Today I have attended one of our Board seminars. We call them seminars, but in truth they are a meeting where we have Board members and some CCG staff plus invited others, to look in detail at areas of work that need consideration.
Whilst our focus today was to discuss a pilot service related to GPs being based in A&E, the debate naturally spread to other challenges that were all related. As ever, there is no problem in the NHS that is as simple as it looks and consequently solutions (or attempted solutions) end up being complicated.
UHSM, like many A&Es regularly misses its A&E target. However this is not simply down to a) people turning up when they shouldn’t or b) the department being incapable of managing the numbers coming through. A considerable amount is down to capacity elsewhere in the system: recently as many as 120 patients were considered fit to be discharged from UHSM, but, for a variety of reasons couldn’t be. This creates a hospital wide crisis: patients end up in beds on wards that aren’t the right one for their condition, other patients can’t be admitted, cubicles in A&E get full etc etc. (or so I understand).
Now we traditionally do two things 1) try and decide who is to blame (“it’s social services, it’s the management it’s the…”) and 2) devise solutions through clever thinking, diverting resources, using IT better etc. We then write an action plan, monitor it, watch it fail and go round the circle again.
You could identify lots of issues we could tackle: social services (and it differs by LA) can be slow to get packages in place for people who are ready to be discharged, so the patient stays in hospital too long; nursing/care homes won’t send someone to assess their resident to ensure it is safe for them to return to their home at weekends, so the patient stays in hospital for too long; nurses and hospital staff do not have capacity to keep chasing all of the above, so the patient stays in hospital for too long.
It does make you wonder: if we just had a few more nurses – so they could do their caring job and support discharge. If they could just liaise with that extra social worker (if we had a few more) they could help get the patient home: releasing the bed, helping A&E hit their target because the system is clearer. And perhaps if Care/Nursing homes just had another assessor so we could discharge at weekends then there would be even fewer beds in use and managing A&E becomes even easier and doesn’t need all the millions of pounds we keep pouring in and the special winter monies governments love to announce, there may even need to be fewer beds in hospital – so you could release more nurses for greater capacity on wards – they could then liaise with…
Perhaps we don’t need lots of clever pilots or huge innovation around all of this: perhaps we just need a little more: more nurses, more social workers (and other support in the community) – even more GPs who can help prevent the need for people to turn up at A&E in the first place. Oddly it may save the system money overall, get people in and out of hospital quicker (less infections!).
Perhaps the system is not as broke as we sometimes think? Perhaps it’s because we are all a little bit broke in terms of resources – a little bit more, in the right place, might just change a lot.