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

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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. 1 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 2 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. 3 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. 4 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: 5 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 6 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 7 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.
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