Daily Insight: Grim reading

It’s hard to think of a worse way to spend three weeks than in a room with no natural light and inadequate washing facilities while having a mental health crisis. Yet this is the position patients at the Royal Sussex County Hospital have found themselves in.

Care Quality Commission inspectors were told patients attending accident and emergency had spent up to three weeks in what was described as short stay beds within the department while they waited for a mental health bed. The average stay was 52 hours.

Staff seem to have done as much as possible to make this time bearable for patients but the CQC report still makes grim reading. It raises wider questions about where the responsibility for these patients – and the lack of suitable beds – lies.

Some of the rest of the report, however, is also concerning. Although maternity services across University Hospitals Sussex Foundation Trust had improved since the CQC inspected last year, problems with emergency surgery remained, including patients facing up to seven postponements and waits of up to 21 days.

The one to watch

Make no mistake: the modest target set for trusts to have 5 per cent of outpatients on patient-initiated follow-up pathways by March is just the beginning of NHS England’s drive to get PIFU rolled out on an “industrial scale”.

System bosses argue the days of patients and clinicians wasting their time at unnecessary follow-up appointments needs to be consigned to history as a matter of urgency.

And this is why Norfolk and Norwich University Hospitals FT’s PIFU programme – thought to be the most ambitious in the NHS to date and going well beyond the planning guidance ask – is one to watch.

Beyond its scale, what is perhaps the most interesting element of NNUH’s project is its use of technology to address the most fundamental concerns about increasing PIFU usage: namely, that it could drive health inequalities if the wrong patients are put on these pathways or patients are forgotten about.

The jury is still out on the patient safety questions, and a Nuffield Trust literature review on PIFU next week should provide a hugely useful resource for trusts planning their programmes.

The scale of PIFU usage may still feel uncertain but the area is set to grow considerably and trusts would be well advised to work out their plans ASAP.