Dr Gabrielle Silver
CEO CHS Healthcare
Hospital discharge and capacity in the community is becoming an increasingly important issue, with the pressure to keep patient flow moving out of hospital and into the community. Today (7 Jan) on Radio 4 we heard from Chris Hopson, CEO of NHS Providers: ‘Hospitals beds are full, community beds are full and community at home services are also full’. The HSJ also reported on Tuesday (5 Jan):
A spring-style policy intervention to require discharges to be arranged in hours, rather than days, with no dithering over cost, may be required. But where will the staff come from to achieve this? And where can individuals go if they are not ready for home? How do we ensure care homes are not compromised with COVID, and how to enact new policies with the independent care sector setting its own rules?
This highlights how the challenge of staffing has been drawn into sharp focus through this pandemic. I believe we need to think more laterally about how we support aspects of health and care. Hospital discharge is, at its heart, a practical process. Once a patient is medically optimised to leave hospital the clinical job to a large extent ceases. This is why I am not convinced that the issue is staffing per se. I think the issue is how hospital discharge is resourced day-to-day and a lack of effective management tools in the NHS.
Managing the discharge to assess (D2A) pathway is about having strong relationships with local care providers, working closely with families to make sure they are reassured and confident about next steps for their loved one and actively managing each individual’s care timetable to move rehabilitation along.
I see our team’s job as ‘keeping plates spinning’. On a practical level, this is making sure appointments such as occupational therapy take place on time and that any follow-up, like ordering equipment is managed. This detailed hand holding of each patient’s needs means that their care actively continues, and they are able to move quickly back home with support, or into a long-term bed with appropriate funding. And their original bed back goes into circulation for another patient who needs it.
A key element of this is the real-time tracking of patients and their care. We use a digital platform to ensure information about next steps are visible and available at any time to the team involved in their care. These tracking systems are increasingly important within acute trusts to monitor flow across multiple data feeds. We use the same logic but apply it to the discharge and rehabilitation of patients. Gone are the days when care is held up because an excel spreadsheet was not updated or someone forgot to pass a message on or record an appointment.
Technology, deployed correctly, guides staff so they are doing the exact right tasks at the right time to ensure an outcome – in this case patient flow.
As unpredictable as this pandemic has been, we know that pressure on hospital beds will continue for some time to come and that people will need to move promptly from acute services and will require substantial care in the community. The NHS has a huge amount of work to do and where we can provide support and keep things moving, we want to do so.
The workforce solution for many of the current challenges does exist. We must think beyond the NHS for solutions to non-clinical challenges. Where we look to the NHS as the only viable option, we do patients and even people waiting for vaccines a disservice. We need to be proactive and pragmatic – let the NHS get on with the complex and urgent work they need to do and are best placed to do.
When I look ahead past this pandemic and the long-term workforce challenge, I can see that there will be jobs created around health and care which have not even been considered yet. Jobs which we have seen as ‘clinical’ will be broken down and rebuilt as operational support in a whole range of new guises. This will benefit hugely not just the NHS but a completely altered labour market. Data and technology will play a huge role shaping these new job roles. In the meantime lets wrap our support around the NHS at this testing time – we all have a role to play.