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Gaining control of A&E

By improving efforts to understand and take control of it’s supply chain, the NHS will be able to simultaneously reduce its expenditure on temporary staff and improve the patient experience in A&E.

Manageing capacity and demand is key to achieving access targets

Earlier in the month, the BBC published its findings from a freedom of information request it made into spending by NHS Trusts on Locums and agency staff. The focus of the FOI request was on the numbers of temporary staff used to fill the senior posts in A&E. The results were startling; a total cost to the NHS of £120m, and one NHS Trust’s A&E department filling Senior Registrar and Consultant level vacancies with 69% locum employees. In the same BBC article, a consultant from a Trust in the North West then went on record to state that there were some months of the year where he'd not seen a single patient because he "had so much admin to do" in sourcing staff for the department. In all likelihood, this would mean he had to backfill his own role with yet another locum.

A&E is not alone in being dependant upon temporary staff. We see Trusts across all care settings striving to ensure the quality of care remains at its highest by bringing locums in to provide support. There are two key questions that this approach to staffing raises; firstly how well is capacity being matched to demand within the Trust as a whole, and secondly is the Trust in control of their approach to using external support?

At Unipart we have learned over many years the importance of being able to identify a root cause from a symptom. By clearly defining and understanding the supply chain involved in our service delivery to customers, and by equipping our team members with the capability to systematically solve problems, it is possible to rapidly determine where the real issues lie, and take remedial action.

The pressures faced by A&E departments can be viewed in a similar way when analysed as part of a system. Their pressures are a symptom of a wider cause and whilst it is impossible to predict the precise number of patients walking through the door of A&E at any one time, it is possible to make a prediction that is informed. To do so requires collaboration and supplier management, and the first step is to use the information available from Social Care, Ambulance Trusts, the GP community and the Hospital itself. These same organisations must then be comprehensively involved in helping to manage patient flow.

Unipart's industry experience of managing globally complex supply chains was key to the success of our partnership with the team at Sherwood Forest Hospitals NHS Foundation Trust. By viewing A&E as part of a system in a supply chain, we were able to help Sherwood Forest reduce its A&E treatment times by 57% and ensure adherence to the four hour wait target, with activity 21% above the Trusts original plan and a 72% reduction in cost. This didn't happen by spending significant amounts of time working in A&E. Instead, it was achieved by engaging and involving the relevant stakeholders who had the right information to hand as well as the autonomy to make decisions on managing patient flow throughout the Trust as a whole.

The element of ownership and autonomy is key to the long-term success of managing patient flow and gaining control over spend on external support. It is often the case that those in the NHS with budget responsibility do not have clarity around what they have available to spend at any given moment. When combined with uncertainty over the available capacity to service demand, it becomes hard not to take the path of least resistance and bring in external support.

The right people must be engaged in the process, provided with the necessary information at the right time and they must be assigned clear ownership. It will then be possible to take control over the decision making process involved in the management of patient flow, and ensure that those decisions are not being made in isolation. It will also ensure that money spent on external support will result in a long-term sustainable solution, rather than acting as a sticking plaster on a problem that will simply come back time and time again.

The Unipart Way: performance improvement that sustains

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