The PSC news-insights: entry

17/05/2020

Beyond COVID-19 – what next for urgent care?

A round-up of the key themes emerging at The PSC's Urgent Care Roundtable event in February - in which senior NHS senior leaders discussed how healthcare systems can change to confidently handle future urgent care demand

In February 2020, we invited senior leaders from across the NHS to our Urgent Care Roundtable.

At the event, guests shared views on how we can move from “just coping with urgent care pressures” to “handling them confidently” – a discussion that becomes ever more relevant as we start to design long-term strategies to deal with COVID-19.

Beyond COVID-19 – what next for urgent care?

Through the course of the discussion, attendees rounded on four key themes:

  1. A bold new model of care for older people
  2. A shift in culture required from clinical teams
  3. Evidence-based identification of the key few local issues in each system
  4. Capacities can be increased via system-wide collaboration

Read our summary below to find out more about the group’s conclusions.

 

Moving from ‘just coping’ to ‘confidently handling’ pressures in urgent care

1. A bold new model of care is needed for our population

A clear driver of urgent care performance is bed capacity and a steady downward trend in system bed numbers over the past 25 years, against rising demand, has taken its toll on patient flow. Announcements from the NHS national team this year have encouraged trusts to keep more beds open beyond winter and this will help.

However, to allow the NHS to handle the urgent care problem and not just cope with it, guests concluded that a more fundamental change was needed. In fact, a bold new model of care would be required to address difficult and long-standing challenges.

The discussion highlighted that many healthcare processes, such as face-to-face outpatient clinics, ward-rounds, specialty reviews of patients in ED, or bed meetings have been around for decades and are probably not fit for purpose in today’s high-demand, high-standard, low-cost world. A future model of care is required, starting with a re-thinking of the role of the NHS in delivering care. Key considerations will be:

  • Models built around patient-needs, reflecting the ageing population
  • The balance of risk being spread across all organisations, rather than sitting at the front door of ED
  • Staff skills aligned efficiently with the outcome requirements of the service
  • Funding being targeted in a way that generates capacity in the right places

2. Evidence-based culture change will be critical for success

Underlying any potential change lies the need for a significant cultural shift. Breaking-down well-established patterns and replacing with new, unfamiliar routines will require strong leadership and a new set of behaviours.

Take, for example, how a team of specialists treat an elderly patient with a range of illnesses. Delays are likely at the start of the patient’s urgent care journey relating to indecision around which team should take responsibility; further delays build as the patient’s conditions are treated in series, rather than in parallel; and finally a decline in the patient’s strength as they spend ever longer in hospital, reduces the speed of recovery.

In this case, a new model of care, appealing to very different clinical priorities (e.g. prioritising length of stay and holistic care, rather than condition-specific treatment), will have to be designed, developed and rolled-out across the NHS. Clinical leaders, rather than operational managers, are therefore essential to designing and leading this cultural shift.

In terms of starting this change, our clinicians in the room admitted that they love data and evidence relating to patient outcomes (rather than patient flow, or performance) and that by re-framing the problem in these terms more clinicians will be brought onboard with these ideas.

3. There are 4-5 silver bullets that exist in each system

Fundamental changes to models of care and culture will take time, resource and strong leadership. In the meantime, there are immediate solutions at a more local level. The group concluded that just adding more beds isn’t the ‘silver bullet’ – those extra beds will need doctors, nurses, porters, radiologists, therapists, pathologists, physiotherapists, community nurses, social care staff and pharmacists to provide care for the patient.

When we think of capacity, we should consider the whole service and not just the bed. In an urgent care system, any one of these many variables could be at play, meaning that there are potentially dozens of problems to solve.

However, in any given system, there are probably only four or five localised key bottlenecks that need to be tackled to unlock flow. And, with a data-driven approach, these can be identified and prioritised. There may not be one silver bullet, but it is likely there are only 4 or 5!

4. Capacities can be increased via system-wide strategies

To support these national and local changes, capacity needs to be grown in the right places, again based on robust demand and capacity data. Leaders from across the system need to come together and collaborate to generate workable strategies. Urgent care issues may be felt most strongly in the hospital, but solutions exist across the whole urgent care system.

The group felt that although the integrated care agenda was bringing leaders together more often, joined-up thinking was needed to handle urgent care pressure confidently.

Finally, thank you to our guests for their time, wisdom and insight at our roundtable event.

 

For further details on this, or our future events, please get in touch with Chris Bradley.

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