Western Trust prepares surge plan for ‘extremely challenging’ COVID-19 winter

The Trust has published its Resilience Plan to addresses winter pressures and any subsequent waves of Covid 19 and it outlines how, at the low (Green) surge, it will ‘endeavour to continue to deliver on the projected service activity levels over the winter period.’

It continues: “At Medium (Amber) Surge, certainly in the acute hospital setting, and at High (Red) Surge in all service areas, there will be scaling down and/or potentially standing down of some services to allow the Trust to prioritise critical and front line COVID-19 and non-COVID-19 care for our sickest patients.”

The report adds that while plans are ‘very clear’ about what will happen at certain points, the Trust will be increasing the command and control arrangements ‘to daily detailed monitoring of what is happening in acute and community settings so that decisions can be made that are relevant, safe and proportionate to any evolving situation.’

The report stresses how, a key commitment from the Trust is that any service that is deemed a clinical emergency or is a significant safety concern in the community ‘will be delivered in some way even at high red level surge.’

This will include services such as cancer surgeries, acute emergencies, services for very vulnerable or at risk clients or families in the community, maternity etc.

The Trust outlined how patient safety remains the ‘overriding priority’ with safe staffing also a ‘key priority.’

Some of the challenges of the plan are workforce challenges, which include the need for some staff to shield due to underlying health conditions.

Other key challenges identified in the report are funding pressures, as well as the physical space available to meet social distancing requirements particularly in busy hospital areas.

The report outlines how, to help address this on the Altnagelvin site, a scheme is underway to create an extended Emergency Room which will provide a segregated COVID-19 pathway into the hospital.’

However, they added that ‘with predicted increasing numbers attending hospital over the winter period facilitating this does remain a challenge.’

The report outlines how a priority area for the Trust to help manage unscheduled care attendances and flow through hospital sites will be ‘to focus on enhancing and expanding ambulatory care provision and pathways’.

At Altnagelvin there will be extended ambulatory care cubicles to provide for a number of primary care direct access beds.

There will be seven day key diagnostics and enhanced discharge planning including rapid access to discharge letters and pharmacy and strengthening controls for weekends.

The report outlines how priority service areas during this winter period and in any further COVID-19 surge ‘will include continued support at home for those assessed as the most vulnerable, rapid access specialist clinical/nursing support, palliative or end of life care, re-ablement and or rehabilitation services.’

The Trust adds that it is ‘harnessing the lessons learned from the first wave of COVID-19 in terms of new ways of working and will work hard to implement the regional initiatives associated with the “No More Silos” project over this Winter period as a priority to support maximising resources.’

It focuses on the following key areas increase resilience through this ‘challenging’ winter period:

1. Maximising capacity in the community therefore avoiding an ED attendance or acute admission.

2. Maximising unscheduled care flow including additional ambulatory pathways to help reduce admissions.

3. Maximising capacity in Hospitals and increasing resources where necessary to deal with managing service demand arising from COVID-19 and winter pressures.

4. Enabling flow and facilitating discharge through collaborative working with hospital wide and community teams and services.

5. ‘Looking After Our People’- making sure patients and clients know what services will be maintained and how, as well as those impacted in the event of any further COVID-19 surge or significant winter pressure period. This also refers to caring for staff - aiming for adequate staffing levels, and ensuring they take planned leave and appropriate breaks.

6. Strengthening monitoring and reporting including enhanced command and control arrangements supporting appropriate implementation of escalation processes and service continuity plans

The report states how the first phase of the COVID-19 pandemic period from March to June required the Trust to work in new and innovative ways in unprecedented timescales. The vast majority of these initiatives ‘remains operational to some degree and provide a strong foundation for the management of further potential COVID-19 surges that may occur.’

“However, the global pandemic continues to present the health and social care system with a number of unique challenges which have dramatically changed the way services were delivered,” it states.

The current surge plan, the report adds, is a capacity plan, and it provides insight into how the Trust will progressively increase the bed capacity for COVID-19 positive patients in acute and step-down/community hospitals, showing clear pathways for these patients

It continues: “The Plan aims to ensure the delivery of safe services, and in the event of a second COVID-19 surge there will be balance to be found in terms of treating the most urgent cases first. As a result some patients may have to wait longer than we would like.”

The report adds that the first phase of the pandemic ‘demonstrated clearly the tremendous energy, courage and resilience of all our staff which must be recognised.’

It continues: “We will be continuing to work in partnership with all our staff as we head into what will undoubtedly be an extremely challenging period for our health and social care services locally.”

The report says the Trust area ‘never reached the peak surge that many other countries and regions faced.’

“And that is undoubtedly down to the early lockdown decision and the real effort and compliance of our population in adhering to the public health requirements.

“The learning from how our entire system had to adapt, change and ready itself in a punishing timescale means that we can face this winter period with a level of confidence in the plans and changes that we have made since March of this year. There will be many challenges over this winter but with the ongoing support of all our colleagues and staff right across the health system we will continue to prioritise safe and effective health and social care service delivery appropriate to the context we find ourselves in throughout the coming months.”