If there was a way to predict the exact volume, type and place of people about to “present” themselves to the Health and Care system it would solve many of the staffing and capacity issues currently faced. Not only would we be able to better plan to receive those destined for entry, so that the right amount and type of staff are there ready to receive them, but we would also be able to intervene much earlier in the treatment pathway, helping to potentially prevent many major and unplanned escalations. The patient experience would be significantly increased and the cost profile against resourcing this demand would be much less for the British taxpayer.
It takes very capable, resilient and experienced individuals, willing to be put under the microscope in a very intensive way for a significant amount of time to affect meaningful change, in what are currently extremely difficult circumstances for Healthcare Trusts and Systems.
Recruiting these people is therefore difficult enough in itself, let alone then actually enabling them to enact change. To do this safely and correctly they arguably need therefore to really understand behavioural change and organisational risk profiles, otherwise the impact of change (if indeed able to deliver it) creates many unhelpful subsequent issues.
This can only happen if people and systems are empowered to do so, backed by good support teams, central and local policy, good data, governance and appropriate finance. By injecting the right capability into the right areas however, this is indeed beginning to be possible.
Target operating models that scale across regions, but still giving some local choice and flexibility, backed by universal standards, are one of the best ways to achieve this. Delivered with a strong but agnostic approach all of these things can then be effectively joined up and different groups of people brought “on board” (even if at very different levels of maturity).
Imagine a world in which cases were quickly and safely prioritised in a clinician's work list, or where practitioners were able to divert their attention away from 80% of their case list for the day in the safe knowledge that these patients did not need to be seen for another three weeks. Imagine a world in which the optimal approach to care could be quickly presented to a clinician to review immediately, without having to go off and do huge amounts of additional research to come to a final decision. Imagine a world in which we could confidently position more effective spend and policy making across a region based upon real insight gained from the analysis of patient data at scale.
This world is actually not that far away, it is now just about showing everyone and bringing forward the right supporting mechanisms (systemically, behaviourally, technically and policy wise) to allow them to take effect. We just need to let it happen.
The ICS “model” is now of course fundamental in seeking to deliver this aspiration, which is critical to the longevity of the NHS (and surrounding “actors”). This can only be realised though if people begin to understand how the “end state” national blueprints being put forward can become attractive enough for all concerned to engender the correct behaviours, ensuring they get there. There are still huge question marks for example, around the varying levels of maturity that exist out there and if these organisations specifically know how they can effectively move forward safely and quickly.
The answer to this is often now “outside the room”, as it is partnerships with third parties (inside and out of the NHS) which we believe are fundamental in being able to now achieve this desired state.
If you were to ask leading executives from systems and Trusts across the UK what they desire most, many of them might respond with “a bus load of well trained, experienced staff to arrive at my door tomorrow!”.
We are unable to build enough capacity, or supply enough trained workers, for the acute care system to effectively cope with the amount of people now coming in through its doors, and to then be able to safely discharge them again. If the answer cannot be to simply provide this additional resource and capacity, it must be to divert people and workloads to other places in which they can be just as effectively delivered to help relieve some of this pressure. If we do not do this, bottlenecks will continue to increase, care quality will continue to go down and we will not be using the great people and skills that we do have to full effect.
COVID has continued to not only shine a light on this need but has now threatened at times to “break” the system. We cannot allow this to happen and what is more, it does not actually need to.