• Providers and commissioners warned plans won’t deliver sufficient improvements
  • NHSI sets out new guidance on reducing long hospital stays
  • Philip’s letter follows confirmation of target to free up 4,000 beds

Local NHS providers and commissioners were given a fresh warning this week that their plans will not deliver the “capacity, productivity or length of stay” improvements required for 2018-19.

The warning came in a letter to local leaders from NHS emergency care chief Pauline Philip on 13 June setting out new guidance on “reducing long hospital stays” and a new national length of stay target.

The target, confirmed this week by system leaders at the NHS Confederation annual conference, is to cut the number of patients spending more than three weeks in hospital by a quarter to free up 4,000 beds by December.

The NHS national director of urgent and emergency care’s letter said that “an unrelenting approach to reducing length of stay” was required because trusts did not have the physical or staffing resource to boost capacity by opening more beds.

She said: “[The 4,000 beds target] is important as providers and commissioners recently submitted plans for 2018-19 showing the NHS is expecting to increase activity and improve performance up to and during winter.

“These plans lack sufficient improvements in capacity, productivity or length of stay to give us confidence that they will be achieved.

“We recognise that most hospitals do not have the physical space or access to the nurse staffing to grow their bed base while maintaining a safe and productive care environment, so the NHS must have an unrelenting approach to reducing length of stay. Ian Dalton has recently written to acute trust chairs regarding the plans.” 

Every acute trust, clinical commissioning group and local authority has been given individual targets with “the most challenged systems expected to make the greatest levels of improvement”.

The letter stressed the need for the drive to be system wide. At least half the opportunity rested within hospitals, but the remainder would require joint working with GPs, local authorities, community health and social care providers and others.

Technical guidance on the “measurement of the ambition and dashboards to enable progress to be monitored” are being finalised and will be sent out in “a few weeks”.

The letter contained some overarching principles for systems, trusts and others on how to approach the length of stay reduction programme.

Among the recommendations

Systems must:

  • Develop long stay patient reviews and multiagency discharge events to ensure “whole system partnership working”
  • Put in place executive lead escalation arrangements working with senior leadership across health and social care systems to tackle blockages that can’t be addressed locally or internally;
  • Drive up seven day working to reduce the variation between weekday and weekend non-elective discharge volumes from acute hospitals.

Acute trusts must:

  • Treat lengths of stay above best practice guidelines as a safety issue which need urgently addressing
  • Get information on all long stay patients in hospital, supported by real time use of patient administration systems used for bed management and to give automatic capacity and occupancy information
  • Work at the front door (and ideally before it), including ambulatory emergency care, therapy services and appropriate care pathways to avoid admissions for patients who do not require acute care in hospital and are at risk of de-conditioning if they do. This will reduce the number of complex discharges;
  • Routinely screen within two hours of presentation all older people (aged 75 and over) for their prior degree of frailty using a validated tool, their prior level of functional need and their present cognitive status. This data and clinical judgment should be used to identify within 72 hours of admission.

See the guidance in full here