Healthcare delivery
Reviewing the flow of patients in and out of the NHS
Kate Woodhead RGN DMS considers the extreme pressures being faced by the NHS and what needs to be done to address the ‘gridlock’ currently being experienced across the system.
The perfect storm is hitting the NHS at present, with patients queuing at the front door and not being able to progress any further for hours at a time. Patients are waiting to be admitted and so are stuck until a bed becomes available, or they are in the back of an ambulance until such time as they can be seen and triaged in A&E. Due to other pressures, it is also proving problematic to release some patients back home or to a community system, following their treatment. The whole system is thus gridlocked. It is a significant problem for both the patients and the healthcare professionals trying to deliver care. The consequences across the NHS are considerable, despite the preparation and planning which has gone into place since last summer. Social care too has immense problems and despite many residential homes having rooms available, they have no staff to support patients, so patients stay in hospital, although they are medically fit to be discharged. Politicians are staying remarkably quiet, leaving patients and clinicians to fill the media with pictures and quotes. There are no easy answers but a short review of the ideas and plans which have been put in place may help to inform.
The bed capacity of the NHS has been
declining since the 1980s, due to the advent and development of day surgery and day care – reducing length of stay for many other patients, and is part of a global trend. Many people are now able to be treated in the community rather than being admitted to hospital, due to services which are available from primary and domiciliary care. Telemedicine and other technologies are playing their part. However, there are also many fewer acute and mental health beds since 2010; it is said to be a reduction of 17,000.1
However,
it is not possible to open more beds without the associated workforce, and that presents another key challenge for finding solutions. It may seem to be an obvious aspect of the supply and demand conundrum, but surely the key to this is to find alternative solutions to the acute admission route – so that those who do not absolutely need to be in a hospital bed can be treated as an outpatient, find diagnostic services away from the hospital, or make arrangements for treatments to be carried out using the independent sector or other options. Community facilities, such as using pharmacists for local advice and prescribing, were
successfully brought into the fold during COVID and could once more provide useful services to prevent people sitting in A&E for hours. The management of discharges is also an essential element of managing the flow of patients out of hospital, but this has already received considerable attention and is being actively worked on by the new Integrated Care Boards and others.
Winter pressure capacity planning In a bid to get ahead of the crisis, last August, NHS England set out steps they would take to increase NHS capacity and resilience.2
The
number of beds was increased by 7,000 through a mixture of new hospital beds (previously mothballed beds), virtual ward spaces and other initiatives to improve patient flow in winter. More call handlers for both 111 and 999 services were employed to help staff meet record demand. There was also a prediction, which has now come around, that both flu and COVID will cause additional stress to hospital capacity. There were also plans to increase timely discharge by working with social care, as well as creating more virtual wards. In addition, a taskforce has been set up to
recruit international staff into critical roles across the system with promises that the process will be ethical.
Demand and supply Demand for elective care has increased due to the COVID backlog and, despite many recent successes with reducing two year waits for surgical care, there are still many people awaiting procedures and care today. It was reported that the figures were 7.2 million people waiting to start treatment at the end of October 2022 – a record number. Urgent cancer referrals are at a record high with 118% of pre-pandemic levels.3 The King’s Fund identified that elective
care waiting lists and waiting times are a product of the fluctuations in and disparities between the demand for and available supply
February 2023 I
www.clinicalservicesjournal.com 15
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