What does winter demand look like?

1. What does winter demand look like? Lynette Drew, Senior Advisor: EDs & Acute Demand, System Integration Team

2. The aim • What are other countries doing around winter planning • Sounds like an easy process – WRONG! lots of information out there, but no single point to go to that shares good examples • What is New Zealand doing around winter planning • DHBs have provided us with really useful baseline information • For you all to mingle, share from each other, and take back to your DHBs • For the Ministry to listen to your experiences, and ideas to support them in producing a useful reference tool for all DHBs

3. International – themes to address winter demand • Appropriately staffed additional/’ring fenced’ winter beds • Specific ‘winter’ monies set aside • Additional staffing (inc pooled nurses (trained in relevant specialty area)) • Full scale management plan with winter demand embedded in it • Encourage people to stay healthier (therefore stay out of hospital) • Modelling (forecasting, simulations) • Communication strategies (staff and public) • Flu campaigns (including seasonal) • Engagement with all public services eg care homes, private providers of care, media, local councils, MetOfficeUK • Collect data, and use it to plan for the immediate, the next year, and future years (locally • Collect data that is submitted to DH on A&E closures, cancelled operations, bed pressures, ambulance delays • Learn from previous years

4. The Department of Health (DH) - UK • The DH recommends that winter planning arrangements are: • “Effectively managed, this should once again help ensure that all services across local health and social care systems are well coordinated and well placed to respond appropriately to the demands of winter: • 1. Handover of patient care from ambulance to acute trust • 2. Operational readiness (bed management, capacity, staffing and New Year elective ‘re-start’ etc) • 3. Out of hours arrangements • 4. NHS/Social Care joint arrangements, including work with Local Authorities to prevent admissions and speed discharge • 5. Ambulance Service/Primary Care/A&E links • 6. Critical care services • 7. Preventative measures, including flu campaigns and pneumococcal immunisation programmes for patients and staff • 8. Communications”

5. International – other initiatives • Extreme weather protocols • Plan for ‘festive demand’ alongside ‘winter demand’ • Utilise 24 hour telephone lines (include them in the winter demand planning) • Pharmacies – national PGD for urgent supply of repeat medicines/appliances • Norovirus/C. Diff strategies • Extra mortuary facilities, designated ward areas

6. What are we doing in New Zealand to address winter demand? • Auckland • Management of demand • Management of flow • Bay of Plenty • Incentivisation (to be determined) • Ensure adequate staff resources • Canterbury • Ensure adequate staff resources • Dedicated influenza inpatient ward • Extending ‘timely discharge’ programmes • Canterbury COPD project (on the agenda) • Canterbury Influenza Group (on the agenda) • Hawkes Bay • COPD pathway • Had 15 medical overflow beds in designated ward areas in the past • Screening of ED waiting room patients, and offering alternative option of going to own GP • Direct dial telephone in ED waiting room for patients to contact their own doctor

7. What are we doing in New Zealand to address winter demand? (cont) • MidCentral • Increase bed capacity (in hospital and in the community) • Nursing resource management (seasonal rostering, increase winter nursing resource, hospital at a glance) • Electives management • Child health: time-critical electives only booked during winter months • Adults: BAU – plan to make standby system more robust (maximise OT utilisation even if major ops deferred) • Patient flow • Dedicated nurse on inpatient ward to facilitate discharge and pull admissions • Flexible beds between wards/units/Child Health ward/CAU (older children to adult wards/younger adults to Child Health etc • Smooth admissions • Isolation beds (traffic-light system for prioritising patients required isolation) • Northland • Improved access to radiology (timely access to diagnostics for I/P, or semi urgent patients – prevents bed blocking) • Review of daily bed meetings (reviewed, restructured, reschudeled for earlier in the day) • Increased use of District Hospitals (Increased transfers to regional hospitals. Decreased ALOS in Whangarei, better ability to transfer in Hospital Overload) • Flu Vax campaign • Increased winter staffing in Paeds • Hospital at a glance • Minimise use of medical beds for day-case procedures including transfusions etc

8. What are we doing in New Zealand to address winter demand? (cont) • Waitemata • Winter planning document • Minimising staff vacancies, building casual nursing pool in specialist areas • Clinical staff trained in administering seasonal vaccinations to staff • Waikato • Influenza vaccinations offered to all staff • Additional vaccinators being certified to provide vaccinations in the community • Primary options for acute care in ED • Increase in paediatric beds

9. Next steps: • Listen to the presentations • Use the breaks as a chance to mingle and learn from each other • Take part in the workshop, learn from each other and take back to your respective DHBs • From the workshop the Ministry will create a document to support DHBs in what makes an effective winter planning strategy (from your comments today) • NZ is in a unique place. We could be the first country to “showcase” what good winter planning looks like to the world in one centralised place