TECHNOLOGY
Unleashing ‘hidden’ minutes in the NHS
Stephen Boyle reflects on why the NHS must change its operating model to address the backlog of care. He explains how healthcare systems can unlock hidden minutes that together add up to make a significant difference to bed availability and patient flow.
It is true that over the year 2020 and into 2021, the NHS has evolved. The NHS dealt with the first COVID-19 wave by switching all of its focus to deal with the virus and nothing else – rightly so. Post the first wave, the NHS quickly re-established some (but not all) services and activity. In the second wave, the NHS managed COVID-19 while maintaining key services and increasing activity, but the ‘Kent’ variant of COVID-19, in late November 2020, saw another profound impact on services. Right now, it very much feels like the NHS is moving on to managing COVID-19 and resetting services back towards normal activity levels. However, the next few months look challenging.
Commenting on NHS hospital
performance data, published in August 2021, Deborah Ward, senior analyst at The King’s Fund, warned: “The waiting list for routine NHS care has ballooned to levels not seen since the early 2000s, and now stands at over 5.4 million and with the potential for many more people who weren’t referred during the pandemic to come forward for treatment, this list will continue to grow. The number of people waiting two years or more for planned care has also rocketed to nearly 6000; people who will be living with conditions that potentially limit their lives while they wait.
“Demand for emergency services has also returned to pre-pandemic levels with 2.2 million people attending A&E in July and
over 1 million calls to the ambulance service last month. NHS hospitals face competing demands for their limited resources and a coherent national strategy for balancing these pressures is urgently needed ahead of winter.” Danny Mortimer, from the NHS Confederation, has estimated that to work through the backlog of known and unknown demand may take 10 years. Behind these big numbers, and the stories of individual suffering, hides significant complexity and choice of how to deal with such a massive backlog. To help cope with the huge waiting lists, NHSE released guidance on a ‘National
There is a need to deploy and operate patient flow system technology at a regional level and remove all responsibilities for bed management from the ward level into the responsibility of the operational teams.
SEPTEMBER 2021
Clinical Prioritisation Programme’, but most NHS Trusts should be carrying this sort of activity on a daily basis, such as RTT harm reviews. What this prioritisation work is likely to uncover are large numbers of patients with a critical clinical need for treatment within the next 1 to 3 months; the so-called P2 and P3 – cohorts. P2 patients are those whose priority means they should be treated within one month and P3 patients have a priority of needing treatment within the next 3 months.
Where will the pressure come from in the next months? As the NHS ramps up activity and attempts to deal with the backlog – the first services to be hit will be the diagnostic services and, as the millions of ‘hidden’ waiting patients begin to be referred, ‘new’ patient outpatient capacity will be at volumes never seen before. By default, the NHS will have to become a 24/7 service. It is worth mentioning that, in both wave one and wave two of COVID-19, the NHS
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