TranslateMedia Protocol
Appendix D:
Winter Media & Communications Escalation Protocol
- Introduction
The NHS and Oxfordshire County Council have capacity escalation plans which outline the systems and processes in place to effectively manage capacity and maintain patient flow. These escalation plans include four different levels of pressure on the health and social care system: OPEL 1 (able to meet demand), 2 (starting to show signs of pressure), 3 (major pressures compromising patient flow) and 4 (organisations unable to deliver comprehensive care) 4.
The NHS is constantly under intense media scrutiny, the public has a vested interest in the NHS and its performance. Whether attracting commendation or controversy it consistently makes headline news. In addition to being a political issue, health is often an emotive one. An essential part of managing pressure on local services is the ability to communicate effectively and consistently to help reassure the public and manage demand. An important part of this is the entire local system speaking with one voice rather than unilaterally.
In the interests of effective media relations, both proactive and reactive, it is important that all organisations (and individuals) adhere to the agreed guidelines set out in this protocol to support when dealing with the media during winter including the escalation process.
2. Responsibility
- Routine media relations are dealt with day to day by individual communications teams (this is mainly with the CCG for proactive media activity and OUH given the focus on hospitals during winter).
- The CCG communications team will keep the NHS England and NHS Improvement Area Communications Teams informed of issues that may be of major significance, including reporting any incidents and capacity related communications
- All communications leads and teams work together across all organisations5 to ensure communications are
- The winter team will send out system-wide daily / weekly update for primary and secondary care – including OPEL status update – key highlights, performance and KPIs. Escalation will be supported by planned communications to support the various OPEL statuses.
- All organisations have their own out of hours contacts (below) and systems for dealing with out of hours media
3. Spokespeople
The following staff are expected to be spokespeople when required over the winter:
|
Organisation |
Spokesperson |
On-call arrangements |
|
Oxfordshire CCG |
|
Out of hours Media Enquiries: 0300 123 4465; In hours: 01865 334 640 |
|
Oxford University Hospitals |
|
Out of hours pager: 07623 940324 In hours: 01865 231471 |
|
Oxfordshire County Council |
|
Outside of office hours: 07825 521524 In hours: 01865 323870 (John Carter) |
|
SCAS |
|
Urgent media enquiries in and out of hours: 07623 957 895 (pager service) |
|
||
|
Oxford Health |
For urgent media enquiries out of hours contact main switchboard: 01865 901000 and ask to speak to the duty director. They will link in with the on-call communications and engagement manager as required. |
4. Reactive Media Relations
4.1 Press enquiries
- On receipt of a press enquiry relating to winter planning which includes pressure on and capacity of services, the receiving organisation should notify system communications colleagues / press offices. This should go to the media leads and
- If the enquiry relates specifically to an organisation’s service rather than the system, then the response should come directly from that organisation but the enquiry and response should be shared with system communications colleagues / press offices. We do however need to be mindful of timings and urgency of deadline. If required the spokesperson will be service / organisational specific. For example, if it relates to funding for urgent care then OCCG will lead the response and put up the spokesperson. NHS and local authority communications colleagues commit to ensuring joint responses to media enquiries, wherever possible. This should be established at the initial contact stage. This can be coordinated by the CCG.
- Where necessary appropriate communication leads from different agencies will be involved. However, media deadlines mean that it is not always possible to wait for a response from each organisation before the response is sent –every effort should be made to agree a joint response within the deadline. If necessary, an extension to a deadline will be requested but if this is not possible and if deadlines are extremely tight, it will be for the Winter Director or organisational spokesperson / own sign off process to agree an appropriate response.
- NHS and local authority colleagues commit to supporting a system wide communication, for example if A&E is under pressure OUH spokesperson will be the key spokesperson supported by a commissioner
4.2 Operational Pressures Escalation Levels
Service disruptions are more likely to occur during winter, and when this happens there is a recognised need for local health and care leaders to communicate this via all broadcast and print media, online and social media channels, to ensure local populations are well informed of pressures in their area and how they can access the care they need even during times of pressure.
It is also recognised that at times of severe operational pressure raising the profile of this pressure can be counter-productive and can increase other pressures and media interest. This can result in increasing concern amongst the public and those working across the health and care system and a resultant reduction in confidence in those services which impacts on reputation. Local and national media interest in winter pressures has increased over recent years and there is a greater appetite to cover stories suggesting the NHS is struggling to cope. The impact of issuing statements to the media asking the public to help reduce pressure has been shown to be ineffective and can have the opposite effect.
Below outlines the media response for different levels of escalation in the system and actions:
|
OPEL Status |
OPEL descriptor |
Media Response |
Action |
|
OPEL 1 |
The local health and social care system capacity is such that organisations are able to maintain patient flow and are able to meet anticipated demand within available resources. The Local A&E Delivery Board area will take any relevant actions and ensure appropriate levels of commissioned services are provided. Additional support is not anticipated. |
Business as usual; implementation of winter communication plan with themed weeks and ad-hoc media relations dependent on weather |
No action required |
|
OPEL 2 |
The local health and social care system is starting to show signs of pressure. The Local A&E Delivery Board will be required to take focused actions in organisations showing pressure to mitigate the need for further escalation. Enhanced co-ordination and communication will alert the whole system to take appropriate and timely actions to reduce the level of pressure as quickly as possible. Local systems will keep NHS E and NHS I colleagues at sub-regional level informed of any pressures, with detail and frequency to be agreed locally. Any additional support requirements should also be agreed locally if needed. |
Business as usual; implementation of winter communication plan with themed weeks and ad-hoc media relations dependent on weather |
No action required |
|
Opel 3 |
The local health and social care system is experiencing major pressures compromising patient flow and continues to increase. Actions taken in OPEL 2 have not succeeded in returning the system to OPEL 1. Further urgent actions are now required across the system by all A&E Delivery Board partners, and increased external support may be required. Regional teams in NHS E and NHS I will be aware of rising system pressure, providing additional support as deemed appropriate and agreed locally. National team will also be informed by DCO/Sub regional teams through internal reporting mechanisms |
Continue business as usual; implementation of winter communication plan with themed weeks and ad-hoc media relations dependent on weather |
Communicate to external partners and the public as needed to be agreed with the Winter Director. |
|
Opel 4 |
Pressure in the local health and social care system continues to escalate leaving organisations unable to deliver comprehensive care. There is increased potential for patient care and safety to be compromised. Decisive action must be taken by the Local A&E Delivery Board to recover capacity and ensure patient safety. All available local escalation actions taken, external extensive support and intervention required. Regional teams in NHS E and NHS I will be aware of rising system pressure, providing additional support as deemed appropriate and agreed locally, and will be actively involved in conversations with the system. Where multiple systems in different parts of the country are declaring OPEL 4 for sustained periods of time and there is an impact across local and regional boundaries, national action may be considered. |
One communication to be agreed with Winter Team for:
Plus messages for the public via all communications channels. Reactive to use drafted responses (see appendix 1). Information should be available via each CCG website. This should not include telling people not to attend A&E |
Ensure status and action plan are communicated trust-wide and relevant external communications managed system wide. |
4.3 Winter scenarios
The grid below sets out likely scenarios and organisational roles. Note that, in all cases, individual organisations are responsible for communicating with their own staff.
|
Winter scenario |
Who is responsible for communicating urgent messages to patients and public |
Who is responsible for communicating with other organisations |
Who should be lead spokesperson for patients and public? |
|
|
Heavy snow/flooding affecting single. Might involve staff unable to get to usual places of work |
OCCG are responsible for coordinating the local communications response including:
Local Providers with OCCG support are responsible for advising where local hospitals have had to cancel operations / clinics due to bad weather and that patients will be contacted individually about this. |
communicating with social care over discharge etc. |
CCG Chair and Provider Medical Director / COO |
|
|
Very cold weather, but no impact felt on services |
OCCG / OCC are responsible for issuing ‘keep warm, keep well’ advice to local people urging them to stay indoors and take care of themselves; for example, reminding the frail and elderly not to go out in icy conditions to avoid slipping over. Information to be cascaded by system partners |
N/A |
Director of Public Health and OCCG Clinical Chair |
|
|
Local GP surgery/surgeries have to close due to bad weather |
OCCG communications team responsible for informing local patients and the public via the media and for setting out the alternatives (including use of 111) Individual practices responsible for informing individual patients who have appointments booked. |
OCCG communications team responsible for informing other organisations, including NHS111, CCGs, trusts, OOH providers, unaffected practices and pharmacies. |
OCCG COO or Head of primary care |
|
|
A&E and / or MIUs department closed/accepting no patients, for example due to major internal incident (Ievel 1) |
OCCG are responsible for coordinating the local communications response including:
OUH and / or OH, with OCCG, support are responsible for advising where local hospitals have had to cancel operations / clinics due to bad weather and that patients will be contacted individually about this. All system partners to support via websites and social media, customising messages as necessary. |
|
CCG chairs and GPs, supported by Trust medical director |
|
|
Closure of A&E department(s) due to major incident affecting a number of providers (level 2) |
NHS England south west team is responsible for co-ordinating the regional communications response, including:
Trusts to support via websites and social media, customising messages as necessary for local consumption. |
|
NHS England plus OUH Medical Director |
|
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Ward closed in local hospital due to Norovirus |
OUH / OH are responsible for issuing advice to patients and the public, reminding them to stay away from the hospital if they have symptoms and providing basic hygiene advice to stop the spread of the infection. Might involve signposting rather than media work, depending on seriousness of outbreak. Trusts to refer to NHS England south west team before media work, in case other providers are affected and wider system response is needed. CCGs responsible for issuing wider advice to patients if outbreak serious enough to affect admissions/capacity to any significant degree. |
|
Trust Medical Director or Director of Nursing |
|
|
Ambulances queuing outside A&E department, causing delays to patients |
Provider and SCAS to develop coordinated media response in collaboration with CCG. Key principle = no blame/no surprises. |
|
OUH Medical Director |
|
|
Delayed discharges causing delays to admissions |
Provider, local authority and OCCG to develop coordinated response, focusing on system- wide solutions and admission-avoidance messages for patients. Key principle = no blame/no surprises. |
|
OCCG COO or Clinical Chair and Director of Adult Social Services |
|
|
OCCG and SCAS are responsible for co- ordinating the regional communications response, including:
Trusts to support via websites and social media, customising messages as necessary for local consumption. |
OCCG responsible for informing other organisations, including NHS111, CCGs, trusts, OOH providers, unaffected practices and pharmacies. |
OCCG COO, Clinical Chair or SCAS lead |
5. Proactive Media Relation
A proactive approach to media is an objective of the system winter communications plan to ‘better inform and educate the media and the general public on what the NHS do to plan and prepare for winter’. This includes themed weeks planned for media over the winter and links in with winter campaigns both local and national. This is coordinated by the CCG but material is shared with partners and joint sign off when required.
Appendix 1: Template responses
Below are draft template response to different scenarios. Please note these statements are not signed off and will require amendments.
1. STATEMENT: high attendance at ED/opening additional beds/postponed planned operations
XXX at Oxford University Hospitals NHS Foundation Trust said: “In Oxfordshire, in common with health systems up and down the country, we are experiencing seasonal high volumes of attendances at our emergency departments. At this time of year we often have greater than normal difficulties in moving patients out of hospital to their next stage of care because of the holiday period.
“Over the last few weeks, we made the decision to open an additional xxx temporary medical beds at the Horton General Hospital. At the John Radcliffe Hospital, in line with national guidance, we have postponed planned operations until xxx
“As always, people should think carefully about where they can most appropriately be treated and only attend a hospital emergency department if that is the right place to be. If in doubt use the ‘Health and Care Oxfordshire’ app to locate your nearest health provider.”
The ‘Health and Care Oxfordshire ‘app can be downloaded from the App Store on Apple devices and the Google Play Store on Android devices.
2. STATEMENT re postponed planned but non-urgent operations/OPEL 4 status
XXXX at Oxford University Hospitals NHS Foundation Trust, said:
“In common with health systems up and down the country, we are experiencing seasonal high volumes of attendances at our Emergency Departments, in conjunction with difficulties in discharging patients who are medically fit to leave hospital. Seasonal flu is also a contributory factor, and we have seen around xxx confirmed inpatient cases since xxx. We are therefore currently at Operational Pressure Escalation Level 4 (OPEL 4).
“In line with national guidance from NHS England, we have made the decision to postpone a number of adult inpatient planned but non-urgent operations at three of our hospitals (John Radcliffe, Churchill and Nuffield Orthopaedic Centre) to help alleviate this pressure. We anticipate that approximately xxx procedures a week will be postponed. Patients who are affected will be informed directly, with a view to rescheduling their operations as soon as possible. Where clinically safe and appropriate to do so, some procedures can be carried out as day cases and so will go ahead. Outpatient appointments, day case operations, diagnostic tests, cancer and emergency treatment will continue as normal.
“An additional xxx temporary medical beds at the xxxx have been opened in recent weeks and a further xxx temporary beds will be opened at the xxxx.
“While these actions are necessary to support our Emergency Departments and Emergency Assessment Units at the John Radcliffe and Horton General hospitals, it must be recognised that these are short term measures. The health and social care system remains focused on developing and growing home based services as xxx patients in our acute and community hospitals could be more appropriately cared for at home.
“As always, people should only attend a hospital Emergency Department in an emergency. If in doubt use the ‘Health and Care Oxfordshire’ app from Oxfordshire CCG to locate your nearest health provider.*
Note:
The ‘Health and Care Oxfordshire ‘app can be downloaded from the App Store on Apple devices and the Google Play Store on Android devices.
3. STATEMENT: restarting non-urgent inpatient elective operations
XXXX at Oxford University Hospitals NHS Foundation Trust, said:
"I can confirm that we are restarting adult non-urgent inpatient elective operations at the John Radcliffe Hospital from xxx
"I would like to thank our patients for bearing with us during this exceptionally busy period and to apologise once more to all those whose operations we had to postpone.
"As always, people should only attend a hospital Emergency Department in an emergency. If in doubt use the 'Health and Care Oxfordshire' app from Oxfordshire CCG to locate your nearest health provider.*
"I would like to thank all staff who are working so hard to provide care for our patients under difficult circumstances at the moment."
*The Health and Care Oxfordshire app can be downloaded from the App Store on Apple devices and the Google Play Store on Android devices
4. STATEMENT: re high levels of demand/use other services
Diane Hedges, chief operating officer at Oxfordshire CCG, said: “The John Radcliffe Hospital in Oxford and the Horton General Hospital in Banbury are both experiencing high levels of demand, in common with hospitals up and down the country.
“This means that patients can expect long waits in A&E. We are urging people across Oxfordshire to use hospital accident & emergency departments for emergencies only.
“Unless there is an emergency, we urge people to seek advice and treatment at other centres including Minor Injuries Units, First Aid Units, GP surgeries and from local pharmacies. There is information about where to go for help at http://www.oxfordshireccg.nhs.uk/your-health/choose-the-right- service/choose-the-right-service.htm.
“The NHS 111 telephone service is also available 24 hours a day, every day for advice and signposting to appropriate services, Their trained call handlers can also make appointments, for example at a Minor Injuries Unit. Ambulance services should continue to be accessed via 999 for any life threatening call.”
5. STATEMENT: re system struggling
XXX said: “[NHS / social] care services across Oxfordshire are under pressure, especially A&E departments, due to the unprecedented demand caused by [the norovirus outbreak/flu cases/bad weather]. Staff are working exceptionally hard in difficult circumstances to ensure patients are treated according to how urgent their need is. We apologise to everyone who has had to wait a long time to be seen, but staff must prioritise the most urgent cases. “Oxfordshire’s health, social care and voluntary services have been planning and working together for months to manage winter pressures under our first ever winter director. We believe, as a system, we have been as prepared as we can be. However, we are keeping our plan under constant review and adjusting it as necessary to deal with changing demands and circumstances to support patients.
“We have been advising people on keeping well so they can avoid admission into hospital, developing new services so our most vulnerable patients are seen before a condition gets worse, and ensuring patients get home from hospital as quickly as possible with the right support. Our GP surgeries are offering many more routine appointments in the evenings and at weekends.
“There are also other ways to access healthcare services, which include asking your local pharmacist for advice, calling 111 to speak to a trained call- handler, or visit your local Minor Injuries Unit. There’s plenty of information here https://www.oxfordshireccg.nhs.uk/your-health/ “
Appendix 2: Social media
Twitter:
(postponed operations)
‘Check if your planned non-urgent operation has been postponed due to the large number of people using local hospitals #helpushelpyou
(operations on)
‘Local outpatient, diagnostic appointments and urgent surgery have not been postponed but check before with the hospital to confirm your appointment time.’
#helpushelpyou
(operations re-started)
‘Non-urgent inpatient operations have resumed at the John Radcliffe and Horton General hospitals; check with the hospital the time of your new appointment.’
#helpushelpyou
(use other services)
A&E departments in Oxfordshire are very busy; use the phone app to find other local health services; download app for iphone here and Android here
Appendix 3: Social media winter messages
Additional winter messaging for facebook and Twitter are available here:
