Industrial action continued across the NHS in July, including the first consultants' strike in a decade. Consultants’ work cannot be replaced by other NHS colleagues, meaning that over the 48 hours of striking between 20 and 21 July a total of 65,557 appointments and procedures had to be rescheduled.
Owing to the last 8 months of industrial action, the cumulative total of rescheduled appointments and procedures across the NHS now stands at a staggering 765,000. NHS National Medical Director Professor Sir Stephen Powis commented that, with each round of industrial action, ‘it’s becoming even more challenging to get services back on track’.
Choosing to strike is not a decision made lightly in the NHS. While consultants are acutely aware of the impact this industrial action will have on patients, one consultant described ‘this as a step we need to take to protect the NHS [and] stop the erosion of the workforce.’
Consultants are campaigning for pay rises in line with inflation, not full pay restoration. If a pay deal is not agreed soon, further strikes are planned for late August.
Care traffic control
While it may feel like the British summer has barely begun, the NHS is already bracing for the winter. New measures set out at the NHS England board meeting in Birmingham yesterday aim to ‘boost capacity and resilience across the NHS as well as building on the recent improvements in ambulance response times and A&E performance.’
A key part of this capacity-boosting plan is the nationwide rollout of ‘care traffic control’ centres, which will ‘provide one stop for staff to locate and coordinate the best and quickest discharge options for patients – either at home or into social or community care.’ Utilising electronic patient records and bringing together teams from across NHS, social care, housing, and voluntary services, these care traffic control centres will streamline the process of determining - and implementing - the best possible discharge pathway for each individual patient.
It is anticipated that ‘a third of patients could be discharged using this model by December.’
Getting this in place and ironing out the creases before the winter strain builds is crucial, especially with predictions suggesting that this may be another year of higher-than-usual levels of respiratory illness. ‘Australia, whose activity often predicts what the NHS in England is likely to see in winter, is experiencing one of the biggest flu seasons on record’.
As Miriam Deakin, director of policy and research at NHS Providers, said, it ‘is never too early to start planning and preparing for winter in the NHS.’
Discharge delay causes revealed
For the first time, figures have been published revealing the precise causes of delayed discharges. The figures ‘show that, among patients in England in June who had been in hospital at least 14 days since their arrival, an average of 1,791 a day were unable to be discharged due the lack of a bed in a residential or nursing home that was likely to be a permanent placement, while 1,727 a day were waiting for a rehabilitation bed in a community hospital or a similar setting.’
Some discharge delays were due to issues within hospitals themselves; last month, an average of 390 patients per day were delayed due to waiting for their discharge summary to be prepared. Other major contributors were waits for community equipment and adaptations to housing (an average of 234 patients per day), a therapy decision to discharge (421 patients), for transport (98 patients) and for medicines to take home (44 patients).
While some of the above issues are seemingly frustrating in their simplicity (especially for patients waiting to go home), a lot of cases are not nearly as clear cut. For example, delays are often caused by ‘a disagreement between a patient, their family and the NHS about a plan to discharge; and when a patient is homeless or has no place to be discharged to.’
When beds are filled by patients who no longer need them, this has a significant knock-on effect on the rest of the system. Increased investment and improved communication between the NHS and community service providers will form an essential part of overcoming these discharge delays and successfully bracing for the challenges ahead.
Managing ill health in an ageing population
A new study from The Health Foundation predicts that 2.5 million more people in England will be living with major illnesses by 2040. This projection is ‘an increase of 37%, nine times the rate at which the working age population (20-69 year-olds) is expected to grow over the same period (4%).’
This will include ‘a rise of more than 30% in the number of people living with conditions such as cancer, diabetes and kidney disease. Overall, the number of people living with major disease is set to increase from almost 1 in 6 of the adult population in 2019, to nearly 1 in 5 by 2040’. This will have a significant impact on the NHS and public finances as a whole.
Much of the projected growth is in ‘conditions such as anxiety and depression, chronic pain and diabetes, which are predominantly managed outside hospitals in primary care and the community.’ This highlights the need for investment in community-based services and the importance of new innovative ways of working such as care traffic control centres.
With 1 in 5 people projected to be living with major illness in less than two decades’ time, the impact will spread far beyond healthcare, warns Anita Charlesworth, Director of the REAL Centre. An ageing population already presents workforce challenges, and that is before you take into account the fact that 20% of the projected increase in major illness will be in the working age population.
These figures are not set in stone and investment - of both time and money - in preventative care will play a crucial role in determining whether these predictions are accurate. Recruiting and training new healthcare staff - and offering enough pay to retain them - is becoming more important than ever.
Virtual wards expand to cover children
Virtual wards enable NHS staff to provide round-the-clock care to patients in the comfort of their own homes and have successfully been used to treat 160,000 adult patients since April last year. A new expansion of this service will soon mean that tens of thousands of children will be able to receive hospital-level care at home:
‘The hospital at home service – already the largest of its kind in the world – will expand to cover children in every region of England from this month after successfully treating more than 6,400 children over the last year.’
Being treated at home can have a significant positive impact on patient outcomes as well as freeing up bed capacity for those who need them most. Remote care is especially beneficial for children as it means they can remain in familiar comforting surroundings and do not need to be separated from their families, providing peace of mind for all involved.
The NHS turned 75 this month, a substantial milestone and a chance to reflect on the NHS’s past successes and plan for its future. To celebrate NHS75, the Distilled Post team had the opportunity to sit down with Sir Jim Mackey to discuss how we can make the NHS more sustainable, modernised, and brought in line with the way we live the rest of our lives.
The significant challenges the NHS has faced over the past 75 years - and the successes it has had despite them - leave many of us cautious yet optimistic about the 75 years ahead. Sir Jim Mackey for one is ‘absolutely convinced the NHS will still be a huge success in 75 years time, it'll just be something that we can’t recognise now.’