Kent and Medway ICS Winter Plan 2022-23 Update & Improvement Initiatives

Kent and Medway ICS Winter Plan 2022-23 Update 6 September 2022

Winter Plan Our ambition is to improve through winter The health economy has proactively managed an increased demand for services throughout the year across all providers SECAmb, social care, primary, acute, community and mental health. A combination of risks of increased demand are starting to be identified for the winter period and will need to be mitigated over the winter period these being: Increased primary care demand o Capacity within community and social care services o Increased paediatric demand through Q3 for respiratory infections o Increased winter Urgent and Emergency Care (UEC) demand (including potential bounce back from COVID) o Desire to maintain elective care due to potential harm of long waiting patients o Workforce capacity across all areas of the system o Increased patient presentations with COVID infection due to further peak of infections in winter o Increased presentations linked to current cost of living crisis o At present there are three areas to the Kent and Medway ICS 22/23 Winter Plan, these are: Winter Surge Plans for each patient pathway assess gap, mitigations and improvements and escalation (OPELs framework) o National UEC Assurance documentation Board Assurance Framework (BAF) and best practice assessment o Local care Winter Plans o

Pathway Winter Surge Plans The whole-system Winter Surge Plan are being refreshed for primary, community, acute, mental health and social care o Surge plans cover pathways of care Critical care, Urgent Emergency Care, Primary Care, Maternity, Paediatrics, Mental Health, these identify surge levels (business as usual, surge and super surge levels) o They show potential gaps in capacity and the mitigations/improvement/investment to bridge the capacity o Data packs provided to surge groups on predicted demand o Deadline for Surge plans to be completed by 9 September 2022 o Desk top practices to aid cross system working, communication and mutual aid if required

4 Winter Surge Plans example of Acute Care Surge Planning Improvement initiatives o Bed gap 350-550 o Provision of additional community capacity o Reduce medically fit for discharge (MFFD) in acute care o Review of integrated discharge team models, focus on weekend discharging o Increase bed base through review of estate, converting offices and store rooms back to inpatient beds o Increase same day emergency care (SDEC) pathways o Whole system back to basics on length of stay (LoS) and discharge management, senior discharge reviews and twice daily board rounds o Frailty, falls and SDEC collaboration o Target - ICS bed occupancy 85% - week commencing 20 December 2022 for acute and community

UEC Assurance Framework (BAF) NHSEI have requested an UEC Assurance Framework document to be completed by each system with a peer review before final submission on 22 September 2022 The Assurance Framework workbook is split into various sections which will be completed across the system by colleagues in the ICB, Providers and Health and Care Partnership leads o Sections to be completed: o Dashboard and Demand and Capacity Plan Actions (individual actions for various areas such as aligning demand and capacity in primary care, improving 111 performance, workforce, and utilisation of the voluntary and community sector) A Self-Assessment Checklist (to be completed by each trust and a combined system version to be submitted) Improvement Framework (a collection of over 200 key lines of enquiry split across the various elements of the UEC pathways) In addition to the assurance document, the UEC team are working closely with regional partners across Sussex and Surry to ensure there is a robust SECAmb Winter Plan in place o The deadline for the 1st draft of this workbook is 3pm on 14 September 2022 We have been paired with the Frimley ICS to peer review submissions prior to the final deadline for submission to NHSEI Southeast on 22 September 2022, followed by their submission to national colleagues on 26 September 2022

Executive team leadership o All executive team members are leading the winter plan with the Chief Delivery Officer coordinating o Specific executives are leading key pieces of work to support pace and readiness for example: Workforce ICB Executive Director for Human Resources and Organisational Development working with provider People Directors around roster and peak staffing periods, use of agency and bank across the year with highlight for peak winter periods Discharge ICB Chief Nursing Officer and Chief Medical Officer working with provider Chief Nursing Officers and Medical Directors to look at supporting best practice on discharge planning Communication Communication Director working with other agencies, NHS national team re building the communications plan Emergency Preparedness, Resilience and Response (EPRR) working with Kent Resilience Forum around how we assist with isolation, places of warmth and food Voluntary sector Chief Delivery Officer and EPRR working with voluntary sector to increase voluntary sectors part in winter response

Winter Plan 22-23 Functional Streams - What will be different? Winter Surge Plan Functional Stream Lead Projects started in 21/22 that will impact this Winter Changes for 22/23 Weekly social care and community team meetings to progress improvement plan. K&M workforce recruitment retention plan. Social Care and Community Capacity 100 Day Challenge Capacity and Demand funding MA Virtual Ward PC Primary Care Hubs Phase 1 of Virtual Ward Implementation Targeted Investment Fund 1&2 funded projects (discharge lounge, SDEC and conversion of clinical to non-clinical space, 111, 999, Urgent Treatment Centre improvement plans). Acute patient flow (Surge and OPEL Plans) PM Improvements to discharge plans Increased Peads Hospital at Home, increased GP draining for respiratory, expansion of community capacity. Pediatric SM Embed Paediatrics Surge and OPEL plans. Year 2 of Winter Access Funding Surge and OPEL framework and escalation Potential 200 GPs to triage patients, Hot Hubs to be explored. Primary care (Surge and OPEL Plans) Year 1 of Winter Access Funding, Practice level dashboard, Primary Care Pressures action plan and GP Bank. SS Implemented Surge processes and pathways, additional capacity and escalation plans. QVH additional funding to increase ITU/HDU beds to protect elective surgery. Conversion of previous separate ITUs into one unit at East Kent providing additional beds. Increase in business as usual beds (8). Critical care (Surge and OPEL Plans) JW Review of new winter roles (including military support) to identify non-qualified roles to improve patient flow. Digital passports, Workforce memorandum of understanding, forward planning for staff rotas including shadows rotas and escalation. Development of health and wellbeing offer to reduce attrition rates. Focus on UEC, CC, Elective, domiciliary/home care. Agency Spend Review Workforce RB Implemented dedicated clinical nurse managers for out of hours liaison psychiatry service. Implemented the 836 police advisory line. Mental Health (Surge and OPEL Plans) MH Urgent care hubs-increased MH provision in ED. New model for MH safe havens. TM Surge and OPEL plan, workforce monitoring and live capacity and demand dashboard. Maternity (Surge and OPEL Plans) CH

Winter Plan 22-23 Functional Streams - What will be different? Projects started in 21/22 that will impact this Winter Winter Surge Plan Functional Stream Lead Changes for 22/23 Redesign programme to implement new 12-hour Clinical Review of Standards. Falls car to be embedded this winter. UTC, SDEC, 111,999, discharge lounge improvement plans. UEC (Acute Surge and OPEL Plans) JW Single patient tracker list, pathway improvements, dedicated green sites, increase use of independent sector, increase theatre utilization and diagnostics recovery plan. Ringfenced green pathway capacity, increased IS capacity, increased elective workforce, elective cancellation procedure to protect capacity, diagnostic improvement programme. Elective care (Acute Surge and OPEL Plans) DC Booster delivery model developed for adults and children Covid and Flu vaccination programmes for Adults and Children. Covid & Flu Vaccinations PK Dedicated CAMHS Team, drafted CAMHS pathway and escalation Increased dedicated CAMHS Team and agreed CAMHS pathway and escalation. CAMHS (Surge and OPEL Plans) SM Embedded forward planning data for Surge and elective demand. Build on 21-22 data with Lightfoot pathway specific data. Data and Analytics CW Build on planning process from 21-22, gather potential TIF bids ready for any potential release of funding, capture provider capacity via Surge plans. Increase operational OCC workforce ready for Winter & further develop all Surge plans Co-ordinated by Operational Coordination Centre (OCC) team, transition COVID OCC to operational OCC, developed operational procedures. Central Planning Co-ordination LM Build on winter communication plan to inform public of UEC pathways. Covid Ambassadors. Stop, Think, Choose Campaign. Transition Covid Ambassadors to Winter Ambassadors Comms FS

Summary and Timelines o The full Kent and Medway Winter Plan in all its elements will be completed for approval at the November 2022 Board Meeting o The Winter Surge Plans will be compiled by 7 September 2022 o The UEC Assurance Framework will be completed for submission on 22 September 2022 o The HCP Plans will be submitted to the central planning team by 30 September 2022 to be compiled by mid-October