Healthcare delivery of healthcare.4 Understanding the root causes
of these disparities and taking corrective action to restore balance between demand and supply and optimising the conditions within the healthcare system is therefore considered key to any strategy to reduce waiting times and sustain them at that level. The forces affecting supply and demand of healthcare are numerous, broad and change over time, and can be summarised into three broad categories: l Supplyside factors, including levels of funding, investment in and capacity of the health and care workforce, beds, equipment, facilities and technology to deliver healthcare.
l Demandside factors, including the healthcare needs of the population, levels of presentations to healthcare services, the availability of treatments, thresholds and criteria for administering treatment and the attitudes and approaches of healthcare professionals in referring for/administering treatment.
l Factors impacting the conditions of the healthcare system that affect the management of waiting lists and waiting times, specifically: l cultural and environmental factors l operational and practical factors
There was a clear focus in the NHS in 2000s to reduce waiting times. NHS Trusts worked their socks off and were successful in reducing waiting times for a variety of procedures to meet the 18-week target. A key focus, which made it all possible, was: l Increased funding and capacity l Central direction and oversight l Performance management and incentives l Targeted support l Leadership and relationships at all levels l Mobilising the know-how and skills on the ground
l Wider NHS reform.
From a then NHS managers’ perspective, it was ‘all hands to the pumps’ with relentless pressure to meet extra surgical operating lists every weekend, and a programme which continued for months. It was very difficult to fulfil all the shifts each weekend and there was huge disparity in payment for extra medical sessions and overtime payments for lower grade staff. It was all very hastily organised and set up a great deal of resentment between hitherto well working team members. Times have changed and a number of different
strategies are in place – there is a host of new scenarios, which were not relevant in the past.
Urgent and emergency care Rising demand of 13% over the last ten years in attendances at A&E departments has made it increasingly difficult to manage demand in a timely manner. There is a change to the perception of the general public as to how they should see a healthcare professional when they have an issue. Many are currently struggling to see a GP and so head down to the nearest A&E department, where it seems they are happy to wait for many hours. Seeing everyone for everything has meant that emergency departments are victims of their own success and currently unable to function effectively. One
A crucial element to all of the unblocking activities and reforms is the need to address staff shortages, which hamper elements at every level. Developments and new activities are almost impossible to implement when staff are under such pressure and vacancies across the professions are having such an impact. But if the system is to avoid collapse, solutions must be found.
16
www.clinicalservicesjournal.com I February 2023
of the ways that could help both patients and staff – as outlined by the NHS Confederation 5 is to devise a scheme that separates non-time critical work – i.e. urgent (or some definitely not even urgent care) is diverted elsewhere, so that Emergency Departments can deal effectively with time critical patients, using their skills and talents to save lives. The present situation is not sustainable and needs to be reformed. The patients who need to be admitted from
A&E also need to be assured that they can be returned to their home with appropriate support or found an assisted place in care. Social care, as well as healthcare, has many problems with staff shortages and there are issues with assessments for discharge as there is a shortfall of social workers. Patients who are medically fit to be discharged are unable to be sent out of hospital until their needs can be met elsewhere. This requires assessment and therein lies another issue, that delayed discharges have the effect of blocking beds for other patients.
Discharge Discharge is a complex area involving the needs of the patients, as well as the wishes of the family. This all has to be co-ordinated and delivered by a number of organisations who may be waiting for adaptations to housing, a rehabilitation bed in the community or a bed in a nursing home. Some of the waits endured by patients can be months of extra care in hospital, when they’d like to be elsewhere. There has been a reduction in the number of community hospitals where immediate rehabilitation from major surgery could be undertaken or major wound healing or an intense programme of physiotherapy. Virtual wards have become one of the solutions for patients and the Operational Planning Guidance 2022/23 has emphasised them further, as well as expanding the Hospital at Home Programme. This has even attracted funding.
Virtual wards support patients who would
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
