News and Comment

It may be spring, but in the NHS planning needs to be done now to avoid winter pressures next year

Friday 7 March 2014

With the trees beginning to bud and flowers sprouting in our gardens, it seems like a strange time to talk about averting the NHS winter crisis. But as recent news coverage has shown, the possibility of an urgent care crisis in hospitals in 2015 necessitates that decisive take action taken now.

Earlier this week none other than Professor Keith Willett, director for acute care at NHS England warned that in their current state urgent care services are “unsustainable.” This follows a warning from a former health advisor to the government, Paul Corrigan, who predicted that: “We need to stop about one in seven of emergency admission from April 2015. If we don’t the NHS runs out of money sometime in early February 2016.”

So good planning needs to be implemented now, if it’s not already underway, but what does good planning look like? Firstly, managers must resist the temptation to see this problem as something solely for the acute sector to solve. As Sir Bruce Keogh made clear in his report:

“We must provide highly responsive urgent care services outside of hospital so people no longer choose to queue in A&E. This will mean providing faster and consistent same-day, every-day access to general practitioners, primary care and community services such as local mental health teams and community nurses for patients with urgent care needs. It will also mean harnessing the skills, experience and accessibility of a range of healthcare professionals including community pharmacists and ambulance paramedics.”

Secondly, there needs to be a realisation that good urgent care management is truly about a whole systems response that involves GPs, Trusts, social care providers, and patient groups working together to find ways to reduce system pressures. This requires a two-pronged approach: both looking at ‘entry’ into the system – A&E, urgent care centres, out of hours – and the exit paths in the form of discharge and care for patients leaving hospital.

Patient education is also a crucial component to consider when drawing up plans. Patients in Control – the moniker for a whole suite of initiatives that try to increase patient involvement and control over decisions – offers a way into addressing the lack of patient awareness and knowledge about how and when to access urgent care. The initiative is intended to influence the commissioning of services so that they support treatment and avoidance of urgent care in communities. The need for this type of action should not be underestimated, with the BBC recently reporting that one fifth of patients admit to knowingly misusing A&E units. The Patient in Control programme, shared decision making, self-care and patient information and social marketing are all essential aspects of any plan that will influence demand on urgent care.

With all of these agencies and individuals involved in the solution, the next pressing question must be how best do you coordinate their involvement? Collaboration between multiple partners and patients can lead to co-designed care pathways which alleviate bottlenecks and reduce unnecessary admission to hospitals, but these kinds of outcomes don’t just happen by magic. OPM recently encountered this situation in Bath, where we worked with the partners involved to design a behavioural simulation process which road tested A&E plans in the face of realistic scenarios and pressures on the system. You can find out more about how the work we did with the local CCG helped to improve performance during the most challenging of periods in this article we wrote for the Health Service Journal.

Later this month OPM will also be hosting a seminar on patient and public engagement where we look forward to questions and suggestions about how engagement can contribute to planning on urgent care.

In the meantime enjoy the sunshine, but please remember, winter is just around the corner.