Winter is coming…

Each year, as the nights draw in and the weather worsens, increased pressures on the country’s health service push it almost to breaking point. A combination of staffing challenges, demand and capacity imbalances, poor patient flow and other local factors impact the NHS’ ability to deliver. Never was this more evident than last year, when the health service experienced a winter crisis that prompted the Government to allocate a record £700m to alleviate the pressure.

That said, whilst winter pressures are predictable the situation appears to be worsening each year, and it will be the same in 2016/17 if hospitals and their local health systems are unable to break the cycle. Indeed there appears to be a growing consensus across system leaders and political parties of all persuasions that funding injections are no longer the only response required to support healthcare organisations experiencing such pressure.

In order to weather the winter months, NHS organisations must prepare early – easier said than done. Whilst building and maintaining resilience across their systems for this winter, organisations can learn the lessons to ensure they are best prepared for delivery next winter.

Clearly, this is not straight forward, and there are no quick fixes. However, there are three key steps that health economies can take to support sustainable performance improvement across all their organisations.

The first step is to reframe demand and capacity planning. Demand and capacity analyses are undertaken as part of the annual planning round, but these plans are typically focused on individual acute trusts and based on historic values. Taking a system-wide approach, there is an opportunity to broaden demand and capacity planning to cover the entirety of the emergency care pathway – recognising that hospital pressures can be alleviated by understanding all pressure points, not just those within the acute setting itself.

The second key approach is to support continuous improvements in patient flow through the hospital. During the summer months, and without the intense pressure seen in winter, pressure points are often left undiscovered, and therefore opportunities are missed to address potential break points. By identifying pinch points earlier, and supporting improvements in patient flow prior to winter, prolonged periods of under performance can be avoided.

Finally, to ensure a sustained performance, it is vital to strengthen operational management and governance. System Resilience Groups (SRGs) are the nationally prescribed structures responsible for strengthening delivery performance. There is a real opportunity for SRGs to become increasingly effective by managing operational pressures in real time. To do so, SRGs can take the opportunity to review their governance and consider establishing operational sub-groups that have delegated authority to proactively manage winter pressures. They could also agree and monitor key performance indicators (KPIs) across the whole system in real time, to help identify and address specific challenges.

Clearly, our NHS is under significant and growing pressure for all the reasons we understand: ageing populations, growing costs, rising public expectations, and so on. There is no ‘silver bullet’ and creating time to identify ways of alleviating this pressure is difficult. However, at a time when short-term funding increases are increasingly recognised as not being the ‘answer’, a focus on longer-term solutions is essential.

Richard Jones, Partner, Moorhouse

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