Thanks to a winter of unprecedented pressure, the OPEL framework is becoming increasingly familiar, both within the NHS and beyond.
Published last October, the Operational Pressures Escalation Levels Framework was developed to establish a nationally consistent system for defining pressure on health and social care systems.
The idea is to have agreed criteria for interpreting pressure and clear mitigating actions to address that pressure at each stage.
Inevitably, media headlines have focused on individual trusts declaring OPEL level four, the highest state of pressure and escalation.
However, lesser publicised detail of the framework, particularly the mitigating factors for each level of escalation, provides a very valuable insight into what can be done when a health and social care system comes under pressure.
For example, when a system moves from OPEL 1 to OPEL 2, across all the mitigating actions, these themes stand out: prioritising discharge in clinical processes plus better co-ordination and communication between acute and community.
The guidance states: the acute trust must maximise rapid discharge of patients. At the same time, commissioners should expedite additional capacity in the community and independent sector, while community care should also maximise use of reablement/intermediate care beds.
This is precisely the interface where we work; we recognise the impact which can be achieved here, despite all the well-known challenges. For example, where we are commissioned to maximise discharge of patients by providing care co-ordination and family support, we are typically reducing DTOC (Delayed transfers of care) by 50 to 80 per cent, depending on trust’s benchmark before our service commenced.
Working effectively with the community health and social care sector, we reduce delays (for example, by supporting care homes to speed up hospital based assessments) and through our close and individual links with care providers, we do find capacity even in the most challenging areas.
Moving up from OPEL level two to three, again, there is a consistent emphasis in all parts of the system to expedite discharge by discharge. Again, the need to ensure care packages are arranged to facilitate discharge is described in the guidance several times. The guidance also states that domiciliary care packages should be increased for individuals in their own home to reduce the risk of those individuals needing an emergency hospital admission.
We work in 25 different hospitals across the country and frequently hear “there is no domiciliary care” resource in certain areas, or where an individual has very complex needs. In some areas, services are working with an automated system of care brokerage, while others are heavily reliant upon email based communications. Our teams speak with home care agencies on a daily basis; through these relationships, we build willingness to meet challenges and the ability to find solutions.
We would not seek to underestimate the challenge of domiciliary care capacity, particularly in some parts of the country. However we have shown, in many areas, that better communication and co-ordination does have a real impact in terms of finding capacity and solutions.
Even on the highest OPEL level four, where the overall emphasis is upon emergency measures, there remains a focus on discharge and community capacity. Community services are tasked with ensuring all available capacity is identified and board rounds are recommended to achieve “quick wins” and better flow. We have been involved in board rounds, tasked specifically with expediting discharge and recognise how this step can have a very significant impact.
In other words – there are factors in an escalation in pressure which are very difficult to control. But there are mitigating factors at each level; there are things which health and social care systems CAN do. And the same theme appears in the mitigating factors in all four escalation levels: expedite hospital discharges by a number of measures applied across the whole health and social system – use board rounds, prioritise discharge, good communication with community providers, consistent and rigorously seek capacity, even in challenging areas. These are all interfaces where we work: we can support patient flow and we do so on a daily basis in NHS hospitals from the south coast to the north of England.