Following the move of the NHS back to Incident Level 4 as a result of the emergence of the Omicron variant, we have been asked to ensure that the NCA as a key stakeholder in the GM system is focusing on the areas of critical importance for managing the pressure on health and care services.
The following is the headline position for the NCA on the overall response to manage the Omicron Wave.
There are a number of principles that the NCA will adopt in response to the likely wave of infections driven by the Omicron variant. These principles are in line and support the GM system response and the ask of GM Hospital Gold Command. To this end we will:
- Ensure we have a focus on patient safety across all services with a focus on our previously agreed clinical priorities and monitoring the impact of our decisions through our Safety Siren.
- Do the best for our patients by utilising all the capacity we can to ensure the most urgent elective surgery continues throughout. This means focussing on how we use our “Green Sites” and available Independent Sector capacity to best effect.
- Support our staff with a focus on any short-term actions and interventions that will help us through the next few months.
- Support the most vulnerable groups in our society aiming to reduce inequalities and ensuring – at the very least – that our actions do not make these worse.
- Work as a system in everything we do creating a response which will be greater than the sum of the individual organisations.
These principles underpin the plans we already have in place for surge, and we feel that these are still the right plans to address surge at this time. Communicating with all our teams and system partners ensuring that the actions we have in those plans are being undertaken and that our people have the autonomy to act on those plans to fully implement. This includes stepping up the focus on the ‘triple strategy’ (SDEC - same day emergency care; virtual wards; faster discharge) across all Care Organisations and includes a focus on our management of Paediatrics in the coming weeks. This will support freeing up of beds to support flow across the hospital sites and rapid discharge. We will deliver what we have described in our plans, including implementing virtual care for all patients where possible and ensuring full use of clinical criteria where patients need to be admitted. These are not new actions but a continuation of, and paying attention to, the plans we have developed over the autumn to support any potential covid surge and are what we already have in place.
As of Friday 17th December GM escalated further the requirement to place ‘paramount importance’ on the need to reduce hospital occupancy to allow for the expected increase in admissions for covid from next Friday 24th December. Further guidance outlining the urgency of implementation of our plans across the system focussed on the incident control processes and actions, all of which have been stood up in the NCA and will be fully operational from Monday 20th December.
These include continuing to pay the utmost attention to:
IPC being at its highest: - Our IPC guidance will evolve in line with any new guidance released – we have already reintroduced mask wearing in shared offices and non-clinical areas. Staff notified that they are a contact of a Covid case are not required to self-isolate if they are fully vaccinated, symptom free and PCR test negative but should follow the guidance for daily testing for a period of 10 days currently. However, the impact of staff absences due to testing positive, given the prevalence and speed at which the Omicron variant is spreading in the community, should not be underestimated. Staff absence remains the highest threat to capacity.
Scaling up vaccination levels beyond where we have been previously: - Vaccination Leads have plans in place for the vaccination hubs to scale up, however, as with all other areas across the Trust staffing will remain an issue. Stepping down other activity down is an option that will be considered if and when appropriate.
Continuing to free up beds as an urgent priority and maintaining high risk urgent and emergency care activity:- Our approach should assume hospitals are less safe for the frail elderly and the management of people with frailty score 5-7 on a virtual ward rather than as an inpatient. All patients can be considered for virtual care if appropriate and further focus on virtual care will support better flow through the hospital sites for the NCA and GM system. Further implementation of agreed urgent care and discharge schemes agreed this week and daily review of data to underpin the discharge drive.
Our people resource:- The availability of our people resource is already extremely challenged, and it is anticipated that this pressure will increase rapidly over the coming days and weeks due to the rapid increase in the Omicron variant and spread. This is likely to affect all staff teams at some level and the instruction for our people to work from home if they are able to has been communicated across the Trust.
Hospital Visiting: - At the present time ‘Hospital visiting’ remains unchanged at the NCA but is under review and discussion with the GM Directors of Nursing. Any changes to this position will be implemented across the NCA at pace as the situation on the ground develops and should changes be required.
Other potential mitigations:- It may be possible to utilise a small number of nursing and other clinical staff who are currently deployed in their substantive roles; namely research; education and redeploy to clinical frontline capacity. Other staff SPA time could also be redirected into clinical facing SDEC and short stay. If virtual clinics accelerate the redeployment of those staff who would normally be used to support face to face clinics could also be an option to support capacity in areas where staff levels are significantly challenged.
Emergency preparedness capacity: - The NCA has well established emergency and business continuity models that are supported by learning from our historic responses to multiple incidents including the previous waves of Covid-19. In preparation for winter where specific emerging threats were identified via EPRRU horizon scanning, inclusive of reduced staffing, Covid -19 mutation and Influenza, NCA EPRRU have delivered a series of table top exercises to each NCA Care Organisation and their respective Community Services.
These exercises were based on scenarios of staff shortages of 25% up to 50% with identified recommendations of identifying triggers to activate control measures, reference to Business Continuity plans to identify least critical services in support reallocation of staff, implement training for non-clinical staff to
work supportively in clinical areas, implementation of a dedicated Care Organisational Staffing Cell to coordinate staff movement and commence recovery planning. Following agreement at GM Gold this week further roll out and implementation of the necessary incident response measures by the NCA EPRRU is already underway and will be reviewed regularly.
This position statement reflects our response to current situation as of 18/12/21. Due to the fast pace of the changes on the ground at the present time the NCA remains agile to review and respond accordingly and further updates will be provided when appropriate over the coming weeks.