Presentation to the Governing Body of NHS Eastern Cheshire CCG

1. Maintaining System
Resilience Through Winter
Jacki Wilkes/Charles Malkin
Governing Body
22 February 2016

2. Setting the scene….
Eastern Cheshire demand for hospital services
down year on year
Unintended consequences include:
• shift in demand across the system
• achieving 95% A&E waiting time target more of a
challenge
Q4
Provider Attendances Admissions
4 hr
Performance
2015/16
Attendances Admissions
4 hr
Performance
2014/15
EAST 6,835 1,404 91.05% 7,234 1,701 85.10%

3. What’s different this year….
• Plan against a review of capacity and demand-
emphasis on flow, people and processes
• Innovative approach to measuring system
resilience
• Intelligent approach to promoting self care
through ‘Choose Well Think Pharmacy’

4. • Using data from these sources to target key
audiences:
GP practices & snow white
• What it tells us:
 Age range of patients (0 – 9, 65+, jobless)
 What’s wrong with them (coughs, sore throats,
diarrhoea , flu symptoms)
• Most of these people should be self-caring or
seeing the pharmacist
The science bit:

5. • Targeting key audiences through:
 School newsletters
 Job Centres
 CVS network
 Partners
 HealthVoice
• Events
• GP screens
• But global communications needed too
What are we doing about it?

6. Whole audience – a new approach!
• Outdoor advertising:
 Billboards – Waters Green
 Morrisons – Congleton & Poynton
 Macclesfield, Knutsford & Wilmslow Railway Stations
 Waitrose – Poynton
 32 telephone kiosks
 25 buses
 Radio

7. How are we saying it?
• Whole audience:
Outdoor advertising (reach: nearly 112,000)
Free sheets (reach: around 150,000)
Health & Social Care Directory (reach: 24,000)
• Total reach = 286,000 – excluding targeted
comms
• And it works across borders

8. • CCG web pages: + 1,000 page impressions
per month in Dec 2015 & Feb 2016
• Twitter: nearly 4,000 followers
• Klout score: 49
• Facebook: 75 likes
• LinkedIn: 98 followers
• HealthVoice & Caring Together feeds
How are we saying it?

9. • Outdoor advertising must be concise
• 111 is best option for reducing demand on
GPs & A&E for urgent care
• Self-care is best option for minor ailments
Why NHS 111 and self-care?

12. • Outputs:
 Audience reach
 % take-up of media releases
 Sentiment & AVE
 ROI: Potential £25k net saving
• Outcomes:
 Awareness (competition, Citizens’ Panel, on-street)
 Behaviour change
How do we measure impact?

13. Primary Care:
General
Activity Levels
Pressure on
Appointments
Other
Click on title for
further info
MDGH (Acute) -
Status: Staff
Bed Cap v
Demand ED Wait
Unplanned
Closed Beds
Non-IP Beds
in use
COMMUNITY:
EAST 14.00 I/M Care I/M Care Nursing HITS IRS
COMMUNITY:
S&VR 14.00 I/M Care IRS OoH-SVR
Staffing Home Visits D&V
12/11/2014
Green
12/11/2014
Beds Overall RAG AM
12/11/2014
Beds Nursing Matrons
11:00 0-1 Hours East Locality SVR Locality
Depts/ Elective
Green
Patient Demand Accessing Services Flu Services Admissions
Business Critical
Packages
PM (prev
day) OoH-East Packages
Yellow
Click to see Primary Care Peer Groups: Flu Info
Click for Data Click for Data
12/11/2014
Care Home Bed Availability
W/C: 27/10/14 44
With Nursing 14
With Nursing/EMI 5
With Nursing & Without Nursing 0
With Nursing & Without Nursing/EMI 1
With Nursing & Care in yr home + supported living/EMI 3
With Nursing / With Rehab (illness or injury)/EMI 0
Without Nursing 13
Without Nursing/EMI 5
Without Nursing / With Rehab (illness or injury) 3
Attends Breaches
147 3
% Factor for Projections:
Respiratory System -5.00% Paediatrics 0.00%
Primary Cardiac -5.00% Falls 0.00%
Maintenance
16:00
Adelphi (Adult
Elderly)
2
Bollin (Adult) 5
Croft (Organic) 1
click for
note
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins Snow Other Adverse Met Office 10 day ind
42 4 0 0 9.52% 88 22 1 0 26.14% 12/11/2014 8 No None None
13/11/2014 10 No None None
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins 14/11/2014 7 No None None
7 2 0 0 28.57% 22 7 0 0 31.82% 15/11/2014 7 No None None
Avg time to
notification to clinical
handover:
08:22
Avg time to
ambulance
clear:
Avg time to notification to
clinical handover:
07:53
Avg time to
ambulance
clear:
16/11/2014 8 No None None
17/11/2014 8 No None None
18/11/2014 7 No None None
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins 19/11/2014 7 No None None
49 4 0 0 8.16% 95 19 2 0 22.11% 20/11/2014 7 No None None
21/11/2014 6 No None None
Jobs H/O 15-30mins 30-45mins >45mins % >15mins Jobs H/O 15-30mins 30-45mins >45mins % >15mins
34 1 1 0 5.88% 28 5 0 0 17.86%
Avg time to
notification to clinical
handover:
10:30
Avg time to
ambulance
clear:
Avg time to notification to
clinical handover:
10:05
Avg time to
ambulance
clear:
Under Development
Total Available
Click for Full Data
Availability to admit patients
(maximum 3)
Click for Data / Commentary
Capacity to Admit Status
25.22
A&E 4hours & DTOCS - Wythenshawe Hospital Site
MDGH - # of empty beds
29.23
12/11/2014 12:00
Previous day's total
NWAS - Wythenshawe Hospital
11/11/2014
Commentary: Temperatures over the next few days
are marginally higher compared with the equivalent
period in 2013. Emergency activity levels, where
weather temperature influences, would therefore
indicate similar levels.
Green
Community
Domiciliary Care
Green
Target Time from Referral to
Assessment for Mental Health
patients assessed as being medically fit
24.25
Infection Control
This remains amber for care
home placements, green for
team and domiciliary care.
Staffing Hospital
Team
Amber
Previous day's total
Liaison A&E (Target
1hr)
NWAS - Leighton Hospital
12/11/2014 12:00
Previous day's total
NWAS - Stepping Hill HospitalNWAS - MDGH
96.30%
12/11/2014 Green
12/11/2014 12:00
12/11/2014 12:00
Previous day's total
12/11/2014
Community Pharmacy
MDGH DTOCs
CWP - East
21.38
97.96%
20 2711/11/2014 11/11/2014
ECCCG - all Practices Congleton / Holmes Chapel
Knutsford C.H.A.W.
Poynton / Bollington / Disley Macclesfield
A&E 4hours & DTOCS - Stepping Hill Hospital Site
11/11/2014
Residential/
Nursing Care Bed
Packages
Overall RAG for CWP
Green
Click for DataEast Cheshire Hospice
07/11/2014
12/11/2014 13:30
Yellow
Green
Green
Click for ECT Community Data
Amber
Click for ECT Intermediate Care Data Click for SVR Community DataClick for ECT (Acute) Data
Yellow
Click for ECT Communication
Amber
Yellow Amber
Green
Green
YES
AAU
Functioning?
Click for System Status Detail
Yellow Green
YELLOW
Green
System Overall Status:
Green
Yellow
12/11/2014
4
3
24
Green
Green
4
24 Red
Position on Scale:
Green
DNs
Last Update:
YELLOW
YELLOW
NHS EASTERN CHESHIRE CCG - URGENT CARE MONITORING DASHBOARD
Amber
Amber
Social Care Click for Weekly Data
A decision to admit to
organic bed when
need and risk
assessment identifies
this plan
Liaison Wards
(Target 48hrs)
Green
Green
NWAS - LIVE PORTAL UPDATES
11/11/2014
Click for A&E Data
8
A&E 4hours & DTOCS - Leighton Hospital Site
Green
Green
11/11/2014
Green
Weather
Click for Weather Data
Minimum Temperature
2014-15 Projected2013-14 - Actual
A&E 4hours - MDGH Site
95.80%
89.80%
12
17
11/11/2014
Click for DTOC Data
MDGH - EMERGENCY ADMISSIONS BY CONDITION - 2013-14 / 2014-15
MDGH Medical Outliers
0
2
4
6
8
10
12
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number Respiratory System
0
2
4
6
8
10
12
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number Primary Cardiac Conditions
0
2
4
6
8
10
12
14
16
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number
Paediatrics
10
20
30
40
50
28/10
29/10
30/10
31/10
01/11
02/11
03/11
04/11
05/11
06/11
07/11
08/11
09/11
10/11
11/11
MDGH Number of Emergency Admission via A&E (trend last 14 days)
-3
0
3
6
9
12
15
12/11
13/11
14/11
15/11
16/11
17/11
18/11
19/11
20/11
21/11
22/11
23/11
24/11
25/11
26/11
Degrees C 2013/14 2014/15 Minimum Temperature
0
1
2
3
4
5
6
12/11/2013
13/11/2013
14/11/2013
15/11/2013
16/11/2013
17/11/2013
18/11/2013
19/11/2013
20/11/2013
21/11/2013
22/11/2013
23/11/2013
24/11/2013
25/11/2013
26/11/2013
Number
Falls
15
20
25
30
28/10
29/10
30/10
31/10
01/11
02/11
03/11
04/11
05/11
06/11
07/11
08/11
09/11
10/11
11/11
MDGH Numberof DTOCs by Day (trend last 14 days)
Measuring wider system resilience…

14. Measuring true impact of the 4 point plan

15. Next steps….
• Refresh external review data and analysis from
snow white
• new plan for 16/17 building on success from
15/16
• Develop wider system measures e.g impact of
reducing Length of stay on primary and
community services
• Deliver 95% performance on A%E waiting time
and maintain