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Uko Umotong, National Discharge and Community Services Manager, CHS Healthcare

On 15 October, we discussed solutions to the most significant challenges to maintaining elective capacity this winter in our webinar ‘Winter pressures: is care coordination the key to capacity this winter?

We were joined by Jane Taylor, Deputy Director Urgent Care, NHS Northamptonshire Clinical Commissioning Group as well as Richard Parker, Board Member of North Norfolk Primary Care, and experienced senior NHS Operations Director as we addressed the crucial decisions those in the health and care system should make while planning ahead for this upcoming winter.
The NHS has had a hugely challenging few months, and as we turn to autumn and winter, the pressure across the entire sector is clear to see. The main obstacles we identified in maintaining elective capacity is recruitment and staffing vacancies, community capacity and an ever-increasing demand at A&E.

How can health and social care professionals enable flow across services?

An integrated approach – why care coordination is vital:

Winter plans – as we once understood them – are no longer fit for purpose with Covid, flu and the backlog we need to have a close look at the alternatives and additions including how to maximise community services. We don’t need to look too far to see the integrated approach some clinical teams and other groups took during the pandemic last year which are strong and positive examples of what professionals can do this winter by working together.

Jane Taylor said: ‘There is no simple solution unless we start coming together. Alignment, connectivity and joint working is absolutely essential during this period. We saw it during Covid, we took down barriers, we had conversation that we thought we’d never have and we need to remember what we did through that and drive it’.

‘At the acute front door, I have a primary care stream, I have a separate out of hours that runs out of there overnight and the key element here is – how do we work together? We always look ahead to where we want to be and where we can start to drive things now rather than wait for the formalities.’

Communication as a catalyst for effective coordination

Although a coordinated and integrated response from the health and social care sector is vital to maximising services, setting expectations and closely guiding patients and their families is an important factor to ensure overall efficiency.

Richard believes ensuring ‘much tighter and tidier communication with patients and families about how they are, what to expect and how to better navigate the system’ is the best approach to encourage patients to still seek treatment without having to increase capacity.

For Jane, communication is also a way to make sure hospital re-admissions are reduced. ‘I certainly have a managed pathway that I use for non-weight bearers which is managed from the point of view of discharge through fracture clinics and out the other end and having a team that manages flow and works to make sure those patients stay out of hospital is something I think we can apply if we’re making sure to follow up with them – it all comes down to communication and making sure who is doing what’.

Can extra funding and the new operating guidance enable smart capacity?

Although the operating guidance is a useful tool to overcome the challenges ahead, it doesn’t have the same degree of impact for private providers including care homes. The focus here is how we can utilise existing resources in a productive way instead of relying on funding.

As the 7 days 8am–8pm working and other initiatives are put in place, Richard believes that they add little value to the system and are harder to implement in practice in the light of the current workforce challenges.

‘What we saw during Covid in the Norfolk health system was that the clinical team actually redesigned the way they worked, there’s been support by commissioners who have taken their hands off the handlebars with the conventional community contract to allow for more creativity and to be more outcomes focused and that’s really worked and motivated the team’ Richard said.

This highlights the many ways we can innovate services and work around looming pressures with the existing resources we have. How can we work together to re-invent the way we work this winter?

‘What gives me some hope for how we might work differently through the winter is concentrating on patient flow through a step-down care home environment – an innovation I witnessed during Covid. Working in partnership with a care home provider with support from senior nurses and a virtual GP who would oversee the discharge issues that were arising in real time led to a reduced re-admission rate and much shorter lengths of stay’ Richard said.

Care coordination – the missing link to patient flow

There is still little awareness about how the coordinated care model works and even more so how it can contribute to speedy and safe discharge. The benefits extend from the overall reduction of occupied beds to improved capacity but also allows for strong support to be provided to patients and their families.

‘Partner relationships rather than siloed working is key but the challenge we have now is breaking it down and standing up to say it’s a model we want to work with’ Jane mentioned.

Care coordination is a feasible and effective solution to current challenges although it requires a mindset favouring overall change, innovation and transformation.

CHS Healthcare has been supporting CCGs with hospital discharge pathways nationally for 25 years and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact enquiries@chshealthcare.co.uk to discuss your needs.

You can access a recording of the webinar here: https://chshealthcare.co.uk/events/webinar-winter-pressures-is-care-coordination-the-key-to-capacity-this-winter/