By James Maxwell
We’re now well into autumn and looking ahead to another challenging winter for the NHS.
One thing that stands out about this winter is that by the end of it (March 2020) NHS trusts should have realised the national ambition announced by the Secretary of State in 2018 to lower bed occupancy in hospitals by reducing the number of long-stay patients (21 days or more) by 40% against a 2017/18 baseline.
As our recent research revealed, trusts are struggling to meet their targets around reducing super stranded patients with 90% of them way off the initial 25% target, let alone the 40% expected by March 2020.
Over the last month, the government has made a flurry of health-related announcements. What’s interesting about these is that many have felt slightly old fashioned and about the infrastructure rather than the patient:
- Spending £2.7bn on building hospitals
- Keeping bed numbers steady (and increasing bed numbers)
- Creating an investigations Arm’s-Length Bodies (ALB)
At the same time long promised plans for social care reform remain stubbornly vague.
While the recent announcements may reassure people that the health system is in good shape and money is being spent on visible elements of the system, the picture at the back door is very different. The health system is increasingly dynamic and solving challenges like reducing the number of older people who are in hospital when they are medically fit for discharge is a team sport, which needs participation from across the sector. At its heart it’s a problem solved by focussing on the patient, especially bearing in mind the negative impact on mental and physical health of a long stay in hospital.
The ‘Where best next’ campaign from NHS England and NHS Improvement outlines five key principles for supporting patients medically ready out of hospital and into care. One of these principles is centered on involving the patient and family in decision making. This is hugely important but often overlooked – we know that dedicated family liaison including after hours and weekend support makes a direct impact on how quickly patients can be helped into care. With our support The Hillingdon Hospitals NHS Foundation Trust was able to move 20 super stranded patients into care within 7.5 days.
Making sure resources are dedicated to the backdoor is the right thing to do for patients and their families, and will help the existing capacity in hospitals to be used for patients who need those beds and care.