NHS England (NHSE) recently unveiled its plans to tackle winter pressures in acute hospitals. The plans include three major interventions: additional acute capacity (beds and ambulances), care traffic control centres to coordinate complex discharges, and additional community health capacity through virtual wards and Acute Respiratory Hubs.
At IMPOWER, we understand the challenges across the sector. Through Valuing Home, we have been supporting a behaviour change approach to improve discharge and flow for the past two years. On a personal level, as someone who spends my working time supporting acute trusts manage Home First models and improve flow pressures, focus on this from NHSE is welcome. But do the outlined interventions go far enough? In this article, I delve into the proposed interventions, and explore the potential challenges and opportunities they present.
1. Strengthening capacity for increased demand
The introduction of 800 new ambulances and 5,000 additional permanent general and acute beds is undoubtedly a significant step in improving emergency response times and enhancing patient outcomes. This expansion must be accompanied by necessary infrastructure and staffing considerations, including not only in the long term via NHS Long Term Workforce Plan, but in the months ahead. The omission of these crucial elements from NHSE’s short-term plans could lead to issues such as infection control problems, staff burnout and quality of patient care.
To address this, consideration of the additional permanent and/or agency staff costs required to manage these beds safely is required, alongside possible investment into modular wards to accommodate the new beds effectively. This way, the benefits of increased capacity can be fully realised without jeopardising patient safety or staff wellbeing.
2. The role of ‘care traffic control’ centres
The introduction of ‘care traffic control’ centres, which coordinate safe and timely discharges for patients requiring ongoing care, is a commendable initiative. These centres play a vital role in reducing avoidable time patients spend in the hospital and improving bed occupancy rates.
For this system to work optimally, there must be adequate community capacity to support patients upon discharge. Without enough resources for domiciliary care, reablement, and intermediate care, the discharge plans created by the ‘care traffic control’ centres may not be effectively executed, leading to delays and bottlenecks in the hospital. One-in-eight beds were occupied by those awaiting community care last winter, and whilst a more coordinated approach to discharge will certainly help, it cannot solve the problem from within the acute alone.
3. The challenge of internal hospital behaviours and processes
Internal hospital behaviours and processes also play a significant role in determining the length of patient stays and bed occupancy rates. Delays in prescribing medications for discharge (TTOs), writing discharge summaries and arranging transportation can all contribute to increased pressure on hospital resources.
To alleviate these issues, it is crucial for hospitals to implement interventions that streamline discharge processes and reduce avoidable time spent by patients in the hospital. This will not only free up beds more efficiently but also benefit all patients, regardless of whether they require care in the community.
A sustainable approach for winter preparations
While the NHS’s winter preparations offer a sense of optimism and hope, it is essential to maintain a sustainable approach that provides long-term benefits for patients, staff and organisations. Addressing the concerns mentioned above and investing in community care capacity will be vital in achieving a lasting solution to winter pressures. Without such considerations, additional beds will provide short-term relief until they too become full with patients who no longer require them. Addressing the root causes of delayed discharge will always be more effective than introducing more beds into the same limited environment.
The NHSE’s plans to manage winter pressures in acute hospitals are undoubtedly comprehensive and reflect the government’s commitment to reducing waiting times and improving patient care. To make these measures truly effective, additional staff and infrastructure support as well as improvements in internal discharge processes, must be considered. We’ve seen this across Manchester and Lincolnshire systems, where a home-first model, underpinned by strengths-based, co-ordinated and timely decision making, has led to reductions in length of stay and a greater proportions of patients being discharged home instead of to placements. This improves patient outcomes and enables significant cost avoidance as a result.
By adopting a holistic approach that addresses both hospital and community care capacities, we can ensure a sustainable release of pressure throughout the winter months. The resilience of the NHS is undeniable. With the right strategies in place, we can navigate through the challenges that winter will bring while providing the best possible care for patients.
If you’d like to continue the discussion, please do reach out and take a look at the impact we are having across our Valuing Home engagements in our 2023 IMPOWER Impact Report.
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