For many years, it has been commonly perceived that winter pressures are the NHS’s problem. But is this fair given that we serve the same communities and the pressure on health and social care is significant?
In response, Brent Council, Brent Clinical Commissioning Group (CCG) and London North West University Healthcare NHS Trust have teamed up to address the problem in recent years.
It is no small challenge because parts of Brent are among the most deprived places in London, and Northwick Park Hospital is one of the busiest A&E departments in the capital. Early planning and a coordinated cross-organisational approach have helped us shape a robust winter plan that maintains patient experience, safety and clinical effectiveness during the most demanding period of the year.
This planning began with lessons learned during the winter of 2017/18, which were subsequently built into our current plan. It boils down to: keeping people out of hospital; ensuring patients who are admitted are treated and discharged quickly and safely; and provision of adequate home support in the community.
Brent CCG responded by giving patients access to GP appointments from 8am to 8pm, seven days a week, via a network of GP hubs. The hubs play a crucial role in curbing the number of people going to A&E with minor ailments. Use of them rose by 42 per cent between October and December 2017 and the same period a year later. The CCG also provided an enhanced service in care homes and a targeted approach to flu vaccinations, and it developed closer working relationships between acute and primary care providers.
The Department of Health gave the council a one-off payment of £1.3 million to support hospital discharges. It ‘purchased’ 15 more beds, offered reward payments to care homes that could quickly assess and accommodate patients, and provided an additional handyman service for home adaptations. It also invested in more social worker, occupational therapist and coordinator capacity, to boost its Home First initiative to get patients home with the minimum of delay.
Handover times between ambulance crews and A&E staff at Northwick Park Hospital have improved and benefited from an extra paramedic/nurse to help with triage, and an advanced assessment triage area.
These plans have helped, but underpinning it all is the dedication and hard work of staff on the front line.
The reality is that we face a growing population that is living longer and is increasingly troubled by a host of long-term conditions. The only way we can manage this, aside from promoting greater personal responsibility for health, is for the public sector and its partners to develop a healthy working relationship that recognises this is everyone’s problem.