Meeting A&E targets 

Labour’s Wes Streeting has promised to hit the 4-hour A&E target within Labour’s first parliamentary term. However, some people believe that this is no longer realistic and it will be a tough ask at the very least. Making progress against this target will require Labour to improve social care and discharge processes to improve flow and free up beds, and to accelerate admission-avoidance programmes such as Same Day Emergency Care (SDEC). 

Improving discharge processes to free up beds 

Our internal analysis, combining national discharge delays datasets with the cost of bed days, estimates that excess bed days in acute and community hospitals cost the NHS £1.9 billion every year. Tackling discharge delays therefore not only frees up beds and improves flow through hospitals (thereby reducing A&E wait times), but also provides significant savings for Trusts.  

The PSC have supported many healthcare systems to improve discharge. We’ve previously outlined some of the key principles of successful discharge programmes, including the need for patient and carer-led design, joint working between health and social care providers, and a joint vision supported by joint-governance. These principles have been used in action in South London and Maudsley NHS Foundation Trust, leading to a 53% reduction in the number of patients who are medically fit for discharge but are still on the wards.  

More recently, The PSC worked with health and social care partners in Hull and the East Riding of Yorkshire to design, test, and deliver a new discharge and intermediate care model that enables as many patients as possible to be discharged to the right place, at the right time, with the care and support they need in the community to recover. In the short-term, the Transformation Programme has resulted in a significant improvement in discharge flow from hospital (for example, supported discharge flow has increased by ~20% from Hull University Teaching Hospitals NHS Trust), while in the long-term Hull and East Riding have been set-up to deliver an ambitious new discharge model that will deliver benefits to both patients and health and care services.  

If you are interested in how we can support you to improve flow through your hospital or to evaluate and transform discharge pathways, please contact chris.bradley@thepsc.co.uk. We will also be hosting a virtual roundtable on improving discharge processes on 4th September - stay tuned for more information! 

Technology within the NHS 

With 22% of doctors reflecting that their IT systems are not suitable for their needs, it is no surprise that harnessing the power of technology within the NHS is a priority for the Labour government. We have worked on several digital and data projects within the NHS, and have also outlined how investing in digital inclusion could deliver £899m of savings for the NHS, through improved access to health literacy and healthcare advice, and a subsequent reduction in the number of GP appointments, as well as potentially improving health outcomes.  

Making the most of the NHS App 

As part of investing in technology, Labour have made a commitment to “transform the NHS App” to put “patients in control of their own health to better manage their medicine, appointments, and health needs”.  

The PSC have been working closely to improve the NHS App for people in London through our support of the Universal Care Plan (UCP) Programme, hosted by NHS South West London on behalf of all London Integrated Care Boards (ICBs). To do this, we are engaging with clinicians and patients to co-develop the Role-Based Access Control specification which determines which fields a patient can view and edit within the NHS App. This will enable patients to input directly into their care plan and receive more personalised care, while also ensuring clinical and data security risks are managed. 

To find out more about this work, or our other digital offerings, please contact phil.buckley@thepsc.co.uk or fiona.jamieson@thepsc.co.uk 

Investing in the healthcare built environment 

In the 2019 election, the Conservative Party promised to build 40 new hospitals by 2030. While timings have slipped – with several NHP contracts that are currently out for tender now extending to 2035 – Labour have promised to honour this commitment. They have also pledged the return of the family doctor, emphasising that “excellent primary care is the key to earlier diagnosis”. Labour will deliver this by trialling Neighbourhood Health Centres, bringing together doctors, district nurses, physiotherapists and other existing community services into a single space.  

Developing estates that enable integration 

While the New Hospital Programme provides an opportunity for redevelopment of the acute state to deliver transformation of health and care, the purpose of this major capital investment is not just to improve buildings, but also to support and enable the transformation of the healthcare sector. New models of care in the acute setting cannot be developed in isolation – systems must consider how to develop coherent, integrated models of care across community and primary settings centred around population need. It is this thinking that led The PSC to codevelop, working in partnership with the Plymouth Local Care Partnership, a ‘Blueprint’ approach to designing estates that both meet population needs and enable integration of care.  

The Blueprint approach comprises four key steps: (1) Identifying the population need; (2) agreeing common principles for models of care; (3) developing estates master plan for key population cohorts; (4) identifying project cases and funding. To address the pressures faced by acute services in University Hospitals Plymouth, we focused on sub-localities within Plymouth instead of looking at needs across the entire city, enabling us to recognise the unique characteristics and needs of different neighbourhoods. 

The Plymouth Local Care Partnership (LCP) commented that “the Blueprint programme has transformed our approach to strategic estates planning in Plymouth. Our planning is, therefore, coordinated as a system, and targeted where it is most needed. This will provide us better value for money for our investment, and prevent the siloed, reactive approaches of the past.” The LCP no longer evaluates their estate based solely on its condition, utilisation, and cost. Instead, the estate is recognised as a critical enabler for service integration and delivery of care aligned to population needs.  The LCP is also better positioned to seize future funding opportunities by developing a strong case for change rooted in local needs and aligned with national policy. 

We’ve helped clients secure more than £1.5bn in estates investment since 2020. For further discussion on how The PSC can assist your healthcare system to develop strategic estate plans using the blueprint approach, please contact ellie.lane@thepsc.co.uk or joe.cruden@thepsc.co.uk. 

The PSC exists to make public services brilliant. We’re known for tackling the most complex challenges in the public sector, including an extensive track record in capital investment programmes. Speak to our team to find out more.