Winter Plan 2024-25

Meeting: Trust Board – Public Meeting

Date: 6 November 2024

Report Title: Winter Plan 2024-25

Agenda Item: PUB24/11/2.2

Author: Natalie Mudge, Head of Compliance

Lead Director: Melissa Dowdeswell – Chief of Clinical Operations

Purpose: Information noting

Link to CQC domain:

• Caring
• Responsive
• Effective
• Well Led
• Safe

Link to Strategic Objective:

• Be an exceptional place to work, volunteer and learn
• Provide outstanding quality of care and performance
• Be excellent collaborators and innovators as system partners

Link to Strategic Risk:

• SR1a: If we do not ensure our people are safe and their wellbeing prioritised, there is a risk that we will be unable to attract, retain and keep all our people safe and well
• SR2: Failure to achieve continuous quality improvements and high-quality care delivery
• SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities
• SR5: If we do not clearly define our strategic plans, we will not have the agility to deliver the suite of improvements needed

Equality Impact Assessment: No negative impact identified

Previously considered by: CO Office, Deputy Chief of Clinical Operations, Chief of Clinical Operations, ELT and Trust Board.

Recommendation: The recommendation is for the Public Board to have oversight of this document and to provide feedback if relevant to the 2024-25 winter plan to ensure a safe, prompt and effective service during these challenging times.

Purpose: The purpose of this paper is to outline how EEAST will operate during the winter period in the form of a robust plan. The paper also provides examples of how directorates will support the winter pressures. The paper explains how the trust will work over the winter period compared to BAU functions. You can find further supporting information with regards to the winter period in the summary section below.

Introduction / Background:

Following the 2023-24 winter debrief, a multi-directorate approach has been taken to produce the 2024-25 winter plan. The final winter plan has been developed, reviewed and agreed by ELT and the Trust Board. By implementing the winter plan actions, the Trust should be able to provide better outcomes during this period.

During the winter period, our operational demand constantly evolves. Our winter plan will also constantly evolve and will be adapted and adjusted based on the demand we face, new initiatives, input from our stakeholders and learning from the winter plan that we have in place for 2024-25.

Key Issues / Risks:

Section redacted.

Options:

None – for noting only.

Summary:

Why is Winter so special?

Winter refers to the whole period from 01 November 2024 through to and including 31 March 2025. The term ‘festive period’ refers to the whole period from 11 December 2024 through to and including 14 January 2025. Any specific operations during this time will have dedicated individual operations arrangements detailed and signposted within the winter plan.

Winter is now considered as business-as-usual (BAU) with additional capacity and oversight planned to ensure there is sufficient leadership and resource to deliver safe and timely care to our patients. The winter period proves to be significantly challenging for the NHS in general and to the EEAST region. The winter plan documents how we as a Trust will work differently to BAU functions and what additionally we are putting in place to support the winter period.

Significant impacts have been felt in recent winters through increased hospital handover delays, 999 and 111 activity, adverse weather, and above normal levels of staff absence. The winter plan has been developed using previous planning experience, lessons learnt during previous winters, system feedback and lessons learnt from the COVID-19 pandemic. By the nature of the dynamics of planning, learning and modifications will take place throughout the lead-up to and throughout the winter period, as necessary.

Key issues over the winter period:

• Increased demand
• Increased nighttime economy activity
• Festive gatherings/parties
• Colder/adverse weather
• Poor driving conditions from snow/icy roads
• Increased handover delays
• Risk to the elderly, children and patients with long-term health conditions
• Increased staff absence due to sickness
• Winter-related illness – mainly flu
• Fleet availability
• Increased pressure on wider NHS systems

Winter Specific Risk Vs Key Actions

EEAST Objectives:

• To provide a safe, prompt and effective service to patients and the saving of lives is prioritised and maintained.
• Ensure the efficient use of resources and that as a Trust we are adequately resourced.
• Achieve the relevant standards associated with service delivery.
• Maintain public confidence in the Trust.
• Provide compassionate leadership to ensure the health, safety, support and wellbeing of staff.
• Ensure the resilience of the Trust to respond to any critical or major incidents.
• Ensure ongoing risk assessments and identification of actions across the organisational functions to maintain business continuity.
• Establish and maintain effective liaison with partner agencies and stakeholders to ensure a holistic and dynamic approach.
• Disseminate public information messages in a timely and co-ordinated manner.
• To minimise meeting and administration time to increase front-line capacity.
• To utilise support staff in other roles during the winter pressure period after full training as been provided and where practically possible.

What are we doing differently

• Mobilise a locality operational cell in HWE
• Senior Managers working more visibly over the winter period.
• The use of Advanced Practitioners to improve see and treat and increase hear and treat volume
• Recruit to a secondment dispatcher specifically to deploy community response resources.
• Increase PFSH and Vehicle Numbers
• Clinically trained staff to cover ambulances as opposed to current role, if possible.
• Increased use of the Access to Stack
• Non-conveyance pathways communicated to staff more frequently.
• A Service Delivery Daily Meeting Battle rhythm
• Analysis to identify where support staff can support in other roles.
• Roll out of Assemble to CFRs and Co-Response
• Advice about the flu alongside the flu and Covid 19 vaccination programme.
• PVSH managers and Tactical Assistant role expansion to support EOC
• Winter tyres stock levels agreed with ATS for the winter period.
• 4X4 Transport for staff and operational calls
• The set up, when required, of a gold cell in the boardroom to manage events, demand and resources.

Due to flat-line budgets and no additional central funding for Winter, Operational overtime and/or incentives would be an at-risk cost implication.

We recognise this winter is likely to see UEC services and EEAST come under significant strain, and many patients will face longer waits at certain points in the pathway than acceptable. It is vital in this context to ensure basic standards are in place in all care settings and patients are treated with kindness, dignity and respect. This means focusing on ensuring patients are cared for in the safest possible place for them, as quickly as possible, which requires a whole-system approach to managing winter demand and a shared understanding of risk across different health and care settings.

Operational Performance Impact

The operational performance improvement plan (OPIP) is based on four priority areas. The Trust’s C2 performance remains the Trust’s largest area of operational risk and is a key priority across the region and nationally. The additional measures being put into place over the winter period aim to support the operational performance and reduce any negative impact to the Trust. The four key priorities are:

Job Cycle Time

The shorter the job cycle time – the total time taken to assist a single patient - the more patients can potentially be assisted. The longest part is typically the on-scene times, and these can be within our control. To help our clinicians address this, the Trust is planning and delivering bespoke training on 'quality efficiencies on-scene’ to all operational areas, providing training on clinical best practice on-scene decision-making, and looking at IT solutions to help – including an operational information portal for clinicians to easily see a range of data about how they are performing to help with learning and improvement.

Vehicles

To tackle the number of vehicles off road, the Trust is bringing in 228 new operational ambulances, increasing workshop infrastructure, and recruiting vehicle technician posts within budget.

Improving Hear and Treat

The Trust plans to increase capacity for H&T, accelerating recruitment and expanding the use of agency clinicians, and undertake GP triage outsource. The goal is to increase the calls handled per hour, focusing resource on specific call types (C2), where appropriate.

Increasing Patient Facing Staff Hours We want to maximise existing patient facing staff hours (PFSH) through reducing the time taken to acquire C1 driving licence sand looking at the benefit of centralised scheduling to accurately plan against demand requirements.

The main impact for the Trust alongside high demand has been identified as the potential for significant and prolonged delays in handing patients over to hospital care due to the slowdown of the Emergency Department through flow. This may be significantly longer this year due to not having the Locality Operational Cell Managers in post.