A Different Approach
There are a number of critical areas where we have built upon the lessons learned from previous winters and taken a different approach to planning. Most notable of these are:
Working in Partnership
We have brought integrated planning into the core of preparations and have developed an extensive joint governance and assurance mechanism between the Scottish Government and COSLA. As part of this, a Whole System Planning and Oversight Group, which is chaired by Chief Executives from health boards, local authorities and a Chief Officer on behalf of Health and Social Care Scotland, has been overseeing and seeking assurance on the implementation of the Delayed Discharge and Hospital Occupancy Action Plan which sets out the interventions we know improve flow through the hospital and, vitally, improve the experience for people.
We continue to support local systems to make the necessary changes to drive these improvements and to monitor the resulting impact as the actions set out in that plan are vital in reducing occupancy and delayed discharge, ultimately freeing up capacity as we head towards a period of higher demand, ensuring people and families are seen to when they need it most. The Whole System Oversight Group ensures alignment with other groups with the overall aim of improving the experience and resilience of the health and social care system.
Where further assurance and escalation for joint decisions between Scottish Ministers, COSLA and the Co-Chairs of the Whole System Oversight and Planning Group on the deployment of options that support the resilience of Health and Social Care are required, a Collaborative Response and Assurance Group (CRAG), co-chaired by the Cabinet Secretary and COSLA Health and Social Care Spokesperson, will be stood up.
Improved data collection and reporting
We have supported local systems in the development and utilisation of data to help us better understand and respond to the challenges being experienced. As part of this, demand and capacity modelling, supported by Public Health Scotland (PHS), provides a set of resilience indicators at Board and HSCP level to enable local services to target interventions during surge responses. PHS are producing a number of scenarios for winter 2023/24 based on Covid-19, flu and additional hospital occupancy to help understand the potential scale and shape of the demand that Covid and flu may present this winter, particularly in acute hospital settings. These scenarios will be adjusted to incorporate emerging data and evidence throughout the winter.
We have developed and launched two new dashboards ahead of this winter which collate data from across the whole system to give Scottish Government, COSLA and the system itself the intelligence required to inform decision-making and action. The Social Care Response and Delayed Discharge dashboard and the Whole System and Winter dashboard provide national and local level data across 25 and 35 indicators respectively. Where these begin to move into below-optimal rates due to increased demand, early responses can be co-ordinated across systems and targeted interventions deployed as necessary.
The first NHS and Social Care Winter Planning Summit, co-chaired by the Cabinet Secretary for NHS Recovery, Health and Social Care and COSLAs Health and Social Spokesperson, was held in August 2023. This Summit brought together more than 300 leaders from across the country to share best practice and local plans for this winter. Crucial to this summit was ensuring people who use our services were at the centre of our preparations. Social care providers, local government leaders and the independent sector were represented alongside NHS colleagues. The Summit generated key expert, stakeholder, and system-wide input into decisions on winter planning and preparedness in advance of responding to surges, including winter 23/24.
Winter Preparedness Checklist
Ahead of finalisation of this Winter Plan, we asked local systems to undertake a state of readiness check. The Winter Preparedness Checklist sets out four key areas against which we asked Health Boards and HSCPs to provide an assessment of preparedness for their local systems:
Section 1: Overview of Preparedness and Business Continuity
Section 2: Urgent and Unscheduled Health and Social Care, and Planned Care
Section 3: Primary Care, Mental Health and Social Care
Section 4: Health and Social Care Workforce and Staff Wellbeing
We are now using the outputs of this checklist along with the Delayed Discharge and Hospital Occupancy Action Plan self-assessment returns and dashboard data to create a holistic system overview and provide targeted and tailored support to those areas identified as having scope to improve and increase resilience. This approach also encourages benchmarking across and within the system, and identification and sharing of best practice between areas.
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