Kieran Brett

Demand is proving demanding: Stepping off the ‘treadmill’

March 31, 2017


Today’s publication of the Next Steps for the Forward View shows that despite some progress in wrestling demand pressures in the NHS, much more is needed. National expectations on the system to deliver will start immediately.

The key point made by Simon Stevens was that “the NHS has not managed to escape the reinforcing cycle” in which “extra demand on hospitals” led to increased costs “but as a consequence pre-empted some of the alternatives that would enable you to step off that treadmill”.

Put another way, there has been more sustaining than transforming. Today’s announcement sends a strong signal that this has to change and managing demand is now the focus. Not just at the A&E front door but across the patient journey when someone is admitted.

Stevens also emphasises how difficult this all feels for staff in the NHS, as well as the problems it presents for patients. So, there is a prize here that will reduce pressure on those delivering the services.

Starting in April, STPs and CCGs will be monitored on two key measures:

  • Containing growth in A&E admissions
  • Reducing bed days with the link to DTOC

So, there is a need to change direction and quickly but this can feel daunting. Our experience at iMPOWER shows that rapid progress depends on getting the relationships and behaviour right alongside new ways of delivering care. That is the key to delivering different, and more effective services, to patients that in turn reduce demand. It is often overlooked, but for example, if local GPs are not bought into the preventative out-of-hospital care, then it will not happen. All of the best-practice in the world (which matters a lot) will not help if nobody wants to move. If you want to solve Delayed Transfers of Care (DTOC), positive relationships between the NHS and Councils are central.

At iMPOWER, we prioritise getting local relationships right and in a way that works for each place, which will inevitably be different because the people are different. We use recognised and proven ways to do that, such as those developed by the Cabinet Office behavioural insights ‘nudge’ unit. Having local support is the crux of all of this and once secured, the changes in care models flows much more easily and quickly. We work across the NHS and local government, so we understand how to make the interfaces work productively.

Whether you are focusing on reducing emergency admissions amongst the ‘super-user’ group of patients with the most need and use, the A&E front door or reducing delayed transfers of care, the same point applies. Working with teams, who are often under a lot of strain, is critical for success.

Demand into and through hospitals will not be solved by tweaking processes. People and relationships are essential to cracking this.

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