Winter resilience: Overcoming seasonal pressures to make winter business as usual
Every year, the NHS braces for an influx of demand. Often related to an increase in people experiencing acute respiratory illness and noroviruses, the very young and elderly are most at risk.
2022 proved particularly challenging for urgent and emergency care systems, which have already endured long-standing capacity issues. The average bed occupancy was 6.6% higher than 2021/22 and 21.1% higher than 2020/21. To anticipate the challenges ahead, the NHS started planning earlier, hoping to ease the struggles of healthcare workers facing the same issues year on year.
Released in January 2023, the urgent and emergency care recovery plan outlines NHS ambitions for tackling seasonal challenges. Keeping people out of hospital is a clear priority. Preventative healthcare and virtual wards will play a significant role in making this a reality, but what about cases where hospital admissions are unavoidable?
In the face of increased demand, patient discharge challenges and those suffering long-term health implications from COVID-19, the government released £200 million to boost NHS resilience and care this winter. £40 million of this has been earmarked to improve social care capacity and hospital discharge services.
Local authorities in the most challenged integrated care systems (ICS) have been invited to submit funding proposals, empowering them to target the most significant challenges to their urgent and emergency care services. The ability to identify and customise solutions to specific pain points is where ICSs can gain the most ground in the war against winter pressures.
Optimising ambulance handovers
Ambulance handover delays are a multifaceted problem. In most instances, they are not an ambulance issue but a whole-system one. This is usually a result of challenges elsewhere in the system, particularly with hospital capacity and patient flow.
The latest data on handover delays show that the percentage of handover times exceeding 60 minutes was seven times higher in July 2022 than in 2019. As Matthew’s story demonstrates, the stakes could not be higher in ensuring the system works as efficiently as possible.
A whole-system approach is needed to tackle ambulance handover delays, requiring greater investment in hospital capacity and patient flow. However, some trusts have successfully implemented solutions on the frontline to meet the rising demand of winter pressures.
Creating additional A&E capacity
Ambulance handover bays are designated areas, typically located near hospital A&E departments, where ambulance crews transfer patients to hospital care. These bays serve as a crucial interface between the pre-hospital emergency care provided by ambulance teams and the hospital’s healthcare services.
Cheshire-based EMS Healthcare has been a trusted partner of the NHS, Health Boards and private providers for over 15 years. It specialises in providing clinical teams with additional capacity whenever and wherever they need it.
EMS recently worked with Mid and South Essex NHS Foundation Trust to introduce a temporary ambulance handling unit in Southend University Hospital. After an initial consultation, the units were customised, implemented and operational within one week.
Positioned near Southend University Hospital’s A&E department, these units provided a safe environment for patients to undergo continuous monitoring and assessment by a clinical team while awaiting availability in the Emergency Department. This expedited patient handovers, allowing ambulance teams to respond to emergency calls more efficiently.
“The introduction of an ambulance handover unit at Southend hospital site will release more vehicles and crews for responding to emergencies. It will also help us meet the challenges of the coming winter months when we know demand will increase. When people call 999, the public expect the ambulance service to attend; units like this will help make sure that we can.”
Tom Abell, Chief Executive at East of England Ambulance Service NHS Trust (EEAST)
While these units are considered a temporary solution, the vision for ambulance handover bays extends beyond simple patient transfer. Rather than acting as another holding area, which will transfer the risk to the hospital but not decrease the risk for that patient, these bays can serve as a point of initiation for patient assessments and care delivery. Nurses and healthcare professionals stationed at these bays can promptly commence assessments and essential care procedures.
These bays not only expedite patient transfers but also kickstart the patient’s healthcare journey, enhancing the efficiency and effectiveness of the system. This proactive approach streamlines the care process and ensures patients receive timely attention, reducing the strain on A&E departments and improving overall patient outcomes.
“Partners from across the health and care system are working together, whether it be new services to support people who have fallen at home, more urgent care in the community and hospital at-home care. Every one of these initiatives will make a real impact on the ground – helping to relieve pressure on frontline staff as well as seeing patients quickly and directing them to where they can receive the best possible care.”
Dr Ronan Fenton, Medical Director for the Mid and South Essex Integrated Care System
Tackling A&E waiting times
A&E departments are often the busiest places in a hospital, handling a diverse range of patient cases. The challenge lies in delivering timely care while ensuring optimal resource allocation. A&E departments saw over 6.5 million attendances in June – August 2023, surpassing the previous record in 2019 by more than 20,000.
Operational targets set by the government aim to improve Urgent and Emergency care, including admitting, transferring, or discharging 76% of patients within four hours by March 2024. However, the Royal College of Emergency Medicine considers the 76% target unambitious. It warns that patients will continue to face long waits if this trend continues, potentially impacting ambulance response times further. In 2004, 98% of patients left A&E within four hours.
Performance below 75% is considered a significant patient safety risk, resulting in long waits in crowded A&E waiting rooms and worsening conditions before treatment. The Royal College of Emergency Medicine estimated long A&E wait times resulted in 23,000 excess deaths in 2022.
The median waiting time for A&E patients increased from 2 hours 9 minutes in May 2011 to 2 hours 54 minutes in December 2019 before nearly doubling to 5 hours 59 minutes in March 2023. Current data analysis by CHS Healthcare, part of Acacium Group, indicates that, based on current trends, NHS targets will not be met. By December 2023, only 66% of A&E attendances will meet the four-hour target, falling short of the 76% NHS goal.
Source: https://www.nuffieldtrust.org.uk/resource/a-e-waiting-times
Overcrowding, long waiting times, and resource mismanagement are common issues nationwide. While the challenges faced by A&E departments may be similar, the solutions can vary depending on patient demographics, geographic location, and existing infrastructure. Forward-looking providers are not only seeking to meet their targets but also learn from when they didn’t.
It’s widely recognised that ‘what gets measured, gets managed’, and just like collecting a patient’s vitals, clinical and operational directors must understand the symptoms to address their department’s problems. Fortunately, a wealth of existing data is at the trust’s fingertips, providing a valuable opportunity to enhance productivity, improve patient outcomes, and drive efficiency through data-driven insights.
Diagnosing the problem with A&E Consultancy services
Acacium Group’s A&E consultancy utilises the newly available Emergency Care Data Set (ECDS), a standardised dataset produced by every trust in the country. Comprehensive data analysis involves cleaning, processing, and modelling the data to create interactive dashboards that provide a holistic view of A&E department performance.
Reviewed and presented by experienced clinical and management consultants, Acacium Group’s experts provide actionable insights on how leaders can optimise resources and operations for a better patient experience. The former National Clinical Director for Emergency Care at NHS England, Professor Matthew Cooke, forms part of this team and has worked with trusts to identify quick wins and long-term solutions to their challenges, including;
- Patient arrivals and seasonality: Data analysis reveals when patients typically arrive by the hour, allowing hospitals to adjust staffing and resources accordingly. For instance, in this trust’s example, Mondays are often the busiest days, reflecting weekend cases that wait until the start of the workweek.
- Bottleneck identification: Data highlights bottlenecks, such as delays in discharging mental health patients at night. This knowledge enables hospitals to allocate resources and support more efficiently.
- Optimisation: Data insights reveal variations in productivity and efficiency. Hospitals can analyse days when they meet the four-hour A&E target and identify days when they don’t, uncovering productivity issues and staffing needs.
- Patient complexity: Data analysis helps hospitals understand the mix of patients, their conditions, and the complexity of cases. This information is crucial for resource allocation and optimising care.
“Having led winter planning work, I understand the complexities this involves. Good patient flow is the heartbeat of our healthcare system, and this starts at ‘the front door’. Ensuring an efficient ‘front door’ process is not just about managing demand; it’s about delivering timely and appropriate care when it’s most needed. This data empowers providers with knowledge and understanding of their system. It also provides the ability to identify and forecast trends in demand and design, and to implement and test bespoke solutions to meet that demand effectively.”
Matthew Cooke, Chief Medical Officer, Xyla Elective Care
Treating the cause of winter challenges
A&E consultancy services leverage data-led insights to create initiatives that enhance department efficiency and patient care. This offers the opportunity to develop bespoke solutions, allowing leaders to treat the symptoms (exceeding four-hour targets, adverse clinical events, staff burnout, delayed discharge) and address the cause of perennial winter challenges. Some of the initiatives suggested off the back of this trust data include;
- GP-led triage service: Hospitals can implement a GP-led triage and ambulatory service to address minor injuries and ailments, reducing the burden on A&E departments during peak times.
- Mental health support team: To address delays caused by mental health patients arriving at night, a dedicated mental health support team can be established to provide specialised care and reduce strain on resources.
- Care home support: Providing medical advice and support to care homes can reduce unnecessary hospital visits. Implementing point-of-care testing and connecting care homes with medical professionals can significantly improve patient care and reduce A&E’s workload.
This data can be modelled before the intervention to assess the impact and then re-evaluated after an initiative to test the effectiveness of the interventions. This data-driven approach is a cornerstone of continuous improvement, enabling departments to assess the impact of their initiatives and make informed decisions about resource allocation.
Regular, timely evaluation provides a feedback loop for departments, offering insights into what’s working well and what requires adjustment. This is essential for improving service quality and operational efficiency.
Over time, department leads can build and evidence a business case to channel more funding to successful initiatives that meet organisational goals. Demonstrating improved patient outcomes, reduced costs, increased productivity, and enhanced patient satisfaction demonstrates the interventions’ value and showcases the return on investment, a persuasive argument for securing further financial support.
Urgent Treatment Centres
The standardisation of various services into Urgent Treatment Centres (UTCs) has been a central part of urgent and emergency care reform in recent years. UTCs have been established alongside many Emergency Departments in England to divert work away from the A&E to enable the emergency care staff to focus on managing the more seriously ill and injured.
While UTCs are classified as type three A&E units and contribute to four-hour wait statistics, their primary role is community-focused care rather than an extension of traditional A&E departments. UTCs are open at least 12 hours a day, every day, and offer appointments that can be booked through 111 or a GP referral. Data from 2021-2022 indicates that UTCs are becoming increasingly integrated into the urgent and emergency care pathway, but there is room for more effective utilisation.
Professor Matthew Cooke believes UTCs play a crucial role in alleviating the burden on Emergency Departments, but to be effective, they must have clear staffing, administration, and patient prioritisation guidelines. A best practice approach to the launch and management of UTCs can ensure trusts and patients benefit, ensuring patients receive prompt and appropriate care.
Professor Matthew Cooke believes UTCs play a crucial role in alleviating the burden on Emergency Departments, but to be effective, they must have clear staffing, administration, and patient prioritisation guidelines. A best practice approach to the launch and management of UTCs can ensure that trusts and patients benefit, ensuring prompt and appropriate care.
As a CQC registered provider with a proven track record in delivering NHS-managed services contracts, Acacium Group’s bespoke insourcing solutions enhance Urgent and Emergency Care performance. The Group can call on a vast network of GPs, ENPs, and A&E doctors, accommodating many patients and conditions across minor illness and injury pathways.
These GP-led services maximise capacity during periods of high demand, including evenings and weekends. On entry, the triage nurses assign patients to either Minor Illness or Minor Injury pathways based on their symptoms. This frees up time for nurses and clinicians to concentrate on treating more complex patients while maintaining clinical oversight of the insourcing service.
Once admitted, Acacium Group’s experienced medical professionals, including GPs, ENPs, and Junior Doctors, provide immediate care. They arrange community follow-up, hospital referrals, or primary care support based on the patient’s needs. This maximises the number of patients that can be seen per hour, depending on facilities, like the availability of plaster and dressing services.
The key service outcomes include:
- Improved performance: Reduced patient waiting times and decreased the total time patients spent in the department, enhancing overall efficiency.
- Effective use of resources: Auditing the number of tests ordered, admission rates, and re-attendance rates to optimise resource utilisation.
- Patient flow management: Acacium Group dedicates teams to safeguard patient flow into the UTC, even when there’s an increase in demand for emergency physicians.
- Enhanced clinical focus: By providing insourcing services, the service frees up time for nurses and clinicians to concentrate on treating more complex patients while maintaining clinical oversight.
- Community follow-up: Acacium Group establishes connections with primary care services to arrange community follow-up when necessary, reducing emergency department re-attendance rates.
- Patient satisfaction. People with minor injuries are seen more quickly by clinicians who do not get pulled away to more urgent cases.
Offering flexible commercial models, UTC services can be tailored to meet specific local needs, catering to all age groups and addressing mental and physical health problems.
Intelligent patient flow and expedited discharge
There’s no getting away from the fact that hospital discharge impacts admissions. Efficient discharge is crucial in making space and getting incoming patients the care they need. In December 2022, a daily average of 13,440 patients continued to occupy hospital beds despite no longer meeting the eligibility requirements, marking a 30% increase compared to the daily average for December 2021.
Speaking to the Healthcare Safety Investigation Branch (HSIB) in 2023, NHS England staff disclosed the impact of being unable to discharge patients into social or community care. They highlighted how late discharge resulted “in further medical intervention and an extended stay in hospital”. In addition to impacting patient flow right across the system, the Health Foundation has highlighted how delayed discharge affects patients’ health, mobility, and independence, posing a further threat to resources in the long term.
Research from CHS Healthcare, part of Acacium Group, revealed that 31 distinct tasks and communication points are involved in discharging medically optimised patients from hospital. These tasks encompass paperwork completion, transportation arrangements, and funding approvals. Nearly half of hospital employees and over half of social care workers surveyed acknowledged that administrative procedures are responsible for discharge delays.
- In 31% of cases, discussions about hospital discharge only occur when treatment is nearing completion or when the patient is medically ready for discharge.
- 18% of staff members agreed that patients are admitted without a clear discharge plan despite discharge planning guidelines.
- 50% of hospital staff admit that resistance from patients’ families and caregivers to the final discharge decision causes delays, which can be mitigated through more timely and effective communication.
In the case of frail and elderly patients, discharge is often postponed due to the challenges faced by the patient’s family in locating and selecting an appropriate care home. Several obstacles come into play, such as the difficulty in finding a care facility with available space or one that can cater to the patient’s complex or personal needs. Additionally, family members might find themselves overwhelmed or in disagreement, which collectively impedes the decision-making process and leads to delayed hospital discharges.
Hospital discharge services
CHS Healthcare offers hospital discharge management services that focus on patients at risk of significant delays in getting out of hospital. These services can be customised to align with organisational objectives through flexible and outcome-focused commercial agreements. CHS operate seven-day services to ensure that patients receive the necessary care and support, further maximising the opportunity to discharge patients and improve patient flow safely.
Working with over 50 NHS trusts, the supported discharge service has facilitated over 28,000 patients to be appropriately discharged from hospital, typically within two days of referral. Operating across key pathways, CHS increases capacity through coordinated and tracked discharge management.
Working as an extension of hospital discharge teams, the service addresses barriers that result in delayed transfer of care. This includes bringing forward the discharge planning in the patient journey, often starting at admission, and streamlining the discharge process. This can involve coordinating with care homes, arranging transportation, sourcing appropriate care in the home, and maintaining effective communication with family members.
The service places a strong emphasis on the quality of reporting. Delays are promptly addressed, and opportunities for improvement are continuously sought. This approach leads to substantial enhancements in the speed of discharges and provides valuable business intelligence to commissioners. Effective case management and targeted care ensure that less than 2% of patients are re-admitted to the hospital, supporting further cost and efficiency savings.
Supported discharge has been used to great effect throughout Durham’s integrated care system, with CHS delivering on priorities around discharge access management and discharge delays. Over the last five years, the service has grown and evolved to fit the Trust’s requirements. Working across all hospitals within County Durham, the service also completes trusted assessments for care home providers where requested.
Between October – December 2022, working in partnership with Durham’s ICS, CHS has delivered;
“The service provided by CHS over the last four years has become a key part of the system, providing effective support not just for professionals but also for service users and their families. Their ability to provide meaningful, up-to-date, detailed management information ensures an ongoing understanding of what is happening with discharges into care homes and identifies opportunities for discharge improvements.”
Neil Jarvis, Senior Portfolio Lead, Integrated Strategic Commissioning
By leveraging timely assessments and end-to-end case management, more patients are enabled to return to the safety and comfort of their own homes. Accelerated patient discharge improves patient flow to benefit providers and enhances the patient experience.
Effective discharge services reduce the stress associated with the uncertainties of leaving the hospital. Families value the personalised support offered during a challenging time, with more than 100% of service users consistently rating the support as ‘excellent’ or ‘good.’
Pioneering patient flow technologies
Addressing the timely and proper care of deteriorating patients is a fundamental safety and quality concern. Patient deterioration is a complex issue caused by various factors, but new and emerging technologies are helping to address the challenge.
Research shows that there are observable physiological abnormalities before adverse events, including cardiac arrest and sepsis, causing unanticipated admissions to intensive care and unexpected death. Acacium Group have partnered with Sensium, part of The Surgical Company, to support early detection of deteriorating patients. This healthcare monitoring service combines state-of-the-art technology with a highly specialised workforce to enable early diagnosis and treatment for patients.
Sensium is a wireless system that monitors a patient’s vital signs outside high acuity areas. Clinicians place a patch on the patient, which monitors their heart rate, respiration rate and axillary temperature in real-time. If a patient’s condition deteriorates, then notifications are sent automatically to clinicians, enabling them to quickly respond to the patient, intervening before their condition worsens.
The system empowers one nurse to monitor up to 35 patients and is designed to be user-friendly and accessible from nursing stations or on the move using mobile apps. The clinical interface is set up to highlight deteriorating patients and focus on patient trends, making it easier for healthcare providers to identify patients who need urgent attention.
Typically, 80% of patients require no additional support. This helps clinicians to make informed decisions about which patients are medically optimised for discharge. This service ensures clinicians have the data they need to act promptly, increasing capacity, reducing readmissions and improving patient flow. There was a 25% reduction in the length of patient stays for the two hospital wards that trialled this technology.
Keeping elective services running
In the past, the growing demand for Urgent and Emergency Care services has resulted in redirecting trust resources away from elective care services. This year, elective care challenges as we enter the winter season with the most extensive waiting list on record. This situation is exacerbated by ongoing industrial action from consultants and junior doctors and a persistently high staff turnover, further diminishing system capacity.
The British Medical Association’s analysis of the NHS’ backlog data reveals how significantly COVID-19 has impacted elective care service delivery. Before the pandemic in February 2020, there were already 4.43 million people on care waiting lists. Figures from September 2023 reveal there are now 7.75 million patients waiting for treatment in England alone.
Source: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis
Speaking to the Independent Healthcare Providers Network (IHPN) in November 2023, the former Health Secretary Steve Barclay said the NHS must make “sustained” use of the private sector to clear the elective care backlog. This sentiment was echoed by the Chief Executive IHPN, David Hare.
“The figures today on waiting times are deeply troubling. We must leave no stone unturned to ensure every person on the waiting list can be seen and treated as quickly as possible. This includes ensuring every NHS patient is aware of their legal right to choose the best provider for their NHS treatment, including partners in the independent sector.”
Steve Barclay, the former Health Secretary
Insourcing and outsourcing services
Xyla Elective Care, part of Acacium Group, are a clinically-led, CQC-registered, managed service provider that provides clinical teams, governance processes and oversight to acute hospital trusts, community services and independent providers. Xyla Elective Care (XEC) services bring together patient flow, diagnostics, surgery and outpatient care, protecting quality and patient experience.
As a CQC-registered, multi-disciplinary provider of elective care services, XEC supports more than 50 NHS trusts to reduce waiting lists through efficient patient flow management. This is achieved through a combination of strategies, including referral triage, enhanced advice, and guidance in elective care and referral assessment.
Services also provide additional capacity through risk stratification, digital-first clinical pathways, one-stop clinics, and the strategic utilisation of insourced and outsourced teams. Increasingly, digital solutions are playing a pivotal role in the process, facilitating remote triage, patient booking, and management and enabling patient-initiated follow-up. This integrated approach ensures a streamlined healthcare experience, leveraging technology and strategic clinical pathways to enhance both the accessibility and quality of patient care.
XEC has developed several strategic partnerships with national estate management and modular building providers, enabling us to offer alternative premises to deliver a fully managed service to manage clinical capacity to benefit patients, ICS and trusts. These alternative premises are easily accessible and can integrate digital and community delivery models. Fixed and mobile premises offer multiple flexible options to best meet providers’ backlog, patient needs and funding.
Teledermatology is an example of these strategies elevating services for vastly improved patient outcomes. Xyla Elective Care provided a digitally-enabled teledermatology service to the Frimley Integrated Care Board (ICB) following routine dermatology waiting lists exceeding 80 weeks. The service provided virtual triage, diagnosis, monitoring, and evaluation of various skin conditions, aligned with British Association of Dermatologists guidelines.
Working with Frimley ICB, a customised approach was implemented to facilitate the referral process for patients by GPs. This accommodated referrals with or without dermatoscopic images. Acacium Group also provided a medical photography clinic, ensuring prompt access to photos within 48 hours for higher-risk patients and no more than ten days for routine cases.
The introduction of teledermatology allowed the Trust to proactively treat patients within the community whenever feasible, resulting in a 40% reduction in two-week wait referrals sent to secondary care. Waiting lists reduced from 560 days to two, significantly improving patient flow, alleviating patient’s concerns and, in complex cases, saving lives.
“I’ve just opened case 239. This lesion has been referred to as urgent. It is actually a high-risk nodular melanoma. Once a melanoma starts to get to this thickness, survival rates start to fall quickly, and any delays to treatment start to have more of an impact. If this patient had been sent to the hospital as the GP requested, it may have taken months to be seen. As we have photos for assessment, the case can be upgraded and will now be seen and given initial treatment within two weeks – this could make all the difference to the patient’s outcome.”
Consultant Dermatologist
Virtual services
Virtual wards are digitally supported services enabling clinicians to support patients remotely across various clinical specialities and pathways. These services aim to provide the traditionally expected services on a hospital ward in the patient’s home. This may include seeking medical advice, monitoring their condition, discussing symptoms, obtaining prescription renewals, and attending appointments without seeing clinicians in person.
Increasingly being used by the NHS, virtual ward services save patients the inconvenience and costs associated with frequent hospital visits, especially for those with chronic conditions requiring regular monitoring. As a result, they can potentially transform how elective care is delivered, increasing capacity and reducing the elective care backlog. These services need a combination of technology support and appropriate staffing.
The NHS has set a target of 40–50 virtual wards per 100,000 people. In October 2023, it was announced the NHS had successfully delivered on the first leg of this target with 10,000 virtual ward beds, treating hundreds of thousands of patients at home. As more NHS organisations adopt them, these digitally-led services can transform the way elective care is delivered, increasing capacity, reducing the elective care backlog, and improving the patient’s experience.
“Our world-leading virtual ward programme is a huge leap forward in how the NHS treats patients, enabling them to receive hospital-level care in their own homes. The NHS is embracing the latest technology, with regular check-ins from local clinicians in daily ‘ward rounds’ while freeing up hospital beds for those that need them most – it is testament to the hard work and dedication of NHS staff across the country that we have delivered on our target and rolled out more than 10,000 virtual ward beds by the end of September.”
Professor Sir Stephen Powis, NHS national medical director
Xyla Elective Care, part of Acacium Group, harnesses technology and clinical expertise to provide world-class virtual services. These services cover a range of healthcare pathways, including frailty, COPD and acute respiratory conditions, heart failure, postoperative monitoring, and elective recovery in various specialities such as orthopaedics, cardiology, ENT, and gastroenterology. Depending on the provider’s needs, these can be insourced or outsourced and operate out of hours.
Upon discharge from hospital, the patient is transferred to the Xyla virtual ward, which follows an expedited discharge pathway. The patient is assessed by a matron who admits them to the ward. The necessary monitoring equipment is provided to the patient, enabling continuous monitoring 24/7. The patient also can contact the clinical team as needed. Throughout the monitoring period, strict clinical protocols are followed to ensure the patient’s wellbeing is maximised, and once they meet the discharge criteria, they are discharged from the virtual ward.
By offering flexible and scalable services, virtual wards can increase the capacity of a constrained workforce and elevate the patient experience, providing more choices and offering alternative locations for treatment with shorter waiting times. Enabling patients to be treated at home in a familiar environment can contribute to a sense of comfort and ease, which can positively impact the healing process. It also allows patients to maintain their daily routines and stay connected with support systems like family and friends.
The pandemic was a catalyst for the development of virtual ward pathways, and it’s clear from the successes of early adopters that realising the potential of virtual wards will have a transformative effect on the NHS’ capacity challenges and patient experience. While some challenges and reservations remain, remote patient monitoring helps avoid hospital admissions, supports early discharge, reduces readmission, and minimises routine outpatient appointments.
“One of the biggest learnings that we’ve had over the past year is to recognise that we’re changing behaviours. We are changing clinical behaviours; consultants, doctors, nurses, and clinicians are very much used to seeing patients face to face, and now we’re asking them to send patients home when they might still have been in hospital. On the flip side, we’re asking patients to be treated at home – we want to make sure that patients see this as a benefit for them, not a benefit for the NHS system. It’s equally important to look at what others are doing out there and other partnerships that are available to support the virtual ward programme, be that workforce, strategy or change management. If we’re struggling within the NHS to do this ourselves, it’s not unreasonable to reach out to other colleagues and partners in the healthcare system to seek that extra support”.
Gurnak Dosanjh, Clinical Virtual Ward Lead for Leicester, Leicestershire and Rutland
Maintaining staffing levels through winter
Staffing challenges aren’t limited to winter. However, as the cold weather drives an increase in patients suffering from seasonal illnesses, healthcare workers are also more susceptible to falling ill. This creates a challenging scenario where the demand for healthcare services surges precisely when the workforce’s capacity may be compromised.
The remaining workforce is under greater pressure, stretching the limits of the care they provide. Over a sustained period, this impacts employee’s health and wellbeing, further diminishing the workforce and leading to burnout and unprecedented levels of people leaving the NHS. Nearly 170,000 workers left their jobs in the NHS in England in 2022.
The Healthcare Safety Investigation Branch (HSIB), responsible for overseeing safety within England’s healthcare system, reported that many NHS staff interviewed during a national investigation exhibited emotional distress when discussing their work environment.
“We heard words like ‘demoralising’, ‘powerless’, ‘hurt’, ‘relentless’ during our interviews with staff. If staff are unwell, they are unable to be at work. That means other staff have to cover for them, which again increases the pressure on the system so teams cannot function as efficiently and safely as they could.”
Neil Alexander, National Investigator, HSIB
Maintaining staffing levels through winter is a complex challenge that requires a coordinated effort from healthcare leaders across the public and private sectors, staff, and policymakers. Speaking at the Public Accounts Committee about staffing challenges in mental health, Dame Meg Hillier MP, Chair of the Public Accounts Committee, said, “Invaluable care for some of our most vulnerable cannot and must not be provided at the expense of the welfare of the workforce carrying it out.”
The sustainability of healthcare organisations hinges on the wellbeing of their workforce. Having the capacity and resources to meet demand is central to safeguarding the workforce’s health and avoiding burnout. However, addressing healthcare staffing challenges is not a one-size-fits-all solution.
Providers must consider different approaches, from immediate solutions to proactive strategies, culminating in strategic partnerships that can drive more cost-effective use of resources. By choosing the right approach, healthcare organisations can better navigate the complexities of staffing during challenging seasons, ensuring high-quality care delivery while focusing on their long-term objectives.
Temporary staffing
When a hospital or healthcare facility encounters an abrupt and unforeseen staffing shortage, it is necessary to bridge that gap immediately. Utilising temporary or agency staff is a valuable resource for swiftly restoring adequate staffing levels and ensuring the continuous delivery of care to patients. This reactive approach is a vital lifeline during crises, allowing institutions to maintain essential services.
The key to successfully navigating unforeseen staffing challenges lies in having a flexible, scalable staffing solution to call upon. The ability to quickly access qualified healthcare professionals when needed the most can make all the difference in maintaining the standard of care that the NHS is known for.
An approved supplier to the NHS, Pulse, part of Acacium Group, holds contracts with major healthcare staffing frameworks, NHS trusts, private hospitals and local authorities. Pulse enables providers to access an extensive network of 45,000 healthcare professionals nationwide, enabling the NHS to benefit from a broad geographical reach and 24-hour service.
“We recognise that temporary staffing is a short-term fix for the underlying problem of substantive gaps, but it can be a valuable solution to alleviate the burden on NHS staff. Pulse is committed to offering bespoke solutions that support healthcare providers in meeting seasonal challenges, including offering cohorts of candidates across winter and preventing workforce transience during seasonal flu and COVID spikes. These solutions can help support NHS providers in the long term, reducing the impact of winter pressures and improving patient outcomes.”
Charlotte Fisher, Managing Director, Pulse
Agency staffing experience also acts as a barometer for the wider workplace culture. Pulse captures these valuable insights as part of Acacium Group’s viewpoint programme. Over the last two years, over 315,000 surveys have been sent to agency workers completing shifts with more than 600 individual UK employers. This experience spans primary care, private sector hospitals, NHS Trusts, Public Health England, nursing homes, and care in the community, providing an unparalleled insight into healthcare worker sentiments UK-wide.
This data gives healthcare providers valuable insight into the employee experience of substantive staff. By better understanding the issues impacting teams on the frontline, they can address them to improve employee attraction and retention in the long term.
Winter ward management
Recognising the limitations of ad-hoc supply, healthcare institutions are increasingly exploring proactive solutions to address their staffing challenges. Acacium Group’s managed staffing services are designed to guarantee that the right staff will be available when needed. This means that the NHS can rely on a pool of qualified healthcare professionals who can be called upon to fill critical staffing gaps, ensuring that patient care remains consistent and of the highest quality.
Rather than simply plugging gaps in provision, this approach seeks to tailor solutions that address the root causes of staffing issues. It’s about engaging in a collaborative effort to design and implement strategies that solve immediate problems and ensure the healthcare trust’s long-term success. Winter ward management is one approach that has been successfully engaged by proactive trusts looking to face winter challenges head-on.
Acacium Group’s managed staffing service provides a complete team of experienced nurses and healthcare assistants who are specifically dedicated to operating and managing winter wards. Collaborating with existing teams to ensure that the ward operates in accordance with agreed-upon service levels, service leads consider specific operational requirements in the design and implementation of the service.
Winter wards are, by nature, designed as short-term healthcare solutions. This adaptability allows healthcare facilities to efficiently allocate their resources and respond to the fluctuating needs of their patient population, ensuring that they are well-prepared to meet the healthcare challenges posed by the winter season.
With guaranteed service availability, streamlined staff rostering, and administrative support, these wards allow in-house teams to focus on core hospital activities. This provides much-needed clinical capacity and frees up resources to consider long-term staffing solutions.
Winter wards operate with fixed costs, eliminating the uncertainties associated with variable expenses tied to agency staffing. This financial predictability is essential for healthcare facilities to plan and allocate their budgets effectively during winter.
Adopting a proactive approach, such as winter wards, enables healthcare providers to allocate resources more efficiently, reducing the need for temporary staff and maintaining consistent quality of care. This approach is more sustainable in the long term and promotes staff stability, fostering a culture of continuity and excellence in patient care.
Encompassing specialist staffing and services businesses, Acacium Group can tailor bespoke solutions to meet provider’s needs. CHS Healthcare and Pulse, both part of Acacium Group, collaborated to support Derby and Derbyshire Integrated Care Board to address a severe shortage of available bed space for medically optimised patients.
Specially trained staff provided 24/7 care on the nurse-led surge unit, alleviating the hospital’s resource challenges. This resulted in a 15-hour discharge turn-around from referral, ensuring patients could return to the comfort of their homes more quickly. A 24-hour post-discharge follow-up call ensured a seamless transition and successfully prevented readmission.
Managed Service Programme
A Managed Service Programme (MSP) arrangement offers a level of strategic collaboration beyond simply addressing staffing shortages; it aligns with the healthcare trust’s broader objectives and strategic vision.
Acacium Group’s MSPs are bespoke to each service, taking responsibility for the end-to-end staffing process, including recruitment, onboarding, scheduling, and performance management. This approach allows providers to focus on their core mission while entrusting the complexities of workforce management to expert teams, with access to thousands of candidates with a broad range of clinical specialities.
The MSP actively engages in an ongoing collaboration with the trust. This involves adapting staffing strategies to meet changing needs, staying informed about industry trends, and working together to address potential challenges. Workforce planning becomes a strategic exercise, aligning staff levels with the trust’s long-term goals and seasonal fluctuations to build a responsive and adaptable workforce.
By embracing technology, MPSs benefit from sophisticated scheduling algorithms, electronic health records, and communication platforms to streamline processes, reducing administrative burdens and allowing staff to focus more on patient care. This technology also enables data collection to provide greater visibility of staffing challenges.
Operating at scale and overseeing the end-to-end workforce management, Acacium Group’s MSPs collect comprehensive data analytics and reporting to provide insights to improve efficiency and cost-effectiveness. Real-time data ensures that decisions are based on the most accurate and up-to-date information available.
This ongoing evaluation ensures that the care meets the highest standards and that any necessary improvements are identified through measurable outcomes. Providers gain a deeper understanding of their operations, supporting informed decision-making and streamlining processes and resource allocation through monitoring performance metrics and key performance indicators (KPIs).
MSPs also promote a culture of engagement and wellness, applying innovative recruitment and retention strategies to attract and keep talented healthcare professionals. Having the means to measure employee engagement through Acacium Group’s Viewpoint programme is a powerful tool for identifying and addressing poor engagement. Initiatives could include wellness programs, mental health support, and recognition programmes to reduce staff turnover by prioritising employee wellbeing and satisfaction.
“Incorporating creativity into recruitment and retention strategies is essential for attracting and retaining top talent. This includes the implementation of initiatives such as mentorship programmes, flexible work arrangements, and competitive benefit packages. The overarching objective is establishing a workplace that places a premium on employee wellbeing and fosters professional satisfaction. MSPs provide the insights and structure to deliver these more effectively, creating a unique and compelling employee value proposition for trusts.”
Scott Siwicki, Director of Workforce Solutions, Acacium Group
The repercussions of inadequate staffing during winter are far-reaching: longer patient wait times, increased stress on healthcare professionals, reduced quality of care, and, in some cases, an overreliance on agency staffing. It is crucial to continue innovating, investing in the workforce, and collaborating to ensure that the NHS consistently provides high-quality care during the most demanding times of the year. Embracing a whole system perspective, the NHS is better equipped to navigate the challenges of winter staffing more effectively.
Next steps
The NHS is built on the principle that quality healthcare services should be available to all. Years of compounding challenges have put the system and its people in a position where they cannot always meet the demands.
Strategic partnerships complement and reinforce our public healthcare system. Incorporating private healthcare services within the NHS presents a comprehensive solution to the challenges of winter pressures. It is a proactive and pragmatic approach that harnesses the strengths of both sectors, creating a healthcare ecosystem that is robust, responsive, and ultimately geared towards providing optimal care for all.
Please contact info@acaciumgroup.com if you would like more information on Acacium Group’s winter pressure solutions.
