One of our key strengths as a company is the vast NHS experience in our team, giving us unique insight into the challenges faced by NHS Trusts and solutions to these.

In fact, at the back end of 2023 and into the first few months of 2024, our Director of Consulting Services, Stephen Hall, a former Executive Director in the NHS, returned to the NHS frontline for a 5-month deployment leading the medicine division (which included the Emergency Department) at an NHS Trust in the South of England on behalf of Acumentice.

Here, he outlines what he saw, the challenges that EDs across the country face, his input to improve the situation and what the new government must do to tackle long-standing issues.

First impressions

We all hear and see the news regularly about how much the NHS is struggling and creaking at the seams, especially over winter.

This is something I saw first-hand, with the conditions certainly challenging in the most recent winter. January 2024 saw a 13% increase nationally in ED attendances compared to the previous year. This was on top of the longest junior doctors’ industrial action in history, therefore putting more strain on the consultant workforce.  

Despite the challenges, what I also saw was a lot of very dedicated clinicians, managers and support staff, working long hours in challenging conditions to do the best for their patients.

What did we do to improve things?

So much of the job for someone leading recovery in a stretched emergency and medicine department, is showing strong, visible leadership and working closely as a triumvirate with the Chief of Medicine and Chief of Nursing. What was important at this Trust, was working with the clinical site team to ensure that patients were in the right beds, so as not to increase their length of stay.    

Early on, it became clear that a significant number of patients did not need to be in an acute bed. However, due to system challenges – e.g. lack of access to community rehabilitation beds, nursing homes, or packages of care – this was often outside the influence of the Trust, creating backlogs for those in need.  

So, what was the solution?

Appropriate clinical leadership

Ensuring that the senior clinical leadership team was sufficiently resourced became one of the most important things from the start. With staff shortages across the NHS, the challenge was getting the appropriate, and in my view, necessary, resource in place at the Trust to deliver for patients.  

I knew that I needed to expand the senior leadership, which led to the submission of a successful business case to increase the number of Clinical Directors from two to four – a successful legacy we were able to leave behind.

Robust governance

It was important to ensure that the Trust – and specifically medicine – were doing all they could to internally improve patient flow. I introduced and chaired twice weekly Long Length of Stay and “No Criteria to Reside”* patient-by-patient review meetings, with clinical colleagues, to help unblock any internal delays and support expediting safe and timely discharge.

Harnessing the value of data

Apart from managing the day-to-day pressures, of which there were many, I also saw the value of improving the emergency data analysis to highlight the pressure points – therefore allowing us to focus our efforts effectively to improve patient flow.  

What can the new government do to bring about long-lasting change?

Now we have a new Labour government in place, the time for action is here.

The idea of very long, historically high waiting lists and a winter crisis in the NHS each year have almost become accepted, inevitable, but it doesn’t need to be that way.

Here are a few things Labour can do to make a long-term and sustainable difference – not only to ease the pressures on EDs but make the whole healthcare system function far more successfully.

• Reduce waiting lists. Learn lessons from the past to bring waiting lists down rapidly and sustainably. In our recent white paper, we found that the Labour government need only look back 17 years, to 2007, when it successfully brought the waiting list down from 4.2m to 2.7m in 12 months. As well as speeding up access to treatment, you also reduce pressures on EDs when you reduce the waiting list, removing the indirect pressure on EDs from people who don’t get treatment in a timely manner – for example someone waiting for a hip replacement who then has a major fall.

• End industrial action for good. Get round the table with junior doctors and provide a fair pay and rewards offer, provide adequate training, and focus on staff wellbeing to ensure people stay in position for longer. Retention has been a major problem in the NHS, and without keeping good people – and recruiting well – the NHS’s productivity issues will continue. It is positive to see Wes Streeting stick to his word and take immediate action in reopening formal negotiations with junior doctors to finally solve the issue, which is certainly a step in the right direction.  

• Invest in social care. Recent governments have promised a proper long-term plan and structural change, but nothing has been introduced. One idea would be to model demand and capacity across both health and social care. Then we could understand how many patients in a hospital require social care, and plan what we need from a social care/community rehab perspective, lessening the logjams we often see which prevents efficient discharge of patients.

• Data infrastructure. Invest in robust data quality infrastructure, so that Trusts can understand more clearly the extent and depth of their waiting lists – and address this accordingly.

• Governance. Staff need to be taught how to do the specific, granular, detailed operational management (reviewing every patient, carrying out regular meetings, attention to detail, studying the root causes, etc) - which is a vital, practical way of bringing waiting lists down and reducing pressures on EDs.    

So, there is plenty the new government can do to help make a difference and ensure another winter crisis isn’t inevitable.

None of it is easy, but it has been promising to see them on the front foot early on. Hopefully, we will start to see the long-term, sustainable change that the NHS has been crying out for, for a very long time. And the change that patients and the dedicated workforce certainly deserve.

*No Criteria to Reside: hospital discharge guidance from NHS England that indicates when a patient no longer needs to stay in a hospital bed

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