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Cutting length of stay of so-called “super stranded” patients, those in hospital longer than three weeks, will be a cornerstone of NHS England’s plan for next winter. Here’s a quick Performance Watch primer on the NHS’s new obsession.
System leaders have based their plan for next winter on the basis that the NHS is at least 4,000 beds short, as HSJ revealed last month.
A cornerstone of the plan to create the extra capacity is around cutting the length of stay of patients who have been in hospital for more than three weeks, the so-called “super stranded” patients.
There are an estimated 18,000 patients currently “stuck” in NHS hospitals for more than 21 days – the equivalent of 36 acute hospitals effectively out of action, NHS England chief executive Simon Stevens told MPs early this month.
National director of operations and information Matthew Swindells fleshed out the plan a little more at yesterday’s news packed NHSE board meeting.
Cutting the number of super stranded patients by 25 per cent would free up 4,000 beds in its own right, he said.
The target echoes last winter’s drive to free up 2,500 beds by addressing delayed discharges of care. It delivered 1,700 beds which were all filled with Flu and Norovirus patients, but can be considered a qualified success, as examined by Performance Watch in March.
Pauline Philip, the NHS’s national urgent and emergency care director, will now lead a new national programme targeting this cohort, he said.
The work will build on NHS Improvement’s guidance on reviewing length of stay and super stranded patients published in September with little fanfare.
Success on this agenda will require the whole system reform as well as a major drive on bed management. The super stranded drive will be accompanied by work to improve weekend transfers, as we reported last week.
Hospital workforce shortages, of course, contribute to lower discharge rates on weekends. But Mr Swindells was clear that success on this agenda would require a huge drive on seven day access across primary care, care and nursing homes, community services and social care services.
Of course, such a call raises fundamental resourcing and workforce questions, with all of these services already suffering significant shortages of both.
NHS Providers chief executive Chris Hopson said plans to deliver extra capacity “suggests we will need to revisit the decision that there will be no extra winter funding this year”. And HSJ understands such negotiations are ongoing.
It’s also important to note that getting a full handle on the long stayers will take years – this is not a quick fix or short term programme. But headway over the next six months would make a huge dent in the capacity challenge faced next winter.
Mr Swindells is no doubt right that fully addressing the issue will require systemwide change. But experts told HSJ significant ground could be made by driving change within hospitals.
Rick Strang, an experienced transformation adviser who focuses on emergency care flow, told HSJ: “The knee jerk reaction from many in the NHS is that it’s a problem about social care services. Of course, that’s a factor, but the predominant issue is how we manage their inpatient stay within the acute trust itself.”
The emergency flow specialist has recently worked with Croydon University Hospital and the Isle of Wight addressing stranded patients.
Close management through designated operational hubs or clinical senates focusing on this cohort can deliver relatively quick progress by stopping patients drifting through the system.
“Long stays are often caused by a series of blocks, having to wait 24 hours for an echo scan, or 48 hours to get use of a certain drug cleared by commissioners, for example or procrastination whilst we await some form of alternative specialty review,” he said.
The super stranded patient metric has been developed over the last few years.
Ian Sturgess, now an independent consultant but a former Monitor associate medical director, is credited as a key driving force, with NHS Improvement’s emergency care and improvement programme having progressed the agenda in recent years.
You can watch Dr Sturgess’s enlightening (and short) presentation here.
Mr Hopson also warned that it was “vital to address the whole pathway not just focus on individual elements like delayed discharges of care, weekend discharges, or super stranded patients. And trusts are bound to ask ‘do we really need yet another target focusing on just weekend discharges’?”
The winter plan will no doubt involve other strands with many keen on pumping more resource into ambulatory care, but the cutting the length of stay of the super stranded group appears to be NHSE’s big play for 2018-19.