Ealing Winter Resilience Health and Adult Social Care Scrutiny Panel 25 November 2015

EALING WINTER RESILIENCE

HEALTH AND ADULT SOCIAL CARE SCRUTINY PANEL 25 NOVEMBER 2015

INTRODUCTION

This report details the Ealing Winter Resilience plans and performance to date across the key providers of the local health and social care system. The key organisations contributing to this report are Ealing CCG, London Ambulance Service, London North West Hospitals NHS Trust, Imperial College Healthcare NHS Trust, and Ealing Adult Social Care. The plans are facilitated and co-ordinated through the Ealing System Resilience Group (SRG), also known as the Ealing Urgent Care Board which meets on a monthly basis.

The report covers the capacity required to ensure the safe delivery of effective, high quality accessible integrated services. The paper also highlights the public and patient winter campaign to ensure the use of right service at the right time.

The following summarises SRG resilience plan, demonstrating how Ealing CCG and Council are working with partners to deliver consistent 4 hour performance in 15/16. This document builds on identified SRG actions and takes account of the 8 High Impact Interventions (‘what good looks like’) from NHSE.

KEY SCHEMES The following summarises the key additional resources invested from system resilience funding and Better Care Fund to enable safe and efficient management during winter. These schemes are based on the winter debrief form 2014/15 and lessons learnt.

Organisation Scheme £

1 LNWHT Discharge Co-ordinators – 7day working - To facilitate £219,016 discharges on all the wards particularly for complex patients and/or possible delayed discharge. 2 LNWHT Additional Inpatient Therapy Support – 7 day £193,735 3 LNWHT Extended ED Consultant Cover at Weekends £29,588 4 LNWHT Expand RAT(Rapid Assessment and Treatment) in ED – £284,170 Weekends and Weekday nights LNWHT – Community Nursing – Winter capacity £250,000 Community LNWHT CDU Nurse – Co-ordinators £114,148 LNWHT Frailty Support in ED - Pharmacist £70,356 LNWHT Medical Registrar in ED £42,244

LNWHT RAPID Team - When A&E is receiving a surge in activity £443,431 the most unwell patients have to be prioritised, this can increase waiting times for those less unwell. The RAPID team is designed to partially segment the care for less serious emergencies, to see and treat patients in a timely fashion and to maintain patient flow when the unit faces capacity issues. LNWHT Patient Flow-Co-ordinator £62,753 Ealing Social Repairs and Adaptations(Handy Person Scheme) £30,000 Services/Housing WLMHT Enhanced Liaison Psychiatry Service to UCC and ED £238,722 Ealing UCC GP Paediatrics Specialist £100,000 Ealing CVS Community Outreach Programme £90,000

NHS 111 Enhanced Clinical Assessment, Medications Enquiries, Dental £50,500 Nurse Triage Primary Care Weekend opening and Weekday additional capacity £400,000

Social Care BCF Additional Investment in Homeward Service £2,544,601 BCF Voluntary Sector Age UK – Homeward Bound £350,000 Schemes – Admission Asian Family Counselling Avoidance RISE/EACH – Drug & Alcohol Users Southall Community Alliance St Mungo’s – Homeless People

EALING INTERMEDIATE CARE SERVICE - HOMEWARD, INCLUDING RAPID RESPONSE

The new jointly commissioned integrated health and social care intermediate care service provided a consortium led by WLMHT, consisting of Ealing Social Services, CNWL (Central and North West London NHS Trust), Chelsea and Westminster Hospitals NHS Trust, LCW Unscheduled Care Collaborative (London & Central West), commenced on the 1st October 2015. The service was formerly known as ICE (Intermediate Care Ealing), provided by LNWHT.

The Homeward Service will enable patients to receive appropriate physical, mental health care and social care support, through one service working under one management team, to be better-supported following discharge and to help more people to avoid hospital admission.

The service provides physical, mental health and social care, for people whose health have deteriorated or have had a recent stay in a local hospital. It will take referrals from GPs, A&E, and acute assessment units; ambulatory care units and hospital wards. The service will support primary care to deliver a rapid response and will provide in-reach into our local hospitals to provide supported discharge. Recognising that Ealing residents use every provider in NWL, Ealing CCG has procured a service that will support patients irrespective of which hospital they use.

PRIMARY CARE – EXTENDED WEEKDAY WORKING HOURS AND WEEKEND WORKING

Ealing has commissioned two schemes in order to increase access to Primary Care during winter 2015/16.

The Extended Weekday Working Hours will provide additional ‘On the Day’ appointments Monday – Friday throughout Ealing. GP Practices will be able to provide additional appointment slots either during their core hours or extended hours during early mornings or evenings. Practices can choose timings which best suit their practice patient demand.

The Weekend Working scheme will provide Primary Care access to all Ealing residents on a Saturday morning and Sunday afternoon, peak times at the Urgent Care Centre. One GP Practice will be open in each of the three Ealing ‘hubs’ and in total will provide at least 70 appointments a weekend. These appointments will be available through NHS 111.

WEST LONDON MENTAL HEALTH SERVICE

Ealing Liaison Psychiatry Service (ELPS) provides an ageless specialist mental health service to patients presenting to Ealing Hospital ED, UCC and inpatient wards with co-morbid physical and mental illness. In 2014 just over 2000 patients benefited from this service.

There is substantial national evidence to support the impact of psychiatric liaison services in improving the quality of patient care and reducing length of hospital stay, accident and emergency waiting time and emergency re-admission rates (Long-term conditions and mental health: The cost of co-morbidities, King’s Fund; With money in mind: The benefits of liaison psychiatry, Mental Health Network-NHS Confederation).

MH patients can occupy a disproportionate amount of resource in ED and having dedicated MH specialists in the ED working in Liaison with ED has been shown to lower the impact of this in terms of patient flow, ED breaches, patient and referrer experience and safety.

One of the winter resilience schemes delivered successfully last year was to enhance the staffing at the front end of the Hospital, and to embed a new patient pathway for joint working between Liaison Psychiatry and the Urgent Care Centre. This diverted 22% of emergency work away from ED, freeing up resources within majors for cases requiring more intensive medical input.

The Liaison Psychiatry Service was also able to maintain a 97% 1 hour response time and limit the contribution of MH patients to Ealing Hospital’s 4 hour breach during the winter period despite a 40% increase in attendances between 10pm and 8am compared with the previous . ELPS is continuing to use the agreed pathways and to see patients in UCC where appropriate.

The Service will again provide the following:  An additional RMN support in UCC and ED in Ealing Hospital out of hours 22:00-09:00, 7 days a week.  Extend Consultant expertise availability from 1700-2000 Monday to Friday as demand is highest in this period and in order to provide senior clinical decision making at this critical time.  Provide 1 session of consultant expertise on Saturdays, Sundays and Bank Holidays in order to work towards the 7 day standards, attend ED ward rounds, and address issues from the previous night. This will provide extra “pull” through the system, extra containment of clinical complexity within ED and can also be used for training purposes to up skill the Out of Hours Nurses and ED staff.

LONDON AMBULANCE SERVICE REPORT:

1. West & Northwest Sector:

2. The LAS today:  Demand for our services increase year on year. In 2014/15 we received over 1.7m requests.  Our operating budget is £316m  5,000 staff, 71 per cent are frontline  Frontline staff work out of 70 ambulance stations  Service transformation, including a management restructure of our frontline  Retention has been challenging with opportunities for paramedics in and outside the NHS have increased dramatically  Focus on international and national recruitment drives

3. How we care for the Capital: Our major service areas:  Call taking and clinical triage  Hear and treat services  999 emergency and urgent care response – delivered using traditional and innovative means e.g. Cycle Response Unit  Intelligent conveyance  111 Services  Emergency Preparedness Resilience and Response (EPRR)  Emergency services across the world regularly visit us to learn how we operate in the capital city and how we have innovated

4. Major Challenges:

Staffing We know we need to improve the morale of our staff as well as increasing staff numbers.

Demand We know there are ever increasing demands on our service and we will need to continue to find new and innovative ways of manage demand.

5. Response Performance (@30.10.15):

The “Cat A performance tail” is monitored as an indicator of safety during periods of underperformance. Using the diagram opposite, LAS achievement against the 75% target is within 10 minutes and 95% within 18 minutes (YTD).

6. LAS Improvement Programme:

7. London Ambulance Service – Winter Resilience:  Review all non-essential (non-patient facing) activity

 Forecast planning and resourcing to meet peak demand  Clinical Hub increased staffing to enhance ‘hear and treat’ responses  Management availability to assist with LAS handover challenges at Emergency Departments  Call cycle time review  Review and focus on existing care pathways to reduce conveyance of patients to emergency departments  Use of alternative Non-Emergency Transport (NETS)  Dedicated Health Care Professional telephone line into LAS Control room with defined clinical need response times  Participate in weekly NWL Surge Conference calls

LONDON NORTH WEST HOSPITALS NHS TRUST

1. Background and factors influencing Emergency Department (ED) performance

1.1 Ambulance Conveyances

The number of ambulances attending Ealing has remained stable however there has been a slight increase at Northwick Park. There has been an upward trend in the number of monthly blue light patient transfers to Ealing, which has added additional demand for A&E services. More of the emergency patients are likely to convert into an admission to hospital, which can create additional pressure on the available bed capacity and cause a delay for those patients waiting for a bed within the ED. When Emergency Departments become full, space to see new patients becomes a challenge and delays in the handover process between LAS and the ED team can occur. Both Ealing and Northwick Park ED’s have processes in place to ensure patient safety on the unit when they are under high pressure levels. The Trust works regularly with the local CCGs, Local Authority, Voluntary Sector and London Ambulance Service to address these issues through its Urgent Care Board.

Table showing Blue Light Emergency Ambulance Transfers for Ealing and Northwick by Month

LAS Blue Light Emergency Transfers

500 400 300

200 Northwick Park 100 Ealing

0 Emergency Transfers

Numberof

1.2 Bed Capacity

Whilst the Ealing site generally meets or exceeds the A&E 4 hour performance target it is a relatively small hospital and during times of demand faces capacity issues. From the bed capacity modelling that has been done across the sector to prepare for winter, it was found that at times of pressure the site is likely to be between 10 to 20 beds short of what it requires. However, Better Care Funded schemes, winter resilience plans and the growth of Ealing’s Ambulatory Care function have been agreed with the CCG, this will help to mitigate capacity problems in order to maintain

patient flow on the Ealing site during periods of increased demand. In addition, the local health system needs to maintain a reduced number of delayed transfers of care (often called DTOC’s) by fully utilising the care and services that are available to help patients leave hospital and remain well in their community setting.

There is an acknowledged inpatient bed shortage on the Northwick Park site. The Trust has been supported by the local CCG, The Trust Development Agency (TDA) and Local Authority to build an additional 48 beds on the Northwick Park site; these beds will open during the winter months.

1.3 Workforce

Both Ealing and Northwick Park Emergency Departments have a relatively stable workforce, however recently there have been a few resignations on the Ealing site. There are a significant number of vacancies in the medical establishment on both sites due to the recognised national shortage of emergency physicians and as a result the Trust is still partially reliant on the use of regular locum doctors. In order to address the vacancies the Trust has a recruitment plan in place targeting international doctors as well as financial incentives to attract and retain staff. Currently the Trust is improving its internal education program which is hoped to attract more candidates. Whilst the current medical vacancy rate in A&E at Ealing is 27% and at Northwick Park is 21%, as one of the largest integrated trusts, London North West Healthcare can better respond to staffing its emergency pathway and providing a vibrant environment for doctors in training.

2. ED Performance to Date

2.1 Ealing Hospital

The Ealing site sees on average, 3500 Type 1 (major emergency) and 5200 Type 3 (minor emergency) attendances per month. The ED at Ealing has generally met or exceeded the 95% Type 1 performance from April to date. There have been a few weeks where performance has dipped and the main cause for this is bed capacity issues within the ED and inpatient wards. Performance has been challenged at the end of October and it is hoped the initiatives that have been agreed through the winter funding with Commissioners will help to address the current issues and put us in a better position for the upcoming months.

Type 1 performance year to date is 93.04%, Type 3 performance is 98.56% and all Types are 96.44%. The Trust has an agreed performance trajectory and Ealing has regularly exceeded the weekly targets.

Graph Showing 4 Hour Performance against Agreed Trajectory at Ealing

2.2 Northwick Park Hospital

The unit manages 8200 Type 1 and 8700 Type 3 emergency attendances per month. Northwick Park A&E Type 1 performance continues to be challenged and the unit has not met the 95% Type 1 standard since April. There was 1 week in Mid- May where there was a significant improvement in performance which was attributed to an increase in inpatient bed availability. Type 1 performance year to date is 68.37%, Type 3 performance is 99.28% and all Types is 87.01%. The Northwick Park site has met the agreed Type 1 performance trajectory in some weeks but overall has been underperforming more recently. The Northwick Park site has been generally tracking along the all types planned trajectory with a significant improvement likely when the bed capacity is increased with the new Modular Ward Block. In the meantime a number of new processes have been introduced by the new Chief Operating Officer (COO), Lee Martin, which will help to improve the flow of patients that receive our services across our hospital and community sites.

Graph Showing 4 Hour Performance against Agreed Trajectory at Northwick Park

3. Remedial Actions to Improve Performance

3.1 The Trust has been working to make improvements in both the Emergency Pathway and general flow of patient care through all our hospital sites and into local community and primary care services. The Northwick Park site has been working towards a Remedial Action Plan (RAP) in conjunction with Commissioners. An action plan is in place at Ealing which has been delivered but these two plans have now been combined into one plan titled the Consolidated Action Plan.

There was an Emergency Taskforce Team which was setup to improve emergency performance and this work is now progressed through the Emergency Pathway Performance Group. This group consists of the CEO, COO, Divisional Managers, Clinical Directors and service leads, who meet every Thursday to review performance and put in place new improvement initiatives.

The Trust will also take the learning from the fortnight of ‘Breaking the Cycle’ to change and improve the patient flows in the hospital.

4. Winter Plans and Key Developments

4.1 The Ealing health economy Urgent Care Board has agreed a set of winter schemes, which will reduce the demand on ED and for beds on the site. Details of the schemes are described above. In addition the following describes initiatives within the Trust:

Initiatives within the Trust

 Working with commissioner’s increase in capacity of the Ambulatory Care Unit at Ealing to reduce the pressure on the ED.  As an Integrated Care Organisation we have mobilised community services to provide additional support to maintain care out of hospital where it is safe to do so. This will include an increased level of pull (from inpatient care to the community and primary care settings) from outside of the Hospital.

 Increased bed base on the Northwick Park site – new beds to open this winter.

 Ensuring patients are in the right care environment – The aim is to reduce the number of ward outliers and improve on length of stay.

 Increased mortuary capacity at the Northwick Park site.

 On week beginning 9th November the Trust will commence our breaking the cycle process. This is a combined health economy effort to improve our emergency pathway by having extensive clinical and management support to patient pathways both within the Trust and in the community. The aim is to reset the system so the Trust can have sufficient capacity to improve and maintain performance.  We have a new Chief Operating Officer and new Executive Appointments who have committed to improving the Emergency Pathway with a whole systems approach.  Senior Management has met with LAS to agree set of actions to reduce ambulance waits during winter.  All sites adopted new access process to improve patient flow throughout the hospital and beyond.

4.2 The progress of the schemes is tracked through the Urgent Care Board(SRG) and within the Trust to ensure they are delivered and any potential issues or risks are managed effectively. The expected impact of the initiatives is evaluated through the performance trajectory and reviewed at the Urgent Care Board.

IMPERIAL COLLEGE HEALTHCARE NHS TRUST

1. Our hospitals

There are five hospitals in Imperial College Healthcare NHS Trust:  Charing Cross Hospital  Hammersmith Hospital  Queen Charlotte's & Chelsea Hospital  St Mary's Hospital  Western Eye Hospital

Imperial College Healthcare NHS Trust provides acute and specialist healthcare for the population of just less than two million people in North West London, and more beyond. We provide care from five hospitals on four sites, as well as, increasingly, a range of community facilities across the North West London region. Around a third of our care is commissioned by our eight local clinical commissioning groups (CCGs) including Ealing, another third of our work is for CCGs beyond our local area, and the final third comprises specialist services commissioned by NHS England.

2. Emergency departments and urgent care centres

Our accident and emergency (A&E) services include emergency departments, urgent care centres (UCC’s) and specialist emergency centres.

Emergency departments are located at St Mary’s and Charing Cross hospitals. UCC’s are located at St Mary’s, Charing Cross and Hammersmith hospitals.

Our hospitals are also the home to some of London’s specialist acute medicine centres:  major trauma centre at St Mary’s Hospital  hyper acute stroke unit at Charing Cross Hospital  heart attack centre at Hammersmith Hospital  24 hour ophthalmic emergency service at the Western Eye Hospital

3. 2014/15 changes to A&E services and performance

Our A&E services were a big focus during 2014/15. In September, after much preparation, we made a number of changes that had been agreed the previous year as part of the ‘Shaping a healthier future’ service reconfiguration programme for North West London, led by local clinical commissioning groups. The changes included closing Hammersmith Hospital’s A&E department and extending the urgent care centre there to a 24/7 service, and concentrating more senior A&E doctors at St Mary’s and Charing Cross hospitals. The changes went smoothly and the increase in A&E attendances at St Mary’s and Charing Cross was broadly in line with projections. However, we also saw a new pattern of attendances emerge, with much bigger fluctuations in numbers during the day and over the week, and an increase in how poorly the patients attending were. Along with many trusts across England, we struggled to meet the A&E waiting time targets through the second half of 2014/15.

A&E performance also reflects how well the whole patient pathway is working, not just how well we are doing at the ‘front door’. In 2014/15 our performance against the target of 95 per cent of patients being assessed, treated, admitted or discharged in under four hours was 93.67 per cent. Challenges to reach this target included ensuring a good flow of patients through our hospitals and a speedy return home or to their local hospital or community facility, when they were well enough.

4. 2015/16 A&E performance

We are beginning to see increased pressure on our urgent and emergency services as 2015/16 proceeds. Performance against the four-hour A&E waiting time standard was 94.86 per cent in August, then 93.54 per cent in September, followed by (provisionally) 92.04 per cent in October against the target of 95 per cent. For the 2015/16 year-to-date A&E performance stands at 93.83 per cent (as at the end of October 2015).

5. Community-based services

Increasingly, we are offering consultations and care in community facilities that would traditionally have been provided in our outpatients clinics, working closely with GPs and other primary and community care organisations. On 1 April 2015, we also became the lead health provider for the community independence service covering three of our boroughs – Hammersmith & Fulham, Kensington & Chelsea, and Westminster. This means partnering with other health care providers and adult social care to enable people with complex needs to get the care they need at home wherever possible, and to help them get home again as quickly as possible if they do need a spell in hospital.

6. Winter resilience planning

We remain committed to delivering high quality care for our patients throughout the winter. The NHS however, is facing a significant challenge again this winter. More very ill people - often frail, elderly people with multiple health problems – will need extensive hospital care and subsequent rehabilitation and integrated community- based support.

Given increasing and complex demand, the key to ensuring timely and high quality care is keeping the flow of patients through the whole health system, from early support to prevent deterioration, to A&E when necessary, through to discharge with the right package of follow-up care in place.

Our winter resilience work is cumulative with tried and tested measures introduced each year and in some cases permanently adopted as year round services.

The Trust’s winter resilience plan, currently being finalised, aims to help manage the additional pressures on services anticipated over the coming months. It seeks to optimise our urgent and emergency care pathways as well as to provide some additional capacity. As such, the focus is on activities that help:  avoid unnecessary hospital admissions (including use of the community independence service and new frailty units)  support fast access for patients who do need to be admitted  make best use of our beds and capacity across all of our sites  Facilitate best practice discharge processes (including support from a 7-day discharge team).

We will be monitoring and publishing our performance on our website regularly.

6.1 Community independence service One key initiative is the community independence service (CIS) – developed in partnership with local commissioners, Central London Community Healthcare NHS Trust (CLCH) and adult social care across three boroughs (Hammersmith & Fulham, Kensington & Chelsea, and Westminster) to support people with complex needs in their own home, preventing them from reaching crisis point and what would often be lengthy hospital stays. GPs can refer an individual to the service’s multi-disciplinary rapid response team. The team will make a home visit within two hours to work out an urgent package of medical, nursing, social and rehabilitation care.

The CIS team also operates an ‘in-reach’ service – supporting appropriate Emergency Department patients to be able to return home after treatment without needing to be admitted to hospital. If someone has had a stay in hospital, supporting their discharge home by providing up to a six-week home rehabilitation package.

6.2 Frailty units Sometimes older people do need a short hospital stay and the Trust has recently opened frailty units at Charing Cross and St Mary’s hospitals. The units provide dedicated bed space for older people requiring a short stay in hospital. A specialist team including doctors, nurses and therapists help older patients manage new and existing problems such as falls, poor memory, weight loss and mobility problems.

Patients can be referred to the frailty units and rapid access clinic by their GP, specialist consultant or community nurse. Patients may also be transferred from A&E.

6.3 Rehabilitation Working with our clinical teams we are supporting the development of our rehabilitation pathways, including the successful Albert Ward for post-surgical rehabilitation which has reduced our length of stay for these patients. Additionally, from October, we opened the new Charing Cross Neuro-Rehabilitation Unit (CNRU).

6.4 7-day discharge from hospital From November a seven-day discharge team will be in place for all of the Trust’s hospitals. The team supports patients and ward staff across our hospitals to make sure all the necessary arrangements are in place – including medication, transport, family support, and follow-up care. The team will work with adult social care who also now provides a seven-day service to hospital patients.

EALING ADULT SOCIAL CARE – DISCHARGES AND DELAYED TRANSFERS OF CARE

Figure 1 highlights the number of delayed transfers of care by days per month for Social Care, NHS, WLMHT and Joint Delays. Figure 2 highlights reasons for delays.

Fig 1 - Days per Month

Fig 1: DToC Days per Month 600 513 523 500

377 366 400 352 344 284 300 238 256 208 198 198 198 200 168 159 141 157 151 112 88 96 81 100 62 62 57 74 31 44 8 0 0 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Social Care Days Delayed NHS Days Delays WLMHT SC Days Delayed WLMHT NHS Days Delayed WLMHT Joint Days Delayed

 Social Care Delays have remained fairly consistent  NHS Delays have fallen  WLMHT delays for Sept are higher than in previous months  Joint delays are relatively small compared to other areas

Fig 2 - Reasons for Delay

The following highlights the reasons for delays both for NHS and Social Care DTOCs. The main reasons for NHS delays are due to patient and family choice and for Social Care they are awaiting Nursing Home Placement or Residential Home Placement.

Fig 2: Reasons for NHS Delays (excl. MH)

250 233

200

174

158

150

125 127

113 Delayed Delayed Days 100 95 88 82 73 67 60 61 51 50 46 36 38 30 31 32 30 29 30 28 25 21 2124 23 17 12 13 12 811 4 7 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 APRIL MAY JUNE JULY AUGUST SEPTEMBER A) Completion of assessment B) Public Funding C) Further non acute NHS care (including intermediate care, rehabilitation etc) Di) Awaiting Residential Care Home Placement Dii) Awaiting Nursing Home Placement E) Care package in own home F) Community Equipment/adaptions G) Patient or family choice H) Disputes I) Housing - patients not covered by NHS and Community Care Act

 Main reason for NHS Delay is Patient and Family Choice followed by completion of assessment and further non acute care.  In non-Acute care the main reason for delay is Patient and Family Choice followed by Housing

Fig 3: Reasons for Social Care Delays (excl. MH)

120 114

100 90 88 83 80 80 76 73 69 65 65 59 60 53 53 53

Delayed Delayed Days 47 45 40 40 35 30 31 25 24 21 19 20 13 10 10 10 8 9 5 6 5 4 3 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 APRIL MAY JUNE JULY AUGUST SEPTEMBER A) Completion of assessment B) Public Funding C) Further non acute NHS care (including intermediate care, rehabilitation etc) Di) Awaiting Residential Care Home Placement Dii) Awaiting Nursing Home Placement E) Care package in own home F) Community Equipment/adaptions G) Patient or family choice H) Disputes I) Housing - patients not covered by NHS and Community Care Act

 The main reasons for Social Care Delay are completion of assessment, public funding and awaiting Nursing Home Placement.

The following highlights the key areas of support from Ealing Adult Social Care for admission avoidance and hospital discharges both from an acute episode stay or community hospital stay in hospital:

1. Out of Hospital Social Work Provision

The Hospital Assessment Team has staff based in Ealing Hospital and Claypond’s Hospital. They have also recently negotiated office space in Hammersmith Hospital, Northwick Park Hospital as well as Charing Cross Hospital. In several of these hospitals they share office space with that hospital’s complex discharge team.

2. Seven Day Social Work Service A prevention of admission and hospital social work discharge service has been established over the past year. Social Workers can now commission packages of care, temporary placements, handypersons’ services as well as re-ablement at the weekend in order to prevent admission or support discharge. They also screen discharges to ensure that patients are being discharged safely and are not at risk of re-admission. Social Workers are based in Ealing Hospital from 10am – 6pm and provide the service to both in and out of borough Trusts.

3. Emergency Duty Team The emergency duty social work team (EDT) supports children and adults in the community out of hours. They have access to care providers and can set up emergency provision to keep customers safe.

4. Home ward Ealing (Intermediate Care Service) Ealing Social Services co-commissioned this service with Ealing CCG. A team of Social Workers work in partnership with the new lead provider – WLMHT – and alongside Clinicians, Nurses and Therapists on level 9, Ealing Hospital. Additional resources to increase the Social Work contribution have been achieved through the Better Care Fund. Several additional Social Workers are in post ahead of winter and the recruitment plan is on schedule. The new service extends the Intermediate Care offer to out of borough hospitals and Social Workers based in those hospitals are actively working with their health colleagues to promote the new service and identify patients who have the appropriate rehab goals.

5. Increased Handyperson Service Through winter pressures funding the Handyperson Service is now able to support people leaving hospital. The service is free and not means tested. It is available to Ealing residents who are carers, who are over 60, who are disabled or vulnerable and to single parents on benefit with children under 16. Hospital Social Work staff have distributed flyers to hospital wards. This is an additional resource since last year.

6. BCF Voluntary Sector Schemes Hospital Social Work staff are establishing strong working relationships with the providers who have been awarded grants that support prevention of admission and prompt discharge. These include RISE and St Mungo’s. This is an additional resource since last year.

7. Housing Related Support A recently appointed worker is dedicated to supporting patients with housing difficulties. Typically he will help to address tenancy issues, identify appropriate accommodation and assist with benefits claims. He spends one day a week at WLMHT and two days in Ealing Hospital. This is an additional resource since last year.

8. Whole Systems - Model of Care Model of Care, Care Co-ordinators are establishing working relationships with Home ward Ealing, the Hospital Social Work and Locality teams. This is an additional resource since last year.

9. Severe Weather Forum Senior Social Service Managers attend the Severe Weather Forum as required. This ensures that crucial information is cascaded to frontline staff in respect to severe weather warnings, serious incidents and any other occurrences that may impact on “business as usual”. The forum is convened by Ealing Council’s Emergency Management Service.

10. Sector Wide Conference Call Social Services Managers work closely with colleagues in the CCG Continuing Care Team and attend the sector wide conference call on a daily basis. They have access to Social Work records in front of them and update the Chair on the progress of each patient’s discharge planning.

11. Choice Policy As part of Breaking the Cycle Ealing Social Services has promoted the re-launch of the Choice Policy across LNWHT. The Choice Policy specifically sets out a process to professionals who are discharging a patient to a care home placement.

12. Hospital Discharge Initiative Ealing Social Services supports the PID currently being developed by the West London Alliance that will explore the possibility of reciprocal cross-border Social Work arrangements. The project is at an early stage with delivery and implementation scheduled for March 2017.

13. Capacity Planning - Home Care Market The Business Management Team for Adults Social Care is currently developing a programme to expand home care provision within the Borough in the current challenging market. Planning is specifically targeted toward Intermediate Care and several options are being considered and developed. Funding for this increased provision has been secured through the Better Care Fund.

EALING WINTER MARKETING COMMUNICATIONS & ENGAGEMENT CAMPAIGNS – 2015-16

BACKGROUND

This year, NHS England and Public Health England have prepared a joint national campaign to help people at risk to ‘stay well this winter’. In Ealing, we are leveraging this national campaign work to target local groups, adding locally relevant messaging about choosing the right care, Ealing A&E and UCC, etc. where appropriate.

NATIONAL CAMPAIGNS

The national team has booked stay well advertising on local media: • TV and radio campaigns including Magic, Kiss, Sunrise Radio, talkSport, Gold (began 12 October)  Bus shelter ads around Ealing—especially close to pharmacies • Press ad for Ealing Gazette • Door drop of 8pp stay well booklet to go to older, less affluent residential addresses

LOCAL EALING CAMPAIGNS

We are working in partnership with the Local Authority, Public Health, care providers and the voluntary sector to utilise local channels of communications and engagement. Alongside this, we are implementing locally targeted marketing and advertising campaigns.

LOCAL ENGAGEMENT

Ealing CVS commissioned to reach 25,000 residents across October 2015-March 2016 with winter health messaging Information circulated to over 800 local voluntary groups, VCS area hubs, community centres on estates and faith centres Structured engagement with target groups, briefing sessions with VCS organisations, and outreach activities with hard-to-reach communities, including BME, newly arrived, family and children groups, older people groups and isolated users Stay well & flu information & web banners provided for ECVS health e- bulletins and information cascade Exploring contract with street marketing providers for mass footfall engagement

JOINT WORKING: LOCAL AUTHORITY

Working with Public Health and council communications to coordinate winter and flu communications Communications to health visitors, children’s centres, school nurses, schools & nurseries School & nursery vaccination schedule on Ealing Grid for Learning web pages District nurses covered direct via NHS Posters in council offices, leisure services and libraries Flu posters and leaflets to health trainers for distribution

JOINT WORKING: LOCAL PHARMACEUTICAL COMMITTEE Liaising with LPC to produce Producing 1 metre high free standing flu card stands for flu vaccine-dispensing pharmacies across Ealing Pharmacies receiving flu posters and shelf wobblers from national team

ADVERTISING

Ads for flu jabs and self-care booked for Argos & 99p till receipts across Southall, West Ealing & Acton Advertising pharmacy/self-care messaging on DESI Punjabi radio Full page colour ad in Around Ealing council magazine Exploring advertising on lamp posts across and LA notice boards

SOCIAL MEDIA Social media content including blogs, video vlogs, tweets and Facebook posts circulated to CCG, LA, VCS and Provider communications colleagues New regular health blog from Mohini Parmar on www.ealing.gov.uk New content for Around Ealing Extra e-bulletin form Jan 2016 Website updates on www.ealingccg.nhs.uk and www.staywellnwl.nhs.uk website Content and Tweets at https://www.healthiernorthwestlondon.nhs.uk

GIVEAWAYS Producing printed thermometers, trolley coin holders and first aid kits as giveaways to support engagement

MEDIA PLAN • Press releases to local press, CVS newsletters, council press • Regular DESI RADIO guest spot for GP Raj Chandok on DESI Radio

GP PRACTICES Articles, artwork, information, posters, leaflets and banners for GP bulletins, GP websites and patient newsletters Articles available on CCG extranets Text messaging via GP practices to patients Producing one meter high flu cards for GP surgeries

EALING DIRECTORY OF HEALTH SERVICES

Full colour directory of Ealing Health Services to include stay well information Door drop to 135,000 residential and commercial addresses across Ealing

PROVIDERS

Providing collateral and social media content to care providers.