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Embracing Collaborative Leadership: Reflecting on the Rise of Shared Leadership Roles in NHS Trusts

The emergence of shared Leadership roles within NHS Trusts is becoming an increasing trend aligning with the NHS’ evolving need to share best practice and make significant improvements across hospitals. Recent analysis has suggested that more than one in three trusts in England now share their chair or chief executive with others. At CHS Healthcare, we view this shift as an opportunity to strengthen collaboration, innovation, and efficiency within our NHS, and support our Trust and ICB partners in embracing changes that contribute to the betterment of healthcare delivery for all.

In this blog, we reflect on the implications of this shift towards collaborative leadership and how it aligns with our commitment to innovative and effective healthcare management that ultimately has the wellbeing of the patient at heart.

Will a shift in leadership dynamics positively impact service delivery in Trusts?

Of the total 211 trusts in England, 71 now have a joint chair or chief executive, or will be moving to this arrangement shortly. This change is often a natural step forward, with many trusts already pooling resources to the benefits of patients.

There is currently very little national policy around shared leadership. The benefits of this approach are likely to be specific to different areas, the structure of trusts and the needs of communities.

Often the move to appoint a shared leadership team is driven by a need to deliver services for local people, within the context of restricted budgets. With less resource, reducing duplication and sharing knowledge can help services do more with less.

What about the impacts on Governance and Decision-Making?

Shared roles can have profound impacts on governance and decision-making processes; fostering synergy, encouraging diverse perspectives, and promoting a more inclusive decision-making environment, all of which are integral to driving positive changes in healthcare delivery.

This could have benefits for hospital discharge, where the burden of admin is felt by individuals. In our 2022 staff survey, 49% of hospital staff surveyed said that paperwork, admin and bureaucracy causes discharge delays, 45% of their time is taken up with arranging discharge for patients who require additional support or a new placement and 22% said it takes them away from vital work. For patients who need additional support or new placement, on average 31 contacts with a range of people, e.g. patient’s family and carers, community nursing teams, local authority adult social care team, are needed to complete discharge. There is hope that shared decision making could lead to closer alignment between services, and reduced admin burden.

Could it enhance efficiency and innovation?

By pooling resources, knowledge, and experience, and potentially whole teams, there is an argument that Trusts may be able to navigate challenges more effectively, ultimately improving the quality of care provided.

One example of the impact of shared leadership can be found in the work between Brighton and Sussex University Hospitals NHS Trust (BSUH) and Western Sussex Hospitals NHS Foundation Trust (WSH). BSUH and WSH established shared leadership team with a substantially shared board. This allowed BSUH to exit special measures and improve its CQC rating to ‘Good’ in 2019. This was supported by “the implementation of a continuous improvement methodology and alignment of governance, risk management and internal control processes”, driving improvements for patients.

Fostering Collaborative Partnerships is key:

The shift towards shared leadership roles in trusts is indicative of a broader trend in healthcare management – fostering collaborative partnerships. At CHS Healthcare, we understand the transformative impact of collaborative efforts. Our partnerships with the NHS, local authorities, and other stakeholders have been instrumental in delivering integrated, patient-centred care.

As shared leadership becomes increasingly prevalent within NHS Trusts, CHS Healthcare remains at the forefront, ready to collaborate and innovate for the benefit of the communities we serve. The essence of collaborative leadership resonates with our core values, and we strongly believe in the power of partnerships and collaborative efforts not only in healthcare management, but also between the private and public sector. Shared leadership roles align with our commitment to creating integrated healthcare solutions that leverage the collective expertise of professionals for the benefit of patients and communities.

Call 0121 362 8840 or email maria.knowles@chshealthcare.co.uk  or philippa.grotzke@chshealthcare.co.uk

An autism diagnosis IS treatment – the reasons to find us

Our new report, ‘Autism and ADHD: The damaging waits for assessment’ written in collaboration with The Brain Charity and The Donaldson Trust, highlights the urgent need for change within NHS neurodiversity assessment services to support both patients and staff.

In our report, we examine the long waits for assessments, and potential contributors to the declining situation and propose ten recommendations for reform. We also look at the human impact of the crisis, and share the stories of people who have been directly affected by long waits for diagnosis and treatment.

One of our collaborators, Jane McNeice has written on the importance of timely autism diagnosis. We are pleased to share her story below.

My experience waiting for an Autism assessment, by Jane McNeice

I can’t tell you how many times people have said to me “but why does a diagnosis matter?”. Two things matter – identification of autism, and diagnosis. Like the Aintree Grand National, that journey is full of hurdles, falls, and for some, fatalities.

For a long time, I felt over-dramatic in that assertion, but not now. It’s not overdramatic, but rather the reality for so many autistic people and their families. The hurdles include:

  • Identification: Finding ourselves and learning that we are Autistic is incredibly difficult. As waiting lists show, our health, social care and education systems are ill equipped to identify and diagnose us, especially if we are female, or identify as. For me this part took 44 years, and in the end, I self-identified, by chance. It had been missed by professionals who weren’t aware of the female Autistic presentation.
  • Making your case for referral: Following identification, convincing the appropriate professional(s), usually a GP in the first instance, or in the case of a child – teachers and special educational needs co-ordinators, of our findings can be the next hurdle. This can take weeks, months, or even years.
  • Criteria for assessment: Once you’ve successfully made your case to the first practitioner, you reach the next hurdle, which is meeting the requirements for assessment. If the person needing an assessment is a child, the parents/carers are likely to face additional barriers such as mandatory parenting courses or Early Help Referrals, which can add weeks, months, or years to the process.
  • Waiting for an assessment: And, if you are finally accepted on the assessment waiting list, you’d better bring provisions, because the waiting times are unacceptably long, and you could be there for a while! This is often a postcode lottery.
  • Diagnosis (or not): You think this is the end of the journey. Wrong, it is just the start of another one!

I could write at length on each part of this journey, the searching, the process following identification, and the journey post diagnosis. Within each exists a plethora of obstacles, frustration and emotional rollercoasting, battles that require energy, and the desperate fight not to break at any point. Some people never find themselves or self-identify in the first place, and their suffering simply leads to too much pain, sometimes resulting in suicide, which is much higher in autistic people than in the neurotypical population. Deaths from substance misuse, neglect, eating disorders, and other connected issues can all be illustrations of undiagnosed Autistics who lost the battle before they were found.

Currently, the picture is of a broken healthcare system for neurodivergent people both at the pre and post diagnosis stage. We are a minority-minority, or ‘double minority’, if we are not yet identified. We know we are different and never feel accepted or understood, but we don’t actually know ‘why’. Imagine not knowing the colour of your skin, or your sexual identity, but having to work that out based on how you feel and how you are treated by the world. This is the life of an undiagnosed searching autistic. This was me for 44 years till I self-identified. At the point of my diagnosis, my family were already part way through the above process with our son (again parent-identified, not professional), so I chose instead to take a private route for myself, being one of the lucky ones who had a choice. We were also lucky to overcome the delays by seeking a private assessment with our son. Sadly, this is not the case for so many, including my daughter who is still waiting on the NHS for an ADHD assessment since her private Autism diagnosis in 2021, and my grandchildren who are waiting for an NHS Autism assessment.

So why is it important that we continue to fight for our truth? Because it matters and may matter even more to those who have a need for facts – autistics. People with autism can also be incredibly determined and tenacious. If we make something our obsession (special interest/SPIN), woe betide he/she who tries to stop it. We will just fight harder. In my working life, I am a mental health trainer, which includes delivering courses on topics such as resilience. We often discuss what resilience actually is and whether we know anyone who is resilient? I actually believe the autistic community to be a good illustration of resilience. We are a group of people surviving in a world not built for us or by us. It requires elevated levels of resilience to survive in those conditions. It also requires high resilience to keep ploughing on in a system with hurdles.

That very same resilience is what helped us to survive sexual abuse (9 out of 10 of us were and have been sexually abused[1]), bullying, and manipulation in many cases. Many Autistics have a victim narrative of some kind, and often we blame ourselves for what happened to us. I am now better able to protect myself from predators post diagnosis.

Many of us have suffered from mental illness, a very common co-existing health issue, and other health challenges linked to autism e.g. hypermobility, dental problems, gastrointestinal problems, amongst others.

Many of us will be very self-aware, but don’t really understand ‘why’. This ‘why’ is the ultimate key to our emancipation. When you self-identify and/or receive a diagnosis of autism, you will for the first time know ‘why’ all of this happened, that you were vulnerable, that you experienced the world in a different way to other people, and that the world you live in was never created with you in mind. These are just some of the reasons why life is hard for us. Finding out ‘why’ and knowing we are autistic is not just a diagnosis, it is a treatment in and of itself.

Our psychological and physical health can improve dramatically by knowing. For me this resulted in the suicidal thoughts that I had lived with for most of my life becoming far more manageable because they had now lost some of their power. My own suicide risk factor has reduced because of the knowing. I now know my identity, who I am, and why I am, and I am proud. I consider myself a survivor in a system that is not working, living in a world I am not suited to.

There are three over-arching reasons to find us that reveal themselves:

  1. Suicide prevention – if we know who the Autistic people are we can better protect them from suicide through acceptance and support and supporting their related health needs, mental and physical.
  2. Child protection and safeguarding – if we know who the Autistic children are we will know those who are doubly vulnerable to the predators of the world. We can offer additional safeguarding and help them to be more alert to predatory behaviours.
  3. Autism is not just a medical diagnosis; it is an identity. Our brain type defines how we view ourselves, our other identities, and everything we are exposed to. Knowing our brain type is therefore fundamental to our identity.

Getting a diagnosis is a health intervention, not just a process towards one.

Jane McNeice BA(Hons), PGCert, Assoc CIPD, CMISMA, is a Mental Health Trainer and Author at Mind Matters Training

Jane was privately diagnosed with autism after 45 years of social masking and related challenges. Jane has provided this blog to describe the challenges facing people seeking a diagnosis and to highlight the critical importance of diagnosis.

Find out more about Autism and ADHD, and the true cost of spiralling waits for assessment here: Mental Health Services | CHS Healthcare

[1] Nine out of ten autistic women are victims of sexual assault (openaccessgovernment.org)

Patients are being failed by long waits for autism and ADHD assessments

NHS neurodiversity services are in crisis. Hundreds of thousands of patients have been waiting for at least a year for an autism or ADHD assessment, putting their lives on hold in the meantime. We know that living with undiagnosed autism or ADHD can have serious consequences on physical and mental health, education, work, and overall quality of life. Patients are left in the dark without support, and NHS organisations are breaching targets of 13 weeks between referral and appointment for autism assessments, and 18 weeks for an ADHD assessment. 

How CHS can help the NHS address waiting lists for autism and ADHD assessments 

With over 20 years of experience partnering with the NHS to support vulnerable people across the health and care system, CHS Healthcare are trusted experts in delivering digitally enabled services that ensure optimal health and wellbeing outcomes for everyone. Our workforce of 500 experienced clinicians and expert administrators is helping to add essential capacity to struggling services by offering remote, in-person and combined NICE recognised neurodivergent assessments, helping the NHS reduce waiting lists by approximately 25% so that people can receive the support they need to plan their future care with confidence. 

Contact Eleanor Norman eleanor.norman@chshealthcare.co.uk to find out more about how we can help you. 

About our new report: Autism and ADHD: The damaging waits for assessment 

Published today, our new report, ‘Autism and ADHD: The damaging waits for assessment’ written in collaboration with The Brain Charity and The Donaldson Trust, highlights the urgent need for change within NHS neurodiversity services to support both patients and staff.

We’ve taken an in depth look at NHS data, and the findings bring into stark focus the true extent of the crisis. Based on the current rate of assessment, and without a change in approach, it will take the NHS over two years to process all the referrals of everyone currently waiting for an autism assessment alone. We also estimate that of the 2.6M people in the UK with ADHD, 2M (80%) are likely to be undiagnosed – 800,000 (40%) of whom may have to wait over a year for diagnosis.

Our recommendations

To address these issues, the UK government and service providers must change trajectory and improve NHS waiting times for both autism and ADHD assessments. Today’s report sets out ten actionable recommendations that will improve the situation for patients and services:

  1. Simplifying information and increasing transparency. Services need to ensure pathways and processes are as clear as possible to mitigate distress and burden for patients.
  2. Curbing the sharing of misinformation. Confusion around accessing diagnosis and support can lead to people seeking information from untrusted sources. Social media users need to know that professional services and signposting is available to them, should they have concerns.
  3. Improving access to support for those left waiting.Collaboration with external organisations can provide additional support to patients whilst waiting for assessments, without increasing workload for the NHS.
  4. Increasing oversight of ADHD services.The introduction of a national ADHD strategy and the implementation of better data sharing to improve oversight of ADHD services and ensure that ADHD and autism services are equally prioritised.
  5. Collaboration outside of traditional models to improve accessibility and efficiency.Clinical teams and different organisations working in silos can lead to further confusion and delay. Better communication across organisations can create a seamless experience for patients.
  6. Prioritising innovative solutions that speed up services.Initiatives such as remote working can unlock additional system capacity through existing staff and ensure the appropriate appointment modality is available for the appropriate context.
  7. Expanding workforce capacity.By utilising additional expertise available through external partners, the NHS can help commissioners, local authorities, and young people’s mental health services that are struggling with staffing numbers.
  8. Improving children and young people’s access to services. By diagnosing and supporting those with neurodivergent conditions early, we can limit the future impact on both the personal lives of those affected, as well as the healthcare system.
  9. Funding further research into ADHD. To improve understanding of the impact of this condition and the support that’s needed by those diagnosed.
  10. Removing the gender bias.To avoid misdiagnosis and improve outcomes for all, we must avoid gender gaps in research.

To find more about the damaging current situation read our new report Autism and ADHD: The damaging waits for assessment here:  Mental Health Services | CHS Healthcare

NHSE’s urgent and emergency care plan: Improving discharge without increasing beds

Last week, NHSE published its strategy to recover and reform urgent and emergency care. The plan sets out key actions for coping with immediate pressures and stabilising the future.

The plan pledges to:

  • Grow the workforce
  • Allocate £1bn to providing extra hospital capacity, equating to 5000 new beds
  • Allocate £1.6bn to speed up hospital discharge by developing care transfer hubs and new approaches to step-down care

The hospital discharge process is complex and multifactorial. Relying on more staff and more beds risks suggesting that this alone will be enough to sustainably reform discharge processes. However, delayed discharge isn’t solely caused by lack of staff or lack of beds, but also through ineffective processes. To tackle discharge delays, we need to recognise and understand the root causes and make better use of the resource we have, otherwise the extra beds provided will be quickly filled with new patients waiting to be discharged. 

Our research found that there are 31 separate tasks and contact points involved in getting medically optimised patients out of hospital – these include completing paperwork, arranging transportation, and approving funding. Almost half of hospital workers and more than half of social care workers surveyed agree that administrative processes cause discharge delays. In 31% of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised. 18% of staff agree that patients have no clear discharge plan at admission, despite this being included in NHS discharge planning guidance. Additionally, 50% of hospital staff agree that resistance from family and carers to the final discharge decision causes delays, which can be mitigated through earlier and more effective communication.

Service redesign is needed, and from our 20+ years of experience partnering with the NHS to improve discharge processes across the country, we know that a successful discharge involves: 

  • Discharge planning as soon as patients are admitted
  • Having dedicated resource for communication with all parties, including families and next of kin
  • Using technology and digital processes rather than relying on paper
  • Dedicated case management from admission to the hospital back door across all steps in the process
  • It is positive that hospital discharge is getting more focused attention and dedicated resource from the government and NHSE. However the insight and experience available through dedicated resources, effective collaboration, and partnerships shouldn’t be underestimated allowing key clinical staff to focus on patient care.

For more information on the work CHS Healthcare has been doing to understand and unlock patient flow visit: https://chshealthcare.co.uk/the-key-to-unlocking-patient-flow/

Or contact: Maria Knowles (maria.knowles@chshealthcare.co.uk) or Lucy Chapman (lucy.chapman@chshealthcare.co.uk)

The current state of autism diagnosis waits

It is currently estimated that around 700,000 people in the UK have a diagnosis of autism(1). Without a formal diagnosis, people can live for years without understanding why they find aspects of life difficult, distressing and harder than their non-autistic peers.

Additionally, some with undiagnosed autism can reach crisis point and some can be mis-diagnosed with a serious mental illness or inappropriately hospitalised in a mental health unit. Being diagnosed as soon as possible means treatment can be implemented sooner to help people manage their condition and make necessary adjustments to their life.

However, recent statistics paint a bleak picture that autism services are in crisis and that thousands are waiting months or even years to access the help that they need.

Last week, the NHS released its latest quarterly autism waiting time statistics. It is recommended that anyone with a suspected autism referral receives their first appointment within 13 weeks, however in July 2022, there were 125,000 people with a referral for ‘suspected autism’ waiting for diagnosis, with 105,000 (84%) of these waiting longer than 13 weeks for their first appointment.

There are also large variations in care across the UK.

Last week’s data highlights the areas with the longest waiting lists; significantly more people waiting longer than 13 weeks in the South East of England compared to other regions.

Picture 1 (1)

Additionally, these statistics do not give the full picture of the crisis. The publicly available NHS data does not indicate exactly how long people are waiting until their first appointment, just if they are waiting longer than 13 weeks or not.

This information was recently obtained through freedom of information requests sent to NHS trusts across the country and found that Berkshire Healthcare NHS Trust has 2,801 autistic children’s referrals still awaiting their first appointment after 60 weeks on average (source).

Looking back to April 2019, where the NHS published this data for the first time, there were 18,701 suspected autism referrals. This is a 465% increase in the number of referrals in just over three years, an unprecedented surge that services were wholly unprepared for.

Greater awareness and understanding of autism and autistic traits, particularly in adults, is cited to be one of the reasons behind this extreme rise, and it looks like there is no sign of it slowing. The NHS will struggle to cope with demand and thousands of people will continue to live in limbo waiting for assessment if additional measures aren’t considered immediately.

CHS Healthcare are offering remotely delivered autistic spectrum condition assessments to help NHS partners reduce waiting lists and add essential capacity to struggling services.

Contact Ellie Norman eleanor.norman@chshealthcare.co.uk  or Sam Jordan sam.jordan@chshealthcare.co.uk to find out more

Our response to the Autumn budget

CHS Healthcare welcomes the government’s focus on additional funding for the NHS and social care system in last Thursday’s budget.

With so much pressure on the system it is encouraging to see that the Chancellor has announced the NHS will receive £3.3bn in 2023/24 and a further £3.3bn in 2024/25, and social care will receive up to £2.8bn in 2023/24 & £4.7 billion in 2024/25.

It is also encouraging that the details of the adult social care discharge fund have been announced following Secretary of State for Health and Social Care, Steve Barclay’s speech at the NHS Providers conference last week. The funding will be distributed through the Better Care Fund and is allocated specifically to help with hospital discharge into care settings. In his speech Steve Barclay also highlighted how local areas will be able to decide how their funding is spent depending on the needs of their population and encouraged attributing the funding to innovative solutions.

This additional funding will provide essential support to struggling trusts and will enable more resource to be put toward freeing up hospital capacity and discharging patients to a more suitable care setting.

But to truly tackle delayed discharge, we need to understand the root causes and look at the entire patient pathway. This funding gives extra breathing space to re-evaluate the hospital discharge operating model and address the causes of poor patient flow rather than taking a tactical, short term approach. Only a redesigned system built on collaboration between healthcare, social care, families and private providers, will future-proof discharge processes and strengthen the future of the NHS.

For more information on the work CHS Healthcare has been doing to understand and unlock patient flow visit: https://chshealthcare.co.uk/the-key-to-unlocking-patient-flow/

Winter pressures rising as energy costs soar

The NHS is facing mounting pressures, and we are facing one of the toughest winters yet with huge demand for healthcare services and overburdened systems struggling to meet demand.

The reasons for these winter pressures are multifaceted. One of the major factors driving increased demand is the cost-of-living squeeze and increasing energy costs, with healthcare leaders warning that these financial issues could become a public health emergency. As temperatures lower and energy bills increase, the number of patients in hospital with respiratory infections are expected to cause an even worse capacity crisis than at the height of the Covid 19 pandemic.

Fuel poverty leading to cold homes exacerbate respiratory, circulatory and mental health problems across all ages, leading to more hospital admissions and a higher demand for social care services. The elderly are particularly at risk, as the cold causes the heart to work harder to keep the body warm, increasing the risk of a heart attack or stroke, as well as reducing dexterity leading to falls. The Welsh Government scientific advisors have warned the cost-of-living crisis may also accelerate waves of winter viruses by spreading quickly through crowded rooms of people trying to stay warm and save money on energy bills.

With waiting lists already at an all-time high, as well as significant challenges with discharging medically optimised patients, this winter could be even more bleak than originally expected. Re-admission to hospital is also more likely if patients are discharged back to cold and damp homes, which will worsen the problem.

The soaring costs of energy bills narrows the bandwidth for people to be able to look after their physical and mental health, due to worrying about money and not being able to afford to cook hot food, further increasing the chance of ill health and hospital admissions.

With unrelenting pressures being felt across the system, accelerating patient flow is the immediate and glaring opportunity to create sustainability in NHS England and NHS Wales and ultimately, protect patient outcomes. CHS Healthcare emphasises the need for a tactical approach to support the system in these unprecedented times and ensure patients are discharged with care in place to help keep them well. This way, we can alleviate winter pressures and create systems fit for the future to ease increasing pressures from expected influx of admissions. We suggest the NHS implement steps that focus on: 

Collaborative planning

Active collaboration between hospitals, social care, families and providers from the moment a patient is admitted is critical. A system that works for patients needs hospital teams, social care services, families and providers working and planning together as early as possible. Our survey showed that in 31% of cases, hospital discharge is not discussed until treatment nears completion. 

System redesign
We need to adopt integrated system design and innovative care delivery models. To address the multi-faceted delays to patient flow we must bring together knowledge and skills from across the entire health and care sector. Discharge is everybody’s business.

Digital infrastructure
Building on the digital infrastructure enables more effective case management, better monitoring of complex cases and ensures adequate resource is available by addressing inefficiencies.  Digital technology also helps us manage and measure patient flow across the system.

Family involvement 

We shouldn’t wait until patients are better before engaging with their family and next of kin. 92% of staff agreed that engaging with the patient’s family and carers early on makes a successful discharge.

We hope that English and Welsh health boards will clearly set out how they will address the pressure fuel poverty has on patient flow. Without this, we cannot hope to move increasing patients efficiently in and out of hospital on a national scale.

Find out more about our work with front-line staff and senior NHS leaders to uncover the patient flow challenge, and how CHS Healthcare can help you to optimise patient flow, here.

For more information regarding our services, please contact: maria.knowles@chshealthcare.co.uk or lucy.chapman@chshealthcare.co.uk

International Infection Control Week 2022: The impact of delayed discharge on hospital-acquired infections

At CHS Healthcare, we believe that improved patient flow is vital to the future of the NHS. The impact of delayed discharge on system efficiencies is well documented, but reducing unnecessary hospital stays also plays a vital role in tackling hospital acquired infections (HAIs).

A HAI is any infection —bacterial, viral, or fungal— that a patient did not have prior to arriving in the hospital and picks up during their stay. According to 2021 research, HAIs can be seen in 14.1% of delayed discharge cases [1]. As of November 2021, data even suggested that one in eight of all COVID-19 deaths in hospital were likely caused by hospital-acquired COVID-19 [2], and 2017 data found that an estimated 834,000 healthcare associated infections cost the NHS a total of £2.7 billion [3].

It makes sense that patients who remain in hospital for longer than needed are more susceptible to HAIs. Extending contact with different members of hospital staff multiple times a day, being moved to other wards, or being near to other patients and visitors, are all additional events that involve further exposure to potential infections. It’s not just infections that patients are more likely to acquire as a result of delayed discharge – patients can also see an increase in mortality, depression, dependency, as well as reduced mobility [4] [5].

Despite the evidence of the of delayed discharge on patient health, thousands of medically fit patients are stuck in hospital every day. According to NHS data from time of writing, 1 in 7 patients in hospitals are well enough for discharge [6] [7], suggesting that the current discharge planning model is broken. As we move into the winter season – traditionally the health service’s busiest period – swift action is needed to improve patient flow.

To unlock patient flow, the NHS needs to focus on:

  • Collaborative planning – The current hospital discharge model is based on thirteen teams, working across primary, secondary, and social care. In this system, patients are passed along the chain with insufficient focus on case management from point of admission to discharge. We must improve how these teams work and plan together, ensuring more alignment and increased continuity of care through case management.
  • Planning for discharge at an earlier stage – NHS Guidance states that discharge planning should start at admission but in many cases this process doesn’t start until a patient has nearly completed treatment or is fit to leave. We need to make sure that discharge planning is starting as early as possible to ensure efficient
  • Improved digital infrastructure – Adopting innovative solutions that eliminate lengthy and unaligned processes, which ultimately result in staff loosing valuable time to otherwise avoidable or repetitive tasks.
  • Family involvement – Actively engaging with families and next of kin throughout the entire process, to ensure that a patients’ needs and wants are involved in the planning for discharge.

By redesigning the hospital discharge system, NHS services can reduce pressure on staff and improve access to and quality of patient care, ultimately resulting in improved patient outcomes and lower levels of hospital acquired infections.

Contact us to find out how CHS Healthcare can help you to improve patient flow this winter and beyond: enquiries@chshealthcare.co.uk

Notes:

[1] BMC – Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study: Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study | BMC Health Services Research | Full Text (biomedcentral.com)

[2] The Telegraph – Exclusive: 11,600 people caught Covid in hospital and died: Exclusive: 11,600 people caught Covid in hospital and died (telegraph.co.uk)

[3] BMJ Open – Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England: Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England | BMJ Open

[4] National Library of Medicine – Impact and experiences of delayed discharge: A mixed-studies systematic review: Impact and experiences of delayed discharge: A mixed-studies systematic review – PubMed (nih.gov)

[5]. National Library of Medicine – Hospitalisation as a risk for functional decline in older adults:

[Hospitalisation as a risk for functional decline in older adults] – PubMed (nih.gov)

[6] NHS England – Hospital discharge data: Statistics » Hospital discharge data (england.nhs.uk)

[7] NHS England – Bed Availability and Occupancy: Statistics » Bed Availability and Occupancy (england.nhs.uk)

Patient flow is the battleground for the future of the NHS in Wales

The NHS in Wales is facing mounting pressures, and progress is lagging behind the rest of the UK. People in Wales are struggling to access health services, staff have been described as ‘dead on their feet’, and waits for care continue to lengthen.

65.7% of A&E patients were seen within four hours in July, compared with 66.4% in June, and 53% of people are waiting over 26 weeks for treatment. Yet despite these record-high waiting times for patients requiring care, thousands of medically fit patients remain in Welsh hospital beds due to delayed discharge.

In 2015, Wales outperformed England in key metrics of their health service performance. 88% of cancer patients began treatment within 62 days of referral, compared to 84% in England, and while England reduced their social care spending by 11.5%, Wales cut theirs by just 0.8%. Now, both countries face the same unprecedented challenges caused by increasing demand and the impact of COVID-19.

So, how can the NHS in Wales overcome these pressures and reclaim the success it once had? To deal with the problem, we need to identify the cause. Not just in Wales, but across the UK, poor patient flow is a leading cause for record-high delays and waiting times. The Welsh Auditor General said: “Some health boards told us that they can have several hundred medically fit patients occupying hospital beds at any one point in time.”

The Welsh Government recently released their programme for transforming and modernising planned care and reducing waiting lists and have also announced their work to improve urgent and emergency care. Whilst the plans set out by the Welsh Government are helpful, they don’t clearly address one of the leading causes for these delays and record-high hospital waiting lists – patient flow.

We recently conducted a survey with hospital and care staff from across the UK, with respondents telling us that they believe almost half (43%) of patients on hospital wards meet the NHS’ criteria for hospital discharge, meaning they are well enough to leave hospital. With NHS Wales facing unprecedented pressures from the COVID-19 pandemic to a workforce crisis, almost one in five UK hospital workers (17%) reported patient flow as the biggest problem they face.

Therefore, we suggest that NHS Wales unlock patient flow by implementing steps that focus on:

Collaborative planning

– Active collaboration between hospitals, social care, families and providers from the moment a patient is admitted to hospital is critical. A system that works for patients needs hospital teams, social care services, families and providers working and planning together as early as possible. Our survey showed that in 31% of cases, hospital discharge is not discussed until treatment nears completion.

System redesign 
– We need to adopt integrated system design and innovative care delivery models. To address the multi-faceted delays to patient flow we must bring together knowledge and skills from across the entire health and care sector. Discharge is everybody’s business.

Digital infrastructure 
– Building on the digital infrastructure enables more effective case management, better monitoring of complex cases and ensures adequate resource is available by addressing inefficiencies.  Digital technology also helps us manage and measure patient flow across the system.

Family involvement 
– We shouldn’t wait until patients are better before engaging with their family and next of kin. 92% of staff agreed that engaging with the patient’s family and carers early on makes a successful discharge.

With unrelenting pressures being felt across the system, accelerating patient flow is the immediate and glaring opportunity to create sustainability in NHS Wales and ultimately, protect patient outcomes.

We hope that Welsh health boards will clearly set out how they will address poor patient flow. Without this, we cannot hope to move patients efficiently in and out of hospital on a national scale.

Find out more about our work with front-line staff and senior NHS leaders to uncover the patient flow challenge, and how CHS Healthcare can help you to optimise patient flow, here.

About CHS’ calculator tool:

It has been well-documented in recent news and social media discussions that hospital trusts across the UK are facing significant challenges with patient flow, leading to many thousands of people spending unnecessary days in hospital.

We know how much a bed day costs the NHS, and we also have significant national data, showing the number of people who are medically optimised and the number of those discharged each day. Prior to COVID-19 we also had data on the days lost due to delayed transfer of care, however publishing of this data unfortunately ceased during the pandemic. What isn’t readily available, is data to show us how many bed days could be saved on a local level through timely discharge, and the financial savings that this would lead to.

To help hospital CEOs generate these figures, CHS Healthcare has created a calculator tool that trusts can use to see the efficiencies and savings that they could make with better discharge planning and a dedicated resource to do so.

Our calculator tool is based on an average 12 day wait for medically optimised patients to be discharged; a figure that we have derived from CHS Healthcare’s recent survey of hospital workers and social care staff.

To use the tool takes approximately 20 seconds; NHS stakeholders simply input the number of patients in their hospital that no longer meet the criteria to reside, followed by their average time from patients becoming medically optimised to when they are actually discharged.

Based on simple multiplication, the calculator tool will output the number of bed days that could be saved, as well the financial saving attached to that figure (based on CHS Healthcare’s minimum KPI requirement of time from referral to discharge and an average of £400 per bed day)

An Example;

We inputted the national NHS statistics for June; across the month, an average 21,148 patients resided in hospital each day, no longer meeting the criteria to reside and as our survey shows, it takes an average 12 days to discharge once the patient is medically optimised.

Using the calculator, we can estimate that 29,607 bed days would have been saved had 20% of these patients been referred to CHS Healthcare, with a financial saving of more than £11 million pounds.

We hope this insightful tool will enable NHS stakeholders to view a tangible representation of how many bed days could be saved by ensuring timely discharge, helping to inform strategy and planning, and ultimately positively affect patient flow throughout their trust.

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