TECHNOLOGY
providers did maintain high levels of activity for cancer treatment and therefore cancer is not necessarily part of the problem, here. Many of the P2 and P3 patients may have underlying cancers that impact services further down the line.
What next? So, what is the answer? More money? More staff? Longer hours of services availability? Increased use of the private sector? Well, that’s already factored in. The UK Government has promised £6 billion of extra funding and the London region has begun planning more activity for private providers. But £6 billion will not go far when spread across all providers and over 24/7 capacity and outside of the London region. The private hospital sector is based on small surgical hospitals, mostly staffed by people who work in both the private sector and the NHS – so it’s not spare capacity.
More beds?
Is the answer more NHS beds? More modular buildings in hospital car parks? Pop-up operating theatres? CT Scans-in- Vans? Maybe not. The opportunities and funding resources to fund more capacity in the NHS are, as usual, constrained. Firstly, there will be little extra capital funding available outside of the 40+ New Hospital Build programme announced in the Conservative Manifesto in 2019. As we all know, this will be less ‘new build’ and more likely ‘refurbishment’. Secondly, even if we could build additional bed capacity, how would we staff those beds? As the King’s Fund points out, there are currently 100,000 open vacancies and 1 in 11 posts unfilled in the UK. There is little in the way of short-term spare workforce capacity and the long-term tactics to boost overseas recruitment and manage the perennial issue of staff retention
are largely focused on maintaining the healthcare workforce. The challenges do not end there. For instance, how do you reset and
restart services in a hospital sector that has been working flat out for over a year managing the pandemic? Plus, how do you do this when a significant part of your workforce is traumatised after facing two waves of COVID-19?
Many front line nursing and medical staff needed to care for patients in the P2 and P3 Cohort are mentally exhausted and accessing occupational mental health support in high numbers.
Peak Transformation
As we have established, there are huge backlogs and only finite capacity. However, over the years there has been plenty of focus on managing demand and capacity. NHS, NHSE and NHSI have had numerous programmes aimed at understanding demand and making the most of every minute of capacity, exploring approaches to release time to care; driving down wasted
time and inefficiency; reducing variation in pathways; and to generally improve all aspects of productivity. These programmes include NHSE Capacity and Demand Tools kits, Releasing Time to Care (The NHS Productive series), Getting It Right First Time (GIRFT), LEAN and many more local and national initiatives. In addition, there has been exploration of improvement approaches from outside of healthcare – such as ‘Marginal Gains’ from the world of elite sport. The Team GB cycling coach, Dave Brailsford, captured the meaning of Marginal Gains in the following definition: “The whole principle came from the idea that if you broke down everything you could think of that goes into riding a bike, and then improve it by one percent, you will get a significant increase when you put them all together.” Its logic appears sound but its application to healthcare has been short-lived. What have we gained? Can we start to assume that we might have reached ‘Peak’ improvement methodology driven change? Or, in a quote attributed to Car Magnate, Henry Ford, are we in danger of “doing what we have always done and getting what we always got?” That being stasis?
Focusing on the minutes I think what will make the biggest change will be to make every minute of lost capacity matter. That can only be achieved by bringing in a new approach to operational management – operational management at scale. This involves establishing regional patient flow command and control, and – at the same time – focusing on patient flow at the provider level.
It means focusing on the minutes between a bed being empty and reoccupied again; reducing every minute lost between each outpatient clinic slot and recouping every minute lost in the operating room when a case starts late or overruns. This will only be done with a mix of technology and transformation.
76 l
WWW.CLINICALSERVICESJOURNAL.COM SEPTEMBER 2021
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 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
