The increase in cancelled surgical procedures highlights that whilst new models of system-wide integrated care are vital to the long term sustainability of the NHS, there remains a pressing need to resolve integration issues at a local level. Taking a broad view within existing care settings will be key to contextualising and enabling progress toward the five year forward view vision of triple integration.
The Guardian and The Times recently reported that in the last three months of 2014 the NHS cancelled 19,471 planned operations as it struggled to cope with A&E demands and bed shortages. Planned “elective” procedures were delayed 3,114 times in the first two weeks of December 2014 alone. This represents a rise of almost 50% on the same period in 2012. Further evidence that the NHS system is appearing to strain under the pressure can be witnessed in the doubling of the number of patients waiting on trolleys for up to 12 hours before being admitted to a ward; rising from 7,634 at the start of December 2013 to 17,886 by December 2014.
Possible causes have been widely posed. The Royal College of Surgeons (RCS) for instance suggest that gaps in community care mean that too many people are visiting casualty wards unnecessarily and are then staying in hospital; i.e. a system-wide integration problem. Yet in the same article (The Times 28/12/2014) Shafi Ahmed, a cancer surgeon and RCS spokesman presented a view that was focussed on the need to manage the number of available beds more efficiently; this being an example of a localised system integration issue.
Speaking at an Institute of Healthcare Management event this month, Simon Stevens continued to emphasise the need for system-wide integration as set out in the five year forward view. However a helpful caveat has begun to creep into the overarching rhetoric of the “triple integration” vision, and that is the need to improve integration and flow within the existing organisational boundaries of the system.
Unipart often finds when working with NHS Trusts that the benefits of taking an integrated and broader view within existing organisational boundaries have often yet to be fully realised. Understanding and then communicating the impact that just one limiting step can have on the wider operational system at the Trust can be an incredibly powerful way of moving toward a collaborative culture. Unipart’s systematic approach to solving problems has been designed to encourage wider participation, and will often include representatives from both our customer community and our supplier base. By encouraging the participation of these stakeholders, the chances of finding the genuine root cause increases, and so does the likelihood of delivering the optimum solution.
It is undeniably crucial to manage the number of beds more efficiently. Yet the efficiency of the theatre administration processes will significantly impact how efficient the wards need to be i.e. without collaboration the wards may only work efficiently based on assumed demand from the theatres. In order for the operational system to reach its full potential, and for the local system to be as efficient and effective as possible, the separate components must work harmoniously.
If a problem is identified with ward efficiency then the first step for the Trust is to gather the relevant meaningful data. From a Supply Chain perspective, it can be helpful to view Hospital beds as a type of storage. As such it is important to understand the way in which the capacity of this storage is being filled and used. The cancelled surgical procedures issue highlights the importance of gathering data on both bed capacity and in that case theatre usage. Obtaining this data means the Trust can begin to understand how patients are being allocated surgical procedures. By then transparently sharing the data and working collaboratively with those staff tasked with bed management, it will be possible to spot emerging trends on the types of procedure being booked, the impact this has on the way beds are filled, and any emerging adverse impacts this has to the patient experience.
To succeed this ‘broader view’ requires a commitment to engage and encourage wider participation in solving the problem. Team members must be supported by a leadership who enable the relevant people to come together and ensure that they are equipped with the skills required to deliver the solution.
Over the next five years it will be very easy for NHS Trusts to become increasingly distracted by the day to day pressures of delivery coupled with a need to get involved in new models of integrated system wide care. However by taking a broader view toward becoming more integrated at a local level, getting the basics in place and then using this as the catalyst to become more collaborative across organisational boundaries, the partnerships advocated by Simon Stevens to achieve the “triple integration” vision will be built on firmer foundations.