August 27, 2019

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Unlocking the back door to get patients the care they need

By Dr Gabrielle Silver

When you think of a health service at full stretch over winter you immediately imagine a Casualty-esque scene, with ambulances queuing outside a jam-packed A&E and Charlie Fairhead running around like a headless chicken trying to manage the chaos. What you don’t visualise is elderly people no longer needing hospital care sat in beds on wards up and down the country. This is, however, the stark reality we are faced with in the NHS, which must be addressed as an urgent priority if any sustained improvements are to be made to patient flow.

This call goes largely unheard and ignored. The recent announcement by our new Prime Minister, Boris Johnson, of a £1.8 billion NHS cash injection to help improve patient care is evidence of this: while it is fantastic that patient flow improvements in Boston, Stoke and Wirral are included within a raft of upgrades outlined, these all relate to urgent and emergency care or bed capacity and unfortunately don’t tackle the critical issue at the back door.

It is not a complicated concept to understand – if we don’t fix timely discharge, we won’t be able fix some of the biggest problems affecting our hospitals such as cancelled operations and long waits in A&E and for planned surgery. If you move patients through the hospital system effectively and into appropriate care settings when they are fit to do so, there will be more beds for people who need them. This results in less pressure on frontline staff and enables them to care for more patients.

The independent research we commissioned illustrates the impact delayed discharge of super stranded patients has on patient flow through the front door. It has revealed that those hospitals missing their super stranded target between January and March 2019 could have undertaken a staggering 17,715 more operations were other contributing factors not in effect.

This isn’t even the full picture. The toll on elderly people of being in hospital for long periods of time is of great concern. NHS Improvement has recorded that 35% of 70-year-old patients experience functional decline during hospital admission in comparison with their pre-illness baseline; for people over 90, this increases to 65%.

In February this year the British Red Cross published a report into patients’ experience of discharge from hospital and their transition from hospital to home. Unsurprisingly, their research found a lack of consistent care provision and that people’s needs are still not being met.

I couldn’t agree more with their call for the implementation of a personalised approach to a person’s journey through hospital and back home or into residential care.

Such an approach is one that we at CHS Healthcare wholeheartedly believe in. We know it isn’t realistic to expect NHS frontline staff to continue to deliver against their clinical demands as well as spend intensive time liaising between families and local care services. Our purpose is to support the NHS getting to know what matters most to patients and their families. We also work closely with local care services to understand real-time availability and make sure referrals are detailed and precise to support efficient placement and reduce readmissions.

With the challenges of winter and flu season fast approaching, and with the NHS on or about at capacity all year round there are few obvious and easily actionable levers which can be used to support patient flow. Giving attention to super stranded patients now – before winter and flu hits – is the right thing to do for patients. It will also release capacity for planned activity as well as create capacity for patients who need clinical care in the future.
Return to the super stranded dashboard

As originally seen on LinkedIn

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