Move to REAP level 4 - extreme pressure

The Trust undertakes weekly reviews of the Resource Escalation Action Plan (REAP) and has taken the decision to move to REAP 4 for the next week, with the next review on Tuesday 9th January 2018.

The reason for the increase in REAP level to the highest level available is in response to the extremes of pressure being experienced within the whole NHS system and an anticipated continuation of this across the next week with the pressures in A&E departments, 111 and primary care services.

The Trust has taken significant steps to protect the safety of patients in the community. We are experiencing exceptionally high demand from Health Care Professionals and the 999 system coupled with very significant handover delays at a large number of acute Trusts across the regions. In the last four days, we have experienced nearly 500 handovers that exceed one hour or more and have lost the equivalent loss of up to 50 ambulance shifts a day in delays.

The Trust is also operating at the highest level of the surge plan (Level Black) for significant parts of the day and we are experiencing long delays for the lower acuity patients as a consequence. This means up to 200 calls are being held in EOC with no resource available.

REAP level 4 is a serious signal to the whole organisation and the wider health system around the safety of our patients in the community. We have NHSE and NHSI, CCGs all actively focussing on improving the position. The following is required of all Trust employees at this time:

  • Any clinically trained personnel in any directorate who are working in non-patient facing capacity are to report for operational duty on an ambulance, rapid response vehicle, support the Patient Safety Intervention Team or provide support to the Patient Transport Service with immediate effect and up to and including Tuesday 9th January when a revised instruction will be provided.
  • Any alternative working duties staff must engage a discussion with a local manager to identify how to support staff working on the front line with handover delays.
  • All response drivers should use this REAP change to ensure journey times to scene are minimised and undue travel time must not compromise further availability.
  • Any handover delays or queuing must immediately be reported to EOC for escalation.
  • All clinicians should consider the appropriateness of waiting on scene for GP call backs, referring to CAL as necessary.
  • All managers are to be booked on duty at Operating level 1.
  • All meetings which involve abstraction from duty of operational staff are to be cancelled or moved to teleconferencing whilst staff remains available until after 9th January.
  • No new leave requests will be granted that fall between now and 9th

If you feel a patient could go in a taxi to hospital or MIU  instead of waiting for back up or conveying in a Trust resource and isn’t included in the below criteria, then please call CAL, Option 2, to request to book a taxi.

A patient with any of the following is excluded from being sent a Taxi:

  • Call coded as a Category 1
  • A patient under the age of 2 (note for children, a child car seat is not a legal requirement although obviously preferable if available)
  • Uncontrolled Active Bleeding
  • Diarrhoea or Vomiting
  • Infectious conditions
  • Mental Health related illness
  • Reduced/no capacity
  • Under the influence of drugs or alcohol
  • Unable to self-mobilise with minimal assistance to get to the taxi

The Gold team will oversee specific other actions to support optimisation of capacity.

We recognise the immense pressure on our staff at this time and have escalated our concerns to the highest level with our regulators.  We have responded safely and provided excellent care to thousands of patients and our patient safety teams have cohorted hundreds of patients to help achieve this. We have heard of exceptional care and management of the flow of resources at some hospitals to support each other for which we thank you.

The Trust thanks all staff in operations, EOC and support staff who are working tirelessly to maintain the safety of patients.

Published 31st December, 2017

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