NHS FifeNHS Fife

Winter 2010-11Winter 2010-11

Preparation Preparation

Winter plans in place in each part of system Winter plans in place in each part of system

Joint escalation procedure agreed and in Joint escalation procedure agreed and in place place

Agreement on information to be shared Agreement on information to be shared across the system across the system

Blue admissionsPink discharges

Month 1Month 1

What significant changes did we note What significant changes did we note – Decrease in nursing home placements (29 v 44 Decrease in nursing home placements (29 v 44

from hospital and 59 v 99 in total) from hospital and 59 v 99 in total) – Increase in delayed discharges ( total &>6 wks)Increase in delayed discharges ( total &>6 wks)

Blue admissionsPink dischargesAmber Boarding bed days

Month 2Month 2 What significant changes did we note What significant changes did we note

– Continued decrease in nursing home Continued decrease in nursing home placements placements

– Continued increase in delayed discharges ( total Continued increase in delayed discharges ( total &>6 wks)&>6 wks)

– Increase in boarding bed daysIncrease in boarding bed days– Wards closed due to NorovirusWards closed due to Norovirus– Cancelled operations due to lack of bedsCancelled operations due to lack of beds– Decrease A&E performance – 98% to 92 % , Decrease A&E performance – 98% to 92 % ,

Increase in 12 hour breaches from 1 to 9 in Increase in 12 hour breaches from 1 to 9 in week week

Month 3Month 3 What significant changes did we note What significant changes did we note

– Increase in nursing home placements Increase in nursing home placements – Wards closed due to NorovirusWards closed due to Norovirus– Reduced number of cancelled elective operations due to Reduced number of cancelled elective operations due to

lack of beds lack of beds – Reduced numbers of admissions during severe weather Reduced numbers of admissions during severe weather – Increasing boarding bed days Increasing boarding bed days – increase in delayed discharges >6 weeks increase in delayed discharges >6 weeks – Severe weather -2 weeksSevere weather -2 weeks– Unfunded beds opened across system Unfunded beds opened across system – Overall System at Red StatusOverall System at Red Status– Decrease A&E performance – 92% to 89% , Increase in Decrease A&E performance – 92% to 89% , Increase in

12 hour breaches to 23 in week12 hour breaches to 23 in week

Month 4Month 4 What significant changes did we note What significant changes did we note

– Wards closed due to NorovirusWards closed due to Norovirus– Increased number of cancelled elective Increased number of cancelled elective

operations due to lack of beds operations due to lack of beds – Variable boarding bed days Variable boarding bed days – Significant increase in delayed discharges >6 Significant increase in delayed discharges >6

weeks weeks – Additional investment from Health and Social Additional investment from Health and Social

care care – Decrease A&E performance – 89% to 86% , Decrease A&E performance – 89% to 86% ,

Increase in 12 hour breaches to 37 in weekIncrease in 12 hour breaches to 37 in week

Month 5Month 5 What significant changes did we note What significant changes did we note

– Significant Increase in nursing home placements Significant Increase in nursing home placements – No Wards closed due to NorovirusNo Wards closed due to Norovirus– Significant increase in nursing home placements Significant increase in nursing home placements – Increased number of cancelled elective operations due Increased number of cancelled elective operations due

to lack of beds to lack of beds – Decreasing boarding bed days Decreasing boarding bed days – Significant decrease in delayed discharges >6 weeks Significant decrease in delayed discharges >6 weeks – Overall status between amber and redOverall status between amber and red– Increase A&E performance – 86% to 94% , decrease Increase A&E performance – 86% to 94% , decrease

in 12 hour breaches to 11 in weekin 12 hour breaches to 11 in week

Month 6Month 6 What significant changes did we note What significant changes did we note

– Increase in nursing home placements Increase in nursing home placements – Wards closed due to NorovirusWards closed due to Norovirus– Reduced number of cancelled elective Reduced number of cancelled elective

operations due to lack of beds operations due to lack of beds – Significant decrease in total delayed dischargesSignificant decrease in total delayed discharges– Closure of unfunded beds Closure of unfunded beds – Decrease in nursing home placements Decrease in nursing home placements – Overall status amber by middle of March Overall status amber by middle of March – Increase A&E performance –to 94%, decrease Increase A&E performance –to 94%, decrease

in 12 hour breaches to 5 in weekin 12 hour breaches to 5 in week

ReviewReview Difficult winter in contrast to success in previous Difficult winter in contrast to success in previous

year year System under significant pressure from early System under significant pressure from early

NovemberNovember Exacerbated by severe weather end of November Exacerbated by severe weather end of November

into early Decemberinto early December Inability to discharge patients in timely manner Inability to discharge patients in timely manner

from acute and community hospitals from acute and community hospitals Emergency admissions similar to previous years Emergency admissions similar to previous years

but increase in proportion due to falls and but increase in proportion due to falls and fractures fractures

Key areasKey areas

Significantly reduced ability to discharge to Significantly reduced ability to discharge to residential care and home care due to demand residential care and home care due to demand overtaking available resources- both financial and overtaking available resources- both financial and staffstaff

Severe weather during November and December Severe weather during November and December 2010 impacting on patients ( e.g. increased 2010 impacting on patients ( e.g. increased fractures and falls) and staff (e.g. transportation) .fractures and falls) and staff (e.g. transportation) .

Concern about the process for making decisions Concern about the process for making decisions to resolve issues around patient flowto resolve issues around patient flow

What are our plans for 2011-12What are our plans for 2011-12 Table top exercise with Senior Management Table top exercise with Senior Management

team and Partnership Management Group team and Partnership Management Group to test escalation procedure (August 2011)to test escalation procedure (August 2011)

Contingency plan being developed in event Contingency plan being developed in event of major incident during move to new of major incident during move to new hospital hospital

Opportunity to introduce new models of care Opportunity to introduce new models of care and enhance intermediate care systems as and enhance intermediate care systems as part of change fund proposals. part of change fund proposals.