While our services experience pressures throughout the year, we know that the winter months are a particularly demanding time across primary care and hospital and community services.
In order to protect our services, we prepare an annual Winter Plan setting out arrangements to manage the predicted increase in demand for our services, particularly within our Emergency Departments.
Our plan is the product of work with the Regional Control Centre (RCC) to develop an operational unscheduled care improvement plan, with targeted actions across a range of areas from pre-hospital care through to acute care and into the community. We have also developed detailed operational plans on implementation. The targeted actions will reflect the priority areas identified through the Department of Health-led ‘Big Discussion’ workshops as well as actions the Trust will implement to improve ambulance handover times.
Unscheduled Care Reform Plan – Stages and Key Actions
The Unscheduled Care reform has been reviewed in a regionally agreed format and defines the actions required specifically for the Western Trust. The plan aligns with the objectives set out in the SIF and includes rigorous oversight of services supported by Growth funding to support improve ambulance handover.
Performance will be monitored against agreed parameters. All activity will be recorded, reviewed regularly and formally reported to the Unscheduled Care and Strategic Change Boards to ensure transparency, accountability and informed decision making.
Pre-Hospital Pathways
- Scope existing community pathway with NIAS
- Maximise Hospital at Home service delivery
- Implement NIAS direct pathway to Ambulatory Care Unit (ACU) Altnagelvin
Same Day Emergency Care (SDEC)
- Increase activity and revise New to Review ratios in ACU
- Expand referral pathways to ACU, including Clinical Communications Gateway (CCG)
- Move to 7 day service in SDEC South West Acute Hospital (SWAH)
- Increase SDEC activity in SWAH
- Implement Clinical Coordinators
Flow Through Hospital
- Design and agree corporate escalation plan
- Reset site coordination processes
- Implement reform plan for patient flow on both sites
- Review and define criteria for Discharge Lounge, including performance parameters
- Reset flow through Acute Medical Unit (AMU)
- Implement short stay beds in ACU
- Implement 12 intermediate care (IC) beds in Level 5, Altnagelvin
Improving Discharge Processes
- Enhance Expected Date of Discharge (EDD) accuracy
- Ensure regular medical reviews
- Run ward manager engagement sessions / SAFER flow bundle
- Embed Community Hub
- Enhance early review Team to maximise Home Care capacity
- Enhance Hospital at Home in care homes
- Contribute to phase 3 of IC review to improve throughput in IC beds
- Reassessment of all P4 delays at day 20, including reassessment of need and alternative options for discharge
- 15-20 additional independent sector beds
Additional Measures
£10m of re-purposed funding has been made available regionally to target specific actions to support the management of unscheduled care and, in particular, to improve ambulance handover times. Within the Western Trust £2m was allocated and the following measures will be in place by the end of October 2025:
- Enhanced Cover at Altnagelvin ambulance handover area – 24/7 service
- 8 additional short stay inpatient beds within the ambulatory care unit at Altnagelvin
- 12 additional rehab/intermediate care beds in our community hospital to facilitate discharge from an acute bed
- Enhanced Allied Health Professional (AHP) and pharmacy staffing in both our ED’s including AHP outreach follow up into patients homes in the northern sector of the Trust
- Enhanced Early Review Team including Homecare Support
- Expansion of Discharge Coordination Team
Key Enablers
Protecting and Promoting Staff Health and Wellbeing
- Flu vaccination programme for staff.
- Manage vacancies while recognising the workforce controls.
- Provide resources and programmes to support staff wellbeing including advice and support on nutrition and exercise, stress management, building resilience and mental health support.
Leadership
- Clear full capacity and escalation plans in hospital and community.
- Ongoing visible leadership, especially during periods of increased service pressure.
- Frequent staff engagement and communication at all levels.
Monitoring and Reporting
- Enhanced oversight at all levels across the organisation.
- Work with other Trusts and the Regional Co-ordination Centre to collaboratively manage hospital and NIAS pressures across NI.
Delivery of Services
- During the coming months, we may find it difficult to provide all of our planned services whilst also managing the expected increase in demand for unscheduled or critical care.
- We will take steps to protect elective care as much as possible, including making best use of capacity in our dedicated elective care centre in Omagh and the elective overnight stay centre at South West Acute Hospital and maximising in-year funding allocations to deliver additional assessments, diagnostic tests and treatments both in-house and in the independent sector.
- Patient safety will always be our priority, whilst we balance these risks.
How you can help
If you become ill or injured and need medical help or advice, choose well by using the right health service for your needs.
Self Care – to treat an ache, pain, upset stomach, cough or cold, get plenty of rest, take simple pain killers if needed and use over-the-counter medicines.
Children’s Symptom checker – If your child is feeling unwell, you can use our symptom checker below to gain a better understanding of what might be happening and where to get treatment.
Your local pharmacist – they are there to give confidential, expert advice and can treat a number of minor ailments such as aches and pains, skin conditions, allergies, eye conditions or upset stomach and emergency contraception.
Your GP – they will give expert medical advice and diagnosis, referring you for further care or consultation as needed
Primary Eyecare Assessment and Referral Service – treats sudden eye conditions such as red eyes, sudden reduction in vision, eye pain or a foreign body in the eye. Visit the HSCNI website for more information on the Primary Eyecare Assessment and Referral Service
Mental Healthcare – if you are experiencing mental health difficulties there are a range of services available to help you. Visit the NIDirect website for more information on Mental Healthcare Support
Emergency Dental Treatment – if patients have an urgent dental need then they can follow the advice on the HSCNI website
Minor Injuries Unit – treats injuries that are not life threatening such as broken bones, sprains, bites and burns. Our Minor Injuries Units are available in:
- Altnagelvin Hospital and
- Omagh Hospital and Primary Care Complex Urgent care and treatment Centre. For more information and detail on these services, click here
Urgent Care Centre – Treats injuries that are not life threatening such as broken bones, sprains, minor scalp wounds and suturing of minor wounds. For more information on our Urgent Care Centres click here.
Emergency Department – provides the highest level of emergency ease for patients, especially those with acute illnesses or trauma, such as heart attacks, stroke, serious accidents or head injuries. Call 999 when there is a risk to life or serious injury. For more information on our Emergency Departments, click here.