The Health Systems Patient Flow Summit 2023 brought together NHS leaders from over 110 organisations to collectively address the patient flow challenges currently facing the NHS at large.
Those in attendance work across different geographies and different environments, but face very similar problems.
"We still have a huge problem of hospital discharge,’ notes Ian Smith, Chairman of Surrey Heartlands ICB. "We hit a winter crisis every year, and it is getting increasingly urgent with an ageing population that we crack this problem.’ Crisis management is a seemingly constant state for the NHS; shifting from this reactive state to a proactive one is at the heart of today’s summit.
A System Under StrainChanging Our Crisis Culture
Sir Jim Mackey - CEO Northumbria Healthcare NHS Foundation Trust - reminded attendees that our problems didn’t start in 2020. A steady period of decline was already well underway before the pandemic began.
Great plans and goals are often laid out, but delivering the proposed outcomes remains challenging. The NHS is a complex multifaceted system with many players, making change far from simple.
In order to address the challenges and cultures that create these problems every year, the NHS must look at the underlying assumptions and mindsets of the key players and groups in this arena. Unless these challenges are understood and addressed, the NHS risks stumbling from crisis to crisis, year on year.
The NHS is an excellent crisis management organisation - arguably one of the best in the world - but Ian Smith wonders whether that crisis culture could be hindering long-term change.
The handling of the pandemic was heroic, and the way the NHS scrambles every year to solve the winter crisis is impressive. However, this constant firefighting is unsustainable and means that long-term challenges can go unaddressed.
As a whole, the NHS must ensure that it is not addressing short-term challenges at the expense of durable long-term solutions. In the long term, processes need to be engineered so that the NHS has an operating model that solves these problems once and for all.
Understanding the Flow Challenge
When addressing the issues facing the NHS, a key challenge is balancing the national overview with the challenges facing specific specialties. Events like this summit are an essential part of bringing together various specialties to address challenges that are universal across the NHS and identify challenges that may not be quite as unique as we think.
Variation between specialties and regions is undeniable, making a national approach challenging. However, focusing on too small a scale or one specific area of the NHS neglects the joined-up realities of care delivery - for example, solving discharge is not just a question of getting discharge right.
Ian Smith noted that, while social care plays an essential role in discharge, providers are almost never at the table when we discuss the healthcare system. From a workforce perspective, attempting to formally separate things such as urgent and elective care is challenging.
One key issue that Sir Jim highlighted is that a massive proportion of outpatient capacity is used to see people who are already on a defined pathway or under a treatment plan. The NHS must take a different approach to avoid both the disturbance this causes to patients' lives and the vast number of appointments that patients do not attend. Transitioning to a patient-initiated follow-up model can help alleviate this strain, but this change is only a small part of the puzzle. And, as always, it is much easier said than done.
List size is stabilising, but it has settled at an alarmingly high figure: over 7 million people currently sit on the elective waiting list. While Sir Jim would have liked to reveal a single perfect solution, the reality is that ‘it’s nearly all about good data, good clinicians and managers sitting down together, ploughing through data, and doing the hard work.’
The level of understanding and visibility of waiting lists currently remains poor, and this carries over into the media and public understanding, increasing patients’ understandable frustration with wait times.
Keynote speeches held at the Health Systems Patient Flow Summit highlighted the challenges and opportunities surrounding patient flow within healthcare systems.
As an opportunity for exchanging knowledge, sharing best practices, and fostering collaboration to enhance the efficiency, quality, and patient experience across the continuum of care, Sir Jim Mackey urged attendees to utilise the summit to approach the future of flow with ‘confidence’.