Healthcare delivery
otherwise be in hospital to receive the care, monitoring and support they need in a place they call home. This may include either prevention of admission into hospital or early supported discharge out of hospital, while remaining under consultant care. Patients in virtual wards are supported and monitored, on a daily basis, using remote monitoring apps – utilising technology platforms and using pulse oximeters, for example, to record regular data. Hospital at Home is another scheme run
by some areas where patients are supported to remain at home while being supported by a multi-disciplinary team, who visit as often as necessary. It provides hospital-level interventions and diagnostics – such as point of care tests, endoscopy, I.V fluids, therapy and Oxygen, while being carefully monitored. There are strict inclusion and exclusion criteria. Alternatives are being supplied by some
Integrated Care Boards, notably in Bristol, Devon and Cornwall, which have commissioned private healthcare companies to support discharged patients in local hotels from January 2023 until March. It remains to be seen how successful these can be. It seems to be a sensible idea and can release beds in the acute sector, to unblock some of the obstacles, increasing the flow in the acute hospital.
Healthcare workforce 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. International recruitment may provide some answers, but it is known that new staff – particularly from overseas – need a great deal of help and support to settle in and find their feet. Some Trusts have appointed specific individuals to support new staff, which can only be to their benefit.
Conclusion If the separation of urgent and emergency care is to occur, in order to relieve ambulance services and long queues in A&E, then there needs to be a comprehensive public education programme. People need to be re-taught how to use their local departments to best effect. This would include the use of 111 services, the urgent care centres which have been set up all around the country, and other options for minor problems such as the pharmacies.
February 2023 I
www.clinicalservicesjournal.com 17
To ease the constant flow of particularly elderly into hospital, with complex problems, some areas are setting up crisis teams in localities, which provide services in the home and prevent unnecessary admission to hospital. Referrals can be made by a wide range of people including ambulance staff, GPs and other healthcare professionals. Admission avoidance is the objective here.6 There is a wealth of ideas around, which may
help to relieve the blockages, but little time to put them in place. Money has flowed from the centre to help hospitals and integrated care boards to find and implement solutions. However, the ‘twindemic’ of COVID and flu has somewhat hampered the efforts and staff shortages have further damaged the potential developments. It is to be hoped that the peak of the viral wave is soon spent and a return
to normal winter pressures provides relief for everyone.
References 1 General election 2019: Have 17,000 NHS beds been cut in England? BBC News
2 NHS England, NHS sets out package of measures to boost capacity ahead of winter, August 2022
3 Dear colleague, NHS England, October 2022
https://www.england.nhs.uk/wp-content/ uploads/2022/10/BW2090-going-further-on- our-winter-resilience-plans-letter-oct-22.pdf
4 Strategies to reduce waiting times for elective care, The King’s Fund (
kingsfund.org. uk), December 2022
5 Re-envisaging-urgent-and-emergency-care. pdf (
nhsconfed.org)
6 Ibid CSJ
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