opening additional 5 beds from 31/10/13.
 SSIP (Specialist Surgery inpatient) GP referral unit (4 spaces) from 1/11/13.
 JR EAU planned estates work to increase trolley capacity by 6 to be in place by Dec 13. A further 6 trolley spaces are
planned to be opened after Christmas.
The Manor hospital is currently being utilised to support elective activity for a number of services. This will continue throughout the
winter.
Winter monies funding has been allocated to funding additional beds across the Surgical Emergency Unit and general wards (65
beds in total)
2.2 Patient review arrangements (e.g. twice daily senior clinical review)
Oxford Health
 Further medical staffing has been identified for escalation, with interface medics attached to the EMU’s supporting clinical
decision making both within the EMU’s and locality setting. Roll out of DPT across all community hospitals.
 The DPT (Discharge Pathways Team) comprises of the Senior Nurse or ward co-ordinator, a therapist and a Social worker
as a minimum meeting for 20 minutes max at the Patient Status at a Glance (PSAG) board 3 days a week to identify,
allocate and time actions required for discharge planning for patients.
o There is still the weekly larger MDT with medical cover where possible.
o The Social Worker will be available on the phone if not available in person.
o This speeds up actions and gives the person on duty that day tasks to be completed that day.
OUH
 All emergency take services hold twice daily senior clinician reviews of patients.
 Additional senior medical provision within Emergency Assessment Unit, Medical Assessment Unit, Surgical Emergency
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Units to undertake rapid patient assessment and turnaround if appropriate
2.3 Seven day working arrangements
Oxford Health
 There are plans in place to extend the 7 days working across all community services that provide unscheduled care. This is
being supported by senior clinical on call 24/7 and management cover extended to weekends.
 The following Urgent Care services are open as follows:
o OoH’s: Mon-Thurs 18.00-08.00hrs, Friday-Monday 18.30-08.00hrs BH- 24hrs
o H@H: 24hrs 7 days a week
o Abingdon MIU Mon-Sun 10.00-23.00hrs X-RAY: Mon-Sat 10.00-18.30hrs Sun 11.00-17.30hrs
o Witney MIU Mon-Sun 10.00-20.00hrs
X-RAY: Mon-Sun 10.00-20.00hrs
o Henley MIU Mon-Sun 09.00-20.00hrs
o Bicester FAU Mon-Sun 18.00-23.00hrs
o Wallingford FAU Mon-Fri 08.30-18.30hrs
Emergency Multidisciplinary Unit:
o Abingdon Monday-Friday 08.00-20.00hrs Sat-Sun 10.00-16.00hrs
o Witney EMU opening October 2013
Single Point of Access:
o Mon-Fri 08.00-20.00 Sat-Sun 08.00-18.00hrs
SCAS
 999- This is a 24/7 service with dedicated 111 Senior management on call if required.
 111- This is a 24/7 service with dedicated 111 Senior management on call if required.
 PTS- Transport arranged for both day / outpatient and discharged patients across 7 days
OUH
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
All critical services are provided 24/7. Increased access for patients awaiting diagnostic coronary angiography at the
weekends. Increased in access to emergency and urgent operating time for patients in general surgery. Provision of
Consultant surgeon to cover SEU.
Ox County Council
 Cover on JR site, cover on Horton site for EAU,ED & EMUs weekdays by mid October & weekends from 1 st Nov.
2.4 Demand / capacity mapping (e.g. predictive hourly activity)
OCCG
 OCCG has led various demand and capacity mapping exercises through the Urgent Care Working Group, Urgent Care
Taskforce (UCTF), Joint Management Group (across health and social care) and other fora. Following last Winter, an indepth provider review was undertaken through the UCTF which included identification of good practice, exploration of issues
and lessons learnt and demand modelling.
 UCTF and through this, UCB have been reassured regarding capacity for this Winter. Capacity in terms of bedded care,
community teams (both nursing and social care), domiciliary care, availability of diagnostics, senior medical, therapies and
social worker capacity are planned above levels from last year, with some of these additional resources being sought
through Winter monies funding,
 CSU informatics team provide information to the urgent care taskforce on hot and cold impacts on the system, demand
profiling and KPI achievement.
 The urgent care taskforce comprised of providers across health and social care, leads activity reviews across the system,
monitoring activity as well as using historic trends to predict upcoming demand which is disseminated across all
organisations. Where service failure has occurred, services are requested to produce action plans to address each aspect of
failure which are scrutinised and discussed by the whole system.
 Oxfordshire has a well-established system wide resilience web-based dashboard which allows for real time monitoring of
demand and capacity within organisations and across the locality. This dashboard is updated at least daily to provide
organisational RAG assessments as well as an overall system RAG assessment. This dashboard is linked to the systemwide escalation plan with defined thresholds for escalating / de-escalating RAG ratings and associated actions for each
organisation.
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OCCG is leading ‘Healthier at Home’- a pan-organisational programme focused on older adults (65+) and the frail elderly.
Within this mapping has been undertaken to understand patient flows across the system and develop organisations in
creating capacity proactively rather than responding to demand. This transformational change work will continue over Winter.
The old CMS web-based capacity system has been rewritten, and it has been agreed that TVEA will support NHS agencies
across the Thames Valley area to enter capacity data onto the new modules in the Pathways Directory of Services to
facilitate patient flow, system resilience and escalation. Oxfordshire Community Hospitals and the Re-ablement Service are
already entering data. The acute trust will be able to enter data on capacity and pressures in Emergency Departments, bed
status, Maternity & Neonatal departments, Paediatrics and Critical Care. Staff will be able to view summaries of this data,
and also of services in neighbouring areas. Work is in hand to develop a capacity reporting tool for Primary Care, and it is
possible to create further capacity modules.
Oxford Health
 This has been reviewed in 111, Oxfordshire reablement and out of hours. There are clear predictions for trends in activity
across the winter, this can be adjusted if surveillance identifies trends in illness patterns, i.e. seasonal influenza.
 Urgent care OoH’s has completed a winter activity mapping project (post introduction of 111), and has adjusted resources
accordingly
SCAS
 999- Profiling of demand mapped against previous years’ demand, including hourly mapping of arrivals to acute trusts to
support staff profiling within those organisations. Additional resource available to manage short term increases in demand.
 111- In preparation for winter the 111 service is updating monthly profiles in line with current activity and making seasonal
adjustments to the hourly staffing profile to ensure it is as accurate as possible to meet expected demand. This is checked
weekly and adjusted as required in line with actual activity. Bank holidays are planned as December weekend actual data
with uplift.
 PTS- Mapping of day/ outpatient and discharged patients completed based on previous years’ activity
 PTS- Additional capacity planned over Winter, including well established links with private providers (both seated and
specialist transport) for management of rapid additional demand for transport.
 PTS- Additional activity funded from Winter monies bid resourced to support discharges from acute and community
hospitals. 15 additional journeys daily during weekday evenings, 20 additional journeys daily at weekends
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OUH
 Trust working with CCG and SCAS to obtain 999 and GP arrival patterns for winter period. SCAS has shared their current
activity profiles and predictive model for the winter.
 Prof. David Mant is leading a review of A&E attendances and admissions in Oxfordshire, with support from acute and
primary care physicians. This work has informed preparations for Winter through the Urgent Care Working Group, Urgent
Care Taskforce and organisational groups and a number of the workstreams that will be supported with Winter monies
funding to avoid unnecessary attendances and admissions.
Ox County Council
 Demand and capacity assessments undertaken to influence commissioning /contracting resource requirements winter
2013/14
 Interviews with providers for Discharge to Assess domiciliary care 11/10/13
 Looking to provide increased resource. Additional capacity currently being commissioned
2.5 Gaps / bottleneck identification & resolution
OCCG
 System-wide resilience teleconference held daily (1000hrs), with a whole systems approach to resolving problems. Issues
are escalated to relevant line managers and beyond as agreed in the current escalation framework.
Oxford Health
 On going DTOC audits in community services will provide information to enable more effective management of system
bottlenecks and blockages.
OUH
 On-going monitoring of all processes to ensure early identification and resolution of issues.
 Provision of nursing input to Supported Hospital Discharge Service (SHDS) and extended therapies input to facilitate the
earlier transfer home of patients.
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To avoid DTOC, additional dedicated discharge co-ordinators are to be recruited to work across acute medicine, trauma and
surgical wards at the JR & HGH.
SCAS
 111- Daily sitrep monitoring in line with KPI. Live performance monitoring by Team leaders and escalation as required
 Winter monies will fund one additional ambulance within Oxfordshire to support achievement of 75% standard for Red 1 calls
 Hourly mapping of ambulance arrivals (data for the previous 2 years) completed and shared with OUH to map predicted
demand and associated staffing requirements within ED.
2.7 KPI benchmarking / monitoring
OCCG
 OCCG monitors KPIs via provider contract meetings, daily teleconference, Urgent Care Taskforce and Urgent Care Working
Group
Oxford Health
 Currently Oxford Health FT are involved with the national ED benchmarking audit. KPI monitoring is ongoing.
SCAS
 111 & 999- Daily sitrep monitoring in line with KPI. Live performance monitoring by Team leaders and escalation
SCAS_REAP_2011_v
1.52[1].doc
OUH
 Monitoring of emergency takes and capacity in real time with identified trigger thresholds for escalation to senior clinicians
and managers.
 Twice daily monitoring of staffing and dependency.
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Use of TVEA for monitoring neighbouring heath economy pressures.
Used of SCAS REAP level to monitor demand in area.
3 in-depth audits described in the Mant report will be undertaken. Audit of admissions in the 40-50 age group finalised by
3/10/13. Audit of blue light conveyances completed by 26/9/13 and an audit of 65+ acute admissions via ambulance transder
to be completed in October 2013.
Implementation of the Kings Fund and ECIST recommendations and winter plans will be monitored via the OUH ED action
Plan.
Ox County Council
 KPI’s to be monitored by Urgent Care Working Group
2.8 Service availability (e.g. diagnostics / pharmacy)
Oxford Health
 As per business continuity arrangements, reviewing business continuity with community xray,
 out of hours repeat prescription services during bank holidays are in place.
 Reviewing of equipment provision availability this links into 7 day working and integrated localities.
OUH
 All critical services are provided 24/7 either on site or through on-call arrangements.
 Increased access for patients awaiting diagnostic coronary angiography at the weekends.
 Increased in access to emergency and urgent operating time for patients in general surgery. Provision of Consultant
surgeon to cover SEU.
 Purchase of additional ultrasound machine and point of care testing to increase availability of machines to speed up
diagnosis.
2.9 Step up / Admission avoidance / rapid assessment planning
OCCG
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Winter monies will fund urgent home visits (within 2 hours) for people at imminent risk of admission and smooth out
admission requests made in hours, to provide capacity within ED. 3 wte GPs, 8.75 wte Emergency Care Practitioners and 5
.25 wte drivers will be funded to provide additional home visits.
Winter monies will fund two additional dedicated GP urgent vehicles and crews to support rapid transportation of patients for
assessment and support channelling of patients to ambulatory care pathways where appropriate
Oxford Health
 Easy access via SPA to alternative community support
 EMU referral 7 days per week. Still remains a gap in provision of PTS transport to Witney EMU.
 Integrated locality front doors to support rapid assessment and admission avoidance.
 Step up beds across community hospitals with additional medical support
 Promotion of alternatives with SCAS.
Winter monies will fund the following additional Oxford Health capacity
 a dedicated 111 ED navigator, responsible for taking warm transfer of 111 calls resulting in an ED disposition, to find the
most appropriate pathway for patient This service will be available 0800-2200, 7 days a week
 additional GP triage within ED linking with community teams and Emergency Multidisciplinary Units at weekends to support
channelling of patients away from ED
OUH
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Specialist nurses utilised to prevent crisis in care.
Specialist nurses see patients on wards and assisting in expediting timely discharge.
Specialist nurse see patients in Outpatients and consider alternatives to an acute admission.
Chest pain nurses supporting effective decision making re “chest pain” at front door (JR).
Chest pain protocol in place for the emergency department (JR).
Operational Managers co-ordinating patient flow out of hospital through organisation of transport etc.
All “front door” staff identify patient that could be redirected to community based services.
Well established hub and spoke arrangements with neighbouring DGHs (renal/ cardiac/ neuro/ children/ cancer).
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Established peripheral clinics/services within Oxfordshire (gynae/ paeds/ older people/maternity/diabetes).
OUH clinical representatives on 111 steering group, working actively with partners to avoid admissions to acute sites.
Dr J Price managing Abingdon EAU.
Single point of access to community services.
ED/EAU increasing clinicians with skilled staff to support holistic patient management at the front door with a view to
admission avoidance.
Winter monies will fund the following additional OUH capacity
5.2 additional wte nursing staff as clinical navigators to interface with GPs and manage patient flow for emergency
admissions 7 days a week
an additional consultant physician within the Medical Assessment Unit (MAU) 0800 to 1600 7 days a week to support rapid
assessment and turnaround of patients
three additional consultants within the Surgical Emergency Unit 0800 to 1600 7 days a week to support rapid assessment
and turnaround of patients
an additional 5.5 wte paediatric enhanced nurse practitioners to support rapid assessment and turnaround of patients
an additional 5.2 wte band 6 and 10.4 wte band 5 nurses and 12 additional spaces within the Emergency Assessment Unit
Ox County Council
 Winter monies will fund 9 wte additional social workers available 7 days/week to undertake urgent home visits (within 2
hours) for patients at imminent risk of admission
 Commissioned services to respond to 7 day access inclusive of social work cover.
2.10 Specific pathway planning (e.g. Frail elderly, EOL)
OCCG
 Case management – OCCG monitor on a monthly basis admissions to hospital for ACS conditions, e.g. COPD, pneumonia
and influenza, to measure impact of case management in reducing admissions.
 Case management service providers are monitored monthly to ensure that patient caseloads are those identified as at high
risk of admission and that they are meeting activity requirements.
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Yellow folders have been provided to all case managed patients, which contain details of their specific needs and
management plans. All partner organisations have agreed to review these folders when patients are treated by the relevant
service. All patients with yellow folders are also given a ‘message in a bottle’ which directs health and social care workers to
the location of the folder.
OCCG has a well-established MSK Tier 1 and 2 service– This is a county wide triage service to reduce referrals and
increase capacity within secondary care. This will increase capacity of GP referred physiotherapy and elective care capacity.
Respite care and carer support is in place for patients at risk of hospital admission (older people, those with long term
conditions, mental health or learning disability). This is a joint initiative with Social and Community Services.
Winter monies will fund additional management support for the CCG frail elderly programme, a pan-organisational
workstream to manage this specific population
Oxford Health
 EOL care plans – special notes, reviewing end of life facilitation across the integrated teams to ensure availability of experts
across Health and social care.
 Urgent care dementia care pathway.
 The integrated locality care pathways supports frail elderly.
 On going pathway development supports the whole range of services provided by Oxford Health FT
 Mental Health pathway to ensure that vulnerable patients will be supported over Winter and in particular during the Bank
Holiday periods. Standard Out of Hours services will be provided with robust links to Mental Health teams, including Crisis
and substance misuse support.
 MH services will continue over Bank Holiday periods, with all vulnerable MH patients, including alcohol and substance misusers advised of Crisis team contact details, with ongoing contact for high acuity patients. There is a system in place to
ensure that if patients can be discharged with the support of the crisis team then this could free up capacity. Senior
managers on call throughout.
 MH- All Wards open over Christmas and new year period. Assertive Outreach team are working all days. 24 hour cover
throughout the Christmas and New year period for assessment and home treatment
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Winter monies will fund 27 additional wte nurses and travel costs to support flu vaccination of housebound patients
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(predominantly frail elderly and long term conditions) and increased demand for End of Life and post-acute care at home.
OUH
 Fast-track pathways for stroke to dedicated and protected beds, MIs, and NoF.
 Supported Hospital Discharge Service in place to facilitate discharges from the acute setting. The service is looking to
extend working hours to enable more patients to be rapidly discharged.
 Other supported discharge services include: Hospital at Home, and EOL Care pathway. These are managed through the
Single Point of Access Team.
 Emergency medical admission avoidance by use of Geratology rapid access clinic, EMU and other alternative pathways.
 Psychiatric liaison and rapid response arrangements in place for patients requiring such services
 Mechanisms are in place between health and social services to complete a pre-admission assessment to influence the
health care process for people with a learning disability who require hospital admission, including:
o Social Services request for social care providers to complete hospital passport prior to admission to assist in planning
and informing care
o OCC part of the tracking and flagging project to ensure all people with LD, are flagged on the EPR system
o Continuing Health Care Managers for people with learning disabilities are in place and work to ensure correct level of
care in place.
 Specific additional support is available to people with a learning disability who are admitted to hospital and may present
challenges to health services, including:
o Acute Liaison Nurse in post
o Involvement of hospital Learning Disability Champions to assist in planning pathways of care
o Advice and practical support from the Assertive Outreach Team and Community Learning Disability Teams
(Oxfordshire and surrounding counties)
o Psychological medicine service in place.
o Robust implementation of Mental Capacity Act
 Plans are in place for people with a learning disability to allow appropriate and timely discharge from hospital with an
accurate discharge summary/plan, including;
o Acute Liaison Nurse involved in discharge planning
o Where appropriate, pathways of care reviewed for people who are frequently admitted.
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o Use of hospital passport to identify key people involved to inform discharge planning at an early stage
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Winter monies will fund 3 wte consultant geriatricians 7days a week within ED and the Emergency Assessment Unit from
0800 to 1600 to manage the frail elderly pathway
2.11 Discharge planning
OCCG
 Winter monies will fund one wte senior manager and one wte analyst to lead and coordinate the Delayed Transfer of Care
programme across health and social care
Oxford Health
 SPA
 DPT rolled out across community hospitals ,
 reablement use of community therapy to support discharge planning
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Winter monies will fund:
an additional twelve wte Occupational Therapists to assess patients and support early discharge, appropriate post-acute
support and decrease avoidable re-admissions
SCAS
 Winter monies will fund additional PTS capacity with dedicated resources for Transfers and Discharge from acute and
community services- 15 additional journeys daily during weekday evenings and 20 additional journeys daily at weekends. In
addition, general PTS activity will be increased through Winter monies.
OUH
 Revised Trust policy to discharge patients’ pre-noon.
 Pharmacy investment to support dost boxes 7 days per week.
 All patients have EDD and have TTOs written up early.
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Established MDTs review of all patients.
Weekly monitoring of status of all long-term patients, with action focused meetings to co-ordinate discharge planning.
Ensuring Community Hospital and Intermediate Care admission policies are adhered to.
Monitoring and management of delays.
Winter monies will fund:
an additional five wte nurses within the Supported Hospital Discharge Service, a joint nursing and social care team with
focus on short term support to patients being discharged, to reduce delays
additional dedicated discharge support coordinators (0.5 wte per ward) for the thirteen acute medical and trauma wards at
the Horton and John Radcliffe in addition to two wte community coordinators
Ox County Council
 Increase social work provision to further support early supported discharge.
 Further service commissioning to support “Out of Hospital Assessment Pathway.
 Staff on sites, full participation in dpts & mdts in Community Hospitals.
 Support to ED/EAU & EMUs on site to allow swift assessment.
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Winter monies will fund:
an additional twelve wte social workers to support Emergency Multidisciplinary Units, Health Hubs and rapid response
primary care teams 7 days a week
additional equipment and assistive technology to support rapid discharge of patients and maintain them in the community
where appropriate
additional domiciliary care to provide 7 day a week support to patients
2.12 Critical care plans
OUH
 Critical care escalation plans detailed in Business Continuity Management Policy.
 Critical care and ITU bed capacity remains established at previous year’s levels, with additional escalation capacity available
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(see also 2.1)
Transport protocols are well established with SCAS to ensure management of critical care patients.
OUH has well established links with critical care and trauma networks. The Thames Valley Emergency Access (TVEA) team
and the on line Capacity Management System is used to provide real time information regarding escalation capacity
available across other sites, for both adults and paediatrics, to ensure that patients have access to the nearest, appropriate
level of care.
2.13 Escalation plans (inc. Director-on-call arrangements)
OCCG
 OCCG have updated the escalation plan in line with the updated Area Team plan. The framework has clearly defined
indicators for normal, heightened and exceptional status within each organisation and across the system as a whole
(equivalent to RAG ratings). The framework contains triggers and associated actions for organisations to undertake prior to
escalating to the next level, with defined timescales to monitor progress and details of how to escalate to the next level.
These actions include triggers for action from partner organisations, with associated communications strategies and
indicators to measure the effect within partner organisations. This allows for organisations to be confident that requested
actions are being implemented while allowing each organisation to monitor escalation levels for the system as a whole.
 As part of organisational and system wide escalation, each organisation has responsible officers to provide 24/7 coverage at
operational manager and Director level when required, as well as clear protocols for staff to take prior to escalating to duty
director. These rotas include cover by the CCG communications team as system leads with escalation from individual
organisations as appropriate.
 The system wide escalation framework offers robust triggers and corresponding actions both within organisations and from
partner organisations. This allows organisations and the system to manage demand and capacity, maintaining quality at
peak times, ensuring clarity regarding responsibilities within and between services as organisations escalate and deescalate.
 The escalation framework contains pan-system mechanisms to allow release of short term capacity to meet demand, both in
and out of hours.
 Via the Urgent Care Working Group, OUH, OH and OCC have agreed a daily director rota across organisations that is
authorised to commit resources from any of the three providers in response to demand or capacity issues. This will allow
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rapid and co-ordinated management across the system and reduce delays waiting for agreement that resources or funding
can be granted.
Oxford Health
 Tested and In place, supported by additional on call clinical rotas and business continuity plans.
SCAS
 111 & 999- Senior manager on Call 24/7. Escalation to SCAS Director on Call as required
 PTS- On Call PTS Manager in & out of hours, with escalation process in place.
OUH
 The OUH has on site 24/7 Operational Management (Operational) cover for both EDs. This role is supported by 24/7 Duty
Manager (Tactical) and Duty Executive (Strategic) (in hours based at JR, OOHs on call Duty Manager & Executive
Directors).
 The OUH Corporate Bed Management Policy details the operational escalation process.
 The NHS England South Escalation Framework Final May 2013 will be utilised as appropriate should the need arise.
Oxon CC
 Senior officer nominated to coordinate Social Care planning and escalation
 Three Winter surge / escalation leads identified to provide co-ordinated response across Winter, including Bank Holidays
2.14 Staffing (including rapid provision via agency / bank)
OCCG
 The urgent care taskforce review workforce availability, particularly around holiday and predicted high demand periods.
Organisations have been tasked to provide staffing plans and business continuity specifically related to staffing.
 The taskforce uses historic trend activity and known surge demand (e.g. after bank holidays) to identify when additional
staffing will be required. Plans are in place to secure such staffing for health services. Discussions are ongoing with social
care as to how best to ensure sufficient capacity within third sector providers. Funding is available through pooled budgets
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for the purchasing of either health or social care staffing as required to meet identified gaps.
Statistical Process Control (SPC) charts are used to monitor activity against predicted staff demand, with thresholds set to
trigger an increase in staffing as part of system escalation.
The current escalation framework includes triggers to monitor staffing levels and appropriate actions to be taken if staffing in
any organisation, or key department within an organisation, falls below acceptable levels. These actions include the ability to
flex staff both within and across organisations
Oxford Health
 Clear policy for staffing and engagement with agencies.
 Recruitment campaigns undertaken in Madrid and Dublin to increase number of nursing and therapy staff over WInter
SCAS
 999 & 111- Permanent establishment in place.
 Provision to use 4 Private providers and 2 reserve Private Providers , overtime, bank staff.
 The number of staff required is calculated via our demand management system.
 Hourly demand profiling completed and associated staffing in place. This profiling has been informed from 111 demand last
Winter (service began July 2012) to ensure that peak demand (Boxing Day and the Saturday between Christmas and New
Year) is in place. Business continuity plans in place to manage escalated demand within SCAS call answering framework,
with fall back to an alternative SCAS site (Otterbourne, which provides 111 to the SHIP area) in place.
 A predominantly part time model to provide increase headcount and additional hours if required.
 Bank staff available for additional hours if required.
 PTS- establishment in place. Rapid provision via third party agencies
OUH
 Nursing staffing reviewed at the site level twice daily to ensure safe standards of care in all areas.
 Nursing e-roster system linked directly to NHS Professionals.
 Re-launched OUH staff bank, all agency medical staff now booked through NHSp rolling out to all staff groups by end of
December.
 Recruitment campaigns undertaken in Spain & Portugal to increase number of nursing and therapy staff over Winter
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Ox County Council
 Additional temporary staff recruitment underway to support anticipated increase in winter demand
 Robust arrangements for staff cover over surge periods
2.15 Infection control
OCCG
 OCCG lead the co-ordination of management of infectious diseases across health and social care, including assurance of
provider use of the infection control toolkit. This co-ordination ensures that a proactive approach is taken across the whole
health economy.
Oxford Health
 Clear processes in place to manage infection control outbreaks as per national guidelines. Development of new services
includes provision for infection control and outbreaks.
SCAS
 Clear infection control policy with strict targets around vehicle deep cleaning and Trust premises, single use equipment
policy where possible, hand hygiene, immunisations and guidance on needle stick injury etc.
OUH
 Trust infection control team proactively monitor all communicable diseases in inpatients with support from the 24/7
Microbiology team.
 Rapid isolation of confirmed cases with enhanced cleaning minimised spread of infection.
 Robust discharge cleaning procedures in place.
 Daily SITREPS
Oxon CC
 Clear processes in place to manage infection control outbreaks as per national guidelines with support from OUH or OH as
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appropriate.
2.16 Pandemic / seasonal flu
OCCG
 Whole system surge planning and appropriate links to major incident, pandemic influenza and business continuity plans
occur through the urgent care taskforce.
 OCCG is leading the co-ordination of staff vaccination across organisations to achieve the 75% rate required by NHS
England for systems to be eligible to bid for Winter monies funding in 2014-15. Locally a scheme to allow pharmacies to
inoculate NHS and social care staff is being considered in addition to vaccination programmes undertaken in individual
organisations
Oxford Health
 Tested pandemic flu plans and supported by enhanced surveillance and trend predictions to support early escalation.
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Winter monies will fund 27 additional wte nurses and travel costs to support flu vaccination of housebound patients and
increased demand for End of Life and post-acute care at home.
SCAS
 Trust pandemic influenza policy in place.
 Daily SCAS conference call reference REAP level and wider impact of pressure on demand
 111- NHS England can activate a Flu pandemic algorithym for 111 if required
 111 clinical leads will receive up to date information via our Pharmacists, Medical Director. Emergency Planning and local
networks to keep them informed.
 PTS- All essential SCAS PTS staff are offered Flu vaccinations.
OUH
 Trust pandemic influenza policy in place.
 Seasonal flu vaccination programme commenced 30/9/12
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Ox County Council
 Vaccination for front line staff and contracted providers under negotiation within the overarching winter contingency plans.
2.17 Inclement weather plans
Oxford Health
 In place, tested and continued to test. This will be supported also with the enhanced knowledge of patients’ needs within
localities with the integrated front doors.
SCAS
 999- please see attached policy
 11- In the event of severe or inclement weather such as considerable or sudden snow fall, the ability of callers/patients to
reach a service suitable for their needs following a Pathways assessment must be considered. This is particularly important
during the night when temperatures may plummet, public transport may not be available and road conditions may reduce the
capacity to travel safely. The elderly and children are particularly vulnerable at these times and very careful consideration
must be given to their safety, when arranging onward care.
 During the out of hours period, when severe weather conditions occur the SM will liaise by telephone with the on-call OOH
Manager. Details will be provided by the OOH service regarding the availability and safety of base visits.
 Details on road conditions/road closures or particularly hazardous roads/areas will be provided by the call centre.
 Patients who may be put at risk by travelling to a service, during this time will be passed to a Clinical Adviser, who will
manage the disposition appropriately.
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PTS- Provide only essential PTS transport through communication/agreement with hospitals and community clinics to
ensure the safety of patients and staff by providing double crews:
Dialysis and Radiotherapy, Transfers and Discharges will take priority
PTS on-site liaison officers at acute sites will support the timely T&D activity
PTS receives hourly updates from the Met Office which enable us to assess road conditions regularly.
PTS receives from the council road gritting updates to ensure safe routing of road crews to patients.
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SCAS Winter
resilience including Extreme weather draft Ver 1.2 Sept 2013.doc
OUH
 Inclement weather plans detailed in OUH Business Continuity Management Policy and service level continuity plans.
2.18 Business continuity arrangements (e.g. loss of power / facilities)
Oxford Health
 Existing business continuity plans in place for all Oxford Health FT services.
SCAS
 999 & PTS- part of the overall Business Continuity Management Plans and REAP Policy for SCAS.
 111- Existing business continuity plans in place as per 111 Fall Back Procedures
OUH
 All business continuity arrangements are detailed in OUH Business Continuity Management Policy and service level
continuity plans.
2.19 Governance and accountability (including reporting mechanisms)
OCCG
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Oversight and governance of Winter resilience will be maintained by the Urgent Care Working Group. The UCB is fully
established with Director and Chief Operating Officer representation across health and social care organisations with clear
terms of reference in line with National Guidance. The UCB is responsible for the delivery of the system-wide Urgent Care
Improvement plan, which includes actions being taken by all providers to ensure the flow of patients, reduce inappropriate
attendances and admissions within the acute setting. The improvement plan incorporates relevant commissioning
programmes, such as Healthier at Home for the frail elderly, OUH’s emergency department plan, ECIST recommendations
following a review in March and the Delayed Transfers of Care plan. The NHS IMAS paper “Improving Ambulance Handover
– Practical Approaches” will be specifically reviewed by the Urgent Care Working Group, although preliminary evaluation of
the document has determined that many of the actions enacted following the ECIST review and within other plans are
delivering the best practice within it.
OCCG has led a series of system wide workshops, attended by directors and senior managers from all relevant health and
social care providers, locality GPs and clinical leads for the CCG over this Summer. These workshops have been designed
to ensure that commissioners and providers are united in working together towards common goals in preparation for Winter,
that key problems within organisations or across the system were identified and the priorities for each organisation
communicated. The output of these workshops has informed priorities for the Winter resilience plans and have informed the
bid for Winter monies funding.
The Urgent Care Taskforce, a fortnightly pan-organisational group will provide governance at an operational level, supported
by the daily resilience teleconference
In addition, the current escalation framework contains clear lines of accountability within and across organisations. This
includes identified owners for each of the actions set out within the escalation framework, with timescales for resolution and
actions to be taken if issues are unresolved. The framework contains clear governance arrangements for each organisation
with oversight by the CCG
All organisations have agreed SUI reporting and investigation of severe escalation, with the OCCG being informed of all
such incidents.
All organisations, as part of induction and annual training for all staff, provide training on clinical governance and reporting
mechanisms. This includes Datix training where relevant for all providers, which is closely monitored by the CCG clinical
governance team.
OCCG clinical governance team conducts regular meetings with all providers to review all incidents entered on the Datix
system. Such reviews also form part of the monthly contract monitoring meetings held with all providers.
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Oxford Health
 Development of a cross organisational memorandum of understanding to clarify the cross trust management arrangements
during peaks in activity. Winter pressure is a standing agenda item on SMT meetings. Winter Plan has gone to executive
board
 The ‘Healthier at Home’ programme includes the following CQUIN set for Oxford Health ‘Reduction of Winter Pressures:
Reduction in acute medical NEL admissions and NEL beddays’. This sets an aspirational target for community services to
provide alternatives to ED admission and attendances, directly linked to funding within the community contract.
SCAS
 111- Existing arrangements for Governance are in place including teleconference x3 weekly
 SCAS internal quality and safety groups report through to the commissioning review group this in turn reports to
commissioners and SCAS Board.
 Performance information team provides data to the above.
OUH
 General Managers and Clinical Directors have the responsibility for maintaining services, escalating to the Deputy Director of
Clinical Services and Director of Clinical Services as required. The Director of Clinical Services reports to Trust Management
Executive.
2.20 Financial planning (inc. rapid allocation of funds)
OCCG
 OCCG has successfully applied for Winter monies funding to support a range of activities this Winter. The performance
management and allocation of these funds will be undertaken by the CCG Finance and Investment committee, supported by
the Urgent Care Working Group.
 The Urgent Care Working Group has agreed an on-call rota for Directors across health and social care, with prior agreement
that Directors can commit resources or funding from all relevant organisations without seeking authorisation. This will allow
very rapid management of issues as they arise across acute, community and social care.
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Oxford Health
 There are a number of initiatives identified within the winter pressure funding allocation.
OUH
 Pan-Oxfordshire bids for winter planning funding has been agreed by all health and social care economy COOs.
2.21 Risk management
OCCG
 OCCG holds a risk register which is updated by the clinical governance team on a regular basis. OCCG regularly shares
high rated risks with the appropriate organisation, agrees relevant action plans and ensures that such risks are shared
between organisations appropriately.
 All organisations hold risk registers which are updated regularly and reported to respective Boards on a monthly basis.
 The system has integrated governance meetings which meet regularly, with OCCG identifying organisational and systemwide risks. Appropriate plans to mitigate these risks are scrutinised by internal audit committees.
 Any risks that are identified as potentially affecting the running of the health economy are escalated to the CCG assurance
framework and the assurance frameworks of relevant organisations. These frameworks contain detailed action plans for
mitigation, managed on an individual basis by the Executive of the CCG, with responsibility for completion of action plans
lying with the appropriate director.
 All risks are subject to monthly review by organisational audit committees and boards.
 CCG quality systems allow review of SUIs, complaints, patient experience and audit results which highlight if mitigation plans
are ineffective or weak. OCCG’s clinical governance team then works with the relevant organisation to develop robust
procedures to mitigate current and future risks and improve best practice.
 OCCG undertakes a root cause analysis for all appropriate SUIs and for when system failure is evident
 The ‘Healthier at Home’ programme maintains a risk register of workstreams related to adults (65+) and frail elderly, which is
reported to the Joint Management Group, an Accountable Officer led health and social care board responsible for pooled
budgets and joint management arrangements across community services.
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Oxford Health
 Fundamentally changing focus of risk management too being clinically responsive as opposed to being risk averse. This will
be supported by cross organisational management arrangements
 Robust clinical framework in place including winter escalation.
SCAS
 Management of risk via the Datix system overseen by a clinical review group. All critical incidents are reviewed with
corrective measures and shared learning.
 Risk management includes audit control, risk register and a range of Plans e.g. REAP, Business continuity, Bad Weather
etc.
OUH
 A full risk assessment can be found in the OUH Winter Plan.
2.22 Outpatient clinic management
OUH
 Business as usual with normal Bank Holiday closures.
2.23 New Year- Elective case management
OUH
 Elective theatres closed to all elective work (with the exception of Cancer Theatres) on Fri 27th December.
 Normal emergency theatre provision remains in place.
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3. Out of hours arrangements (capacity / availability of services)
3.1 Diagnostics availability
Oxford Health
 Further diagnostics available via the EMU’s,
 Near patient testing being extended to Hospital @Home.
 There is a review of the opportunities to provide a more robust X-ray business continuity.
OUH
 All critical diagnostic services provided 24/7.
 Increased access for patients awaiting diagnostic coronary angiography at the weekends.
 Increased in access to emergency and urgent operating time for patients in general surgery. Provision of Consultant surgeon
to cover SEU.
 Purchase of additional ultrasound machine to increase availability for early diagnosis.
3.2 Staffing (inc. senior clinician availability)
Oxford Health
 Increased staffing – Irish recruitment campaign completed during September,
 senior clinical on call cover to support all community services.
 Interface medical recruitment on going to provide further medical oversight.
 Demand profiling based on previous years’ experience completed to identify staffing needs over Winter, in particular
increased staffing over the Winter Bank Holiday period. Well established protocols in place to source additional capacity at
short notice.
SCAS
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999- staffing profiled for 24/7 service
111- Staffing profiles are put in place to meet expected demand per hour.
Part time staff offer additional hours and flexibility if required
Staffing can be supported by Southern House if required as they are over established with clinicians.
OUH
 24/7 services provided for all critical areas, access to sub-specialities available through an on call system. All teams on-take
providing emergency care have consultant level cover available.
Oxon CC
 EDT already cover all out of hours periods & using Winter Pressures monies to extend cover on hospital sites over this
period. EDT will cover Christmas day & Boxing day but all other days will have robust staff cover on sites.
 This will be part of wider strategy for 7 day working/Out of hours cover.
 Services will continue for those already receiving support. Reablement, Crisis support & Discharge to Assess domiciliary
service will be in place.
 Staff cover agreed over the extended holiday period. Rotas and contacts will be made available to the whole system prior to
Christmas.
3.3 Rapid assessment / discharge plans
Oxford Health
 All community hospitals have adopted Discharge Pathway Team model of working- daily multidisciplinary team across health
and social care to review EDDs, care plans etc..
 Integrated localities/EMU will support rapid assessment and management.
OUH
 Capacity for emergency medical admission avoidance by use of Geratology rapid access clinic, TIA clinic, EMU and other
alternative pathways.
 Trust reviewing Discharge Policy as part of the policy cycle.
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To avoid DTOC, additional dedicated discharge co-ordinators are to be recruited to work across acute medicine, trauma and
surgical wards at the JR & HGH.
OCC
 Fully cooperating in Discharge Pathway teams on Acute & Community Hospital sites and increasing support to rapid
assessment and admission avoidance
3.4 Specific pathway plans (e.g. EOL)
Oxford Health
 Urgent care dementia pathway,
 ECHO project – psychogeriatric input to care homes,
 Long terms condition management for frailty, supported by community services flu immunisations.
 Care Home support service well established to identify and maintain vulnerable patients in the community.
 Home Oxygen service well established to support patients in the community
SCAS
 111- Special patient notes available to support patient requirements for end of life etc
OUH
 Fast-track pathways for stroke to dedicated and protected beds, MIs, and NoF.
 Supported Hospital Discharge Service extending hours into the evening to facilitate discharges from the acute setting.
Oxon CC
 Fully cooperating in Discharge Pathway teams on Acute & Community Hospital sites and increasing support to rapid
assessment and admission avoidance.
 Commissioner meetings with care home providers ongoing as part of planned programme of management. Support systems
established with local nursing/residential homeowners for Christmas/New Year holiday period
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Vulnerable patients supported via care home management plan and via Oxford Health care home support service
Well established plans in place should a private sector home become at short notice unable to provide ongoing care for
residents. These plans have been successfully enacted in the past few months
Established links with primary care, Single Point of Access and care home support service (Oxford Health) to avoid
unnecessary admissions to hospital and facilitate timely return after an admission
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4. NHS / Social care joint arrangements, including work with Local Authorities to prevent admission and speed
Discharge
4.1 Pooled budget arrangements
OCCG
 OCCG and Oxfordshire County Council have pooled budget arrangements in place for the majority of community services
along the older adults (65+) and frail elderly pathway. Risk share arrangements are in place in line with the pooled
contribution of both sides and formal accountability is established via a legal framework
 Intermediate care services are managed through the current contractual arrangements. A multi-agency partnership approach
has been established through the use of pooled budgets. Joint director level and separate operational level meetings are
well established to ensure co-ordinated planning and review of services.
 Service standards are agreed and well established as part of the Joint Management Group.
OUH
 Pan-Oxfordshire bids for winter planning funding has been agreed by all health and social care economy COOs.
4.2 Joint Executive arrangements
OCCG
 The Joint Management Group, led by the Accountable Officer of OCCG and with Executive level membership across health
and social care, oversees the pooled budget and relevant community workstreams.
Oxford Health
 Agreements regarding oversight and demand management between Trusts
OUH
 Agreements regarding oversight and demand management between Trusts
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4.3 Specific pathway plans (e.g. Long term condition, frail elderly)
OCCG & Oxon CC
 Intermediate care capacity has been mapped across organisations based on previous years’ demand. The system has
undertaken joint reviews to ensure that capacity is sufficient to meet both predicted demand of Winter and unpredicted
surges.
 Joint Management Group regularly review IC services both bed based & domiciliary
 Spot purchasing of additional capacity has been planned for, to manage sudden demand for intermediate care.
 Single point of access (SPA) established to streamline access to health and social care, including a full range of intermediate
care services
 The ‘Healthier at Home’ programme across Health and Social care has integrated workstreams, which include admission
avoidance, rapid discharge and DTOC plans across health and social care for:
o Integrated nursing and social care teams
o Emergency Multidisciplinary Units
o Primary Care and responsive GP pathways
o Community beds review
o End Of Life strategy
o Whole systems pathway
o Patient Transport
o Dementia
o Outcomes Based Commissioning
Oxford Health
 ACG tool – locality groups to identify the at risk patients.
 SPA established, providing access to health and social care via a single route, 7 days a week, 24 hours a day.
 Oxford Health are moving towards an Integrated from door model, this will support the needs of the frail elderly populations
within a locality by providing a reactive service to manage EMU.
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Roll out of personal health budgets
SCAS
 111- Special patient notes available to 111 to support alternatives to admission
OUH
 Specialist nursing workforce proactively follow up identified cohort of patients e.g. COPD.
 Patients for support are identified by the ward staff or specialist nursing and are assessed for a finite period after discharge
(variable dependant on service) when they are then handed back to the GP or practice nurse for on-going support.
4.4 Admission avoidance
OCCG
Various admission avoidance schemes will be in place following successful application of Winter monies funding. These measures
include:
 Additional primary care / Emergency Care Practitioner capacity to provide urgent response for home visits for patients at
imminent risk of admission – 3 whole time equivalent (wte) GPs, 9 wte ECPs, 5 wte drivers for five months (OH and OCCG)
 Twelve additional community hospital beds for step up (rapid assessment and admission avoidance) care, including
diagnostics and therapy for five months (OH)
 Increased senior clinicians at A&E, Emergency Assessment Unit, Medical Assessment Unit, Surgical Emergency Unit
assessment services to assess and turnaround patients where possible- c. 9 wte consultants for six months. (OUH)
 Increased capacity in EAU, SEU and wards- 12 EAU spaces, 65 SEU and ward beds. (OUH)
 111 Emergency Department / MIU navigator, to channel 111 referrals (0800 – 2200, 7/7 for six months) to MIUs and
increased OOH provision to manage 111 demand. (OH)
 ED clinical navigator to manage primary care referrals to rapid assessment / ED- 5wte nurses for six months. (OUH)
 GP triage in ED linking to community based teams at weekends for six months. (OUH)

OCCG is working with OH and SCAS to revise 111 dispositions and support increased flow of patients to MIUs .community
based services as alternatives to A&E. In addition, primary care clinicians will support the 111 service for additional clinical
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support over Winter
Oxford Health
 Emergency multidisciplinary Units (EMU) provision across the county available 7 days a week to support the rapid
assessment and diagnosis of frail elderly patients suffering acute illness, supported also by the availability of step up beds
within the community hospital.
 Review of management of 20 minute call backs to Ambulance Trust within Out of Hours will support non conveyance and
admission avoidance,
 Rapid access to community services via Single Point of Access teams and the integrated front door programme. Further
work is being progressed jointly with SCAS to promote these services.
OUH
 Specialist nurses utilised to prevent crisis in care. Specialist nurses see patients on wards and assisting in expediting timely
discharge. Specialist nurse see patients in Outpatients and consider alternatives to an acute admission.
 Chest pain nurses supporting effective decision making re “chest pain” at front door (JR).
 Chest pain protocol in place for the emergency department (JR).
 Operational Managers co-ordinating patient flow out of hospital through organisation of transport etc.
 All “front door” staff identify patient that could be redirected to community based services.
 Well established hub and spoke arrangements with neighbouring DGHs (renal/ cardiac/ neuro/ children/ cancer).
 Established peripheral clinics/services within Oxfordshire (gynae/ paeds/ older people/maternity/diabetes).
 OUH clinical representatives on 111 steering group, working actively with partners to avoid admissions to acute sites.
 Dr J Price managing Abingdon EAU.
 Single point of access to community services.
SCAS
 GP triage in place to ensure 20 minute response to requests from ambulance crews for medical advice to support ‘hear, see
and treat’ and avoid conveyance to ED during in hours and out of hours.
 Well established routes for crews to access Emergency Multidisciplinary Units (EMUs), Minor Injuries Units, primary care
and community
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OCC
Increased staff at ED EAU & EMUS to support admission avoidance
Links with Integrated Front Door services to identify and manage very vulnerable people
4.5 Rapid discharge
Oxford Health
 DPT rolled out to all community hospitals,
 Single Point of Access team
 integrated front door to the localities
Oxon CC
 Supporting & working closely with Oxford Health activities as above
4.6 Delayed Transfer of Care plans
Oxford Health
 The development of a robust process for TOC to reduce choice delays
OUH
 Currently no provision to transfer patients to ICB out of hours due to contracting constraints. The Trust is actively working
with partner agencies to improve out of hour access.
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5. Ambulance service / primary care / A&E links
5.1 GP urgent referral management (inc. transport)
Oxford Health
 EMU’s will support local referral routes, along with the promotion of SPA (Single Point of Access) to ambulance crews.
 Proposal to support primary care with early morning visiting capability.
5.2 GP triage / conveyance avoidance
Oxford Health
 A review of the 20 and 60 minute call backs from the out of hours service is on going to understand the need and resource
requirements and opportunities to support further.
5.3 Strategies to smooth ED arrivals (e.g. arranging home visits earlier)
OCCG
 OCCG is supporting GP locality plans to co-ordinate Duty doctor arrangements across practices, to enable early response to
requests for home visits or management of high risk patients.
 Winter monies has been sought for additional response to manage patients in the community via 3 wte GPs, 8.75 wte
Emergency Care practitioners and 5.25 drivers. This resource will provide urgent home visits for people at imminent risk of
admission and support management of patients early in the day to smooth out arrivals to ED where required.
 The Single Point of Access (a single route into community nursing and social care) is well established with strong links to
primary care. SPA has identified and profiled the needs of high risk community patients for Winter and is working with
relevant GPs to establish their care management of Winter generally and specifically across the Bank Holiday period.
Oxford Health
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Out of hours provide central resourcing for home visiting at peak times to ensure prompt response and aid the smoothing of
any referrals both into the acute and community services.
Primary care urgent home visit support proposal.
OUH
 The ED has implemented the RAT (Rapid Assessment and Triage) and the Rapid Nurse Assessment (see above) models of
care to smooth ED arrivals.
 Increase the level of OT provision in the EDs and EAUs.
5.4 Primary care arrangements
OCCG

Thames Valley Area Team, on behalf of OCCG is co-ordinating access to services and cover for GPs, dentistry and
pharmacies, over Winter, including on call rotas for Bank Holidays and availability of EHC. This work will be
completed at the end of October and the CCG will then disseminate relevant information via its communications
strategy.
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6. Preventative measures, including flu campaigns and pneumococcal immunisation programmes for patients and staff
6.1 Immunisations for staff
OCCG
 The Urgent Care Working Group is monitoring influenza vaccination rates across Trusts and will support organisations as
required to meet the 75% target set for this year.
Oxford Health
 There is a proactive plan aiming to improve upon last year’s performance, linked to the national Flu Fighters campaign. This
incorporates an opt-out rather than an opt-in approach to staff immunisation and an incentives programme.
SCAS
 111- All 111 will be encouraged to take the flu vaccination which will be offered Out of hours and In hours to maximise take
up from staff
 Occupational Health provider will be running flu clinics for immunisation of staff. Training is also underway to ensure Team
Leaders and Clinical Mentors can also give flu vaccines
OUH
 Flu vaccination strategy in place, started 30/9/13. Pneumococcal vaccination is available to inpatients at the discretion of the
lead clinical for that patients care.
Oxon CC
 OCC Front line staff & providers encouraged to have flu jabs & vouchers available from OCC to allow this to be done at sites
convenient to staff.
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6.2 Public flu campaigns
OCCG
 OCCG is promoting the flu vaccination for under 65s with long term conditions – leaflets will be distributed by GPs and
practice staff to patients.
 Flu vaccination for other groups e.g. 2 -3 year olds will be promoted from late September. Linking with PHE flu campaign.
 Project underway in Oxfordshire to encourage uptake in high risk patients under 65 including the use of leaflets specifically
targeted at clinical groups.
Oxford Health
 Planning is underway in partnership with primary care and the local area team.
SCAS
 111- SCAS will be involved in local and national patient education and media briefings as part of Choose well and 111
OUH
 Managed by Public Health England.
6.3 Public Health links
Oxford Health
 Public health are involved in the monitoring of flu vaccination through contract monitoring arrangements with OCCG.
 Monitoring via Oxford Health emergency planning, and through surveillance of patients through out of hours and 111.
SCAS
 111- Via Clinical leads and Medical directors who will disseminate information to support clinicians and call handlers
OUH
 Links in place to Public Health England.
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7. Communications
Communications leads from OCCG, OUHT, OHFT, OCC and SCAS have weekly teleconferences to review what is happening and
where joint work can take place.
OCCG, in partnership with system organisations, has developed a robust Communications & Public Involvement Strategy. This
ensures consistency of message across organisations and allows for joint engagement and dissemination of information to be
undertaken.
OCCG utilises a variety of means to inform patients and colleagues about ‘long’ holiday planning. This includes:
 Press releases about getting the right treatment – links with the Choose Well campaign.
 Information on the CCG’s website regarding access routes and opening hours of services.
 Encouraging people to prepare for holiday periods by getting prescriptions, stocking up on medicines, visiting dentists etc. –
information is provided on the CCG’s website, via press releases (both print and other media) and through dissemination of
information to partner organisations, in particular primary care.
 Providing information about use of out-of-hours, minor injuries and first aid units, emergency dental services and A&E on the
website, via primary care and through partner organisations.
OCCG undertakes a variety of proactive communications:
 Local implementation of the Choose Well Campaign.
 Information on the CCG’s website – e.g. pharmacy opening times during bank holidays.
 Information in a variety of languages and formats to meet the needs of patients
 Consistency of messages with other partner organisations.
 Promoting 111.
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7.1 Proactive public communications (e.g. newsletters, radio campaigns)
OCCG
 OCCG will undertake a co-ordinated comms plan, which will be funded as part of the winter pressures funding bid.
Oxford Health
 Oxford Health are activity involved and engaged with whole system communication plans which include all of the key
elements described below. It is recognised that a cohesive joint partnership approach is required to provide effective
communication.
SCAS
 111- As per SCAS Comms lead in conjunction with Choose well etc
OUH
 All OUH messages echo primary care messages to the public. Close liaison between the OUH and partner agency media
teams ensures continuity of messaging.
7.2 Bank holiday messages (e.g. repeat prescriptions)
OCCG
 Messages planned for Christmas and New Year periods and also school holidays.
Oxford Health
 Via OCCG and OH comms teams (Choose Well campaign and local marketing)
SCAS
 111- As per SCAS Comms leads via Choose well etc
OUH
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All OUH messages echo primary care messages to the public. Close liaison between the OUH and partner agency media
teams ensures continuity of messaging.
7.3 Signposting to other services (e.g. Choose Well, website information)
OCCG
 This forms part of the winter pressures funding bid.
 Choose Well and 111 information is already being included in newsletters. Additional information has been out on OCCG
website
SCAS
 111- 111 will use the Directory of Services to sign post patients to other services as required
OUH
 All OUH messages echo primary care messages to the public. Close liaison between the OUH and partner agency media
teams ensures continuity of messaging.
7.4 Targeted community plans (e.g. BME groups)
OCCG
 Booklet being developed for BME groups in Banbury and Oxford relating to accessing the right services. Other campaign
work is incorporated into the winter pressures funding bid
7.5 Staff communications (e.g. inclement weather warnings, activity surges)
OCCG
 Being planned as part of the winter pressures funding bid and also to be included via internal staff newsletters.
Oxford Health
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Robust internal communications protocols in place with use of emails, newsletters, bulletins, and cascade systems.
SCAS
 111- ‘Hot news’ is in place in order to cascade urgent information to SCAS staff
 Text alerts can be sent directly to 111 staff
 PTS- Participating in any relevant and appropriate commissioner and provider communication/conference calls format as
requested, maintaining internal operational conference calls.
OUH
 Robust internal communications protocols in place with use of emails, newsletters, bulletins, and cascade systems.
Oxon CC
 Robust internal communications protocols in place with internal staff & providers. Clear reporting systems & plans for
exceptional circumstances e.g. major incidents, inclement weather
 Clear processes in place and arrangements for mobile working. Plans for supporting vulnerable people receiving services in
place as part of Businness planning
7.6 Patient education (e.g. long term condition management)
OCCG
 Via GP practices
Oxford Health
 District and specialist nursing teams utilised to assist patients with long-term conditions manage themselves at home and
where to seek help from should it be required.

SCAS
 111- Clinicians use NHS Choices to advise patients as required
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OUH
 Use of specialist nursing teams to assist patients with long-term conditions manage themselves at home and where to seek
help from should it be required.
7.7 Media plan
OCCG
 Plan in place for inclement weather, activity surges etc. This includes urgent communication to the public in case of adverse
events including via electronic media (including NHS websites and Twitter), via fax and email notice to GP practices and
other health services and if required radio and television.
Oxford Health
 plans in place for business continuity / major incident
OUH
 OUH Media and Communications team has both Major Incident and Business Continuity plans in place.
7.8 On-call media arrangements
OCCG
 Each organisation has their own on-call arrangements.
SCAS
 24hour on call in place for SCAS Media, Directors and 111
OUH
 The OUH Media and Communications has an officer on-call 24/7.
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