This year’s winter crisis in the NHS generated the eternal stories and anecdotes. But worse, this year clinicians complained of patients dying in the hospital corridors and unusually high bed occupancy. This may have been a reporting issue. While occupancy rates have never been higher, the overnight bed numbers have fallen some 10% since 2010. The data is complex and demands much closer scrutiny across the whole system, including nursing and residential home beds.
Any declining performance in the NHS and social care is likely to be partly at least a consequence of rising demand for care from a growing and ageing population. Despite that there are signs of progress. The September 2017 target was missed by both the NHS and social care, but the rapid recent growth in delayed transfers was reversed – thanks to more money or to better integrated working ? The extra funding appears to have had an impact on reducing the Delayed Transfer of Care (Older people stuck in hospital beds for social care reasons). The small drop in the social care numbers from 52,783 in November to 49, 227 in December 2017, was particularly laudable as hospital admissions were 3% higher in December 2017 than in the previous period last year.
There is, however, very little evidence on the impact of cause and effect. There is also still no explanation of why some areas do better than others for no discernible reason. One reason could be the differentiation between health and social care spend. Although there is plenty of data, there is very little which gives an analytical insight into the whole picture and even less on how patients flow through the whole health and social care system. A recent CQC report on Local Area Reviews in December 2017 examined local areas and said “Focusing on (DTOC) in isolation will not resolve the problems local systems are facing.” This seems sensible.
The Kings Fund proposes three clear priorities about what needs to be done to ensure that this winter’s crisis does not recur next year. They are not new. The first is to commit to a long term plan on funding and staffing. Jeremy Hunt, Secretary of State for Health and Social Care has already suggested a ten year forward view instead of the current five years. We can expect action on that shortly. The fact that he has renamed The Department of Health to The Department of Health and Social Care is seen as hopeful to some, perhaps a sign that a more integrated approach may be on the way. The second priority is to redouble efforts to improve productivity and efficiency. The Carter Review concentrated on the acute sector and Getting it Right First Time (GIRFT) has made considerable progress on reducing variation, but without better data its hard to see what more can be achieved. The third priority gives cause for fresh optimism - to expand the work to reform the NHS by giving greater emphasis on prevention, population health and to the integration of care.
All three priorities need better integrated and analytical data to understand the past, future and present. You can’t understand without counting and scouring the data. The irony is that the data is all there. The NHS and indeed social care is rich in data. It’s a relatively simple – and utterly necessary - to pull all that data together and use predictive analytics to look ahead.
Understanding the complex inter-relationships of changes in the weather, sick people, provision of health and social care services locally, the number of beds and occupancy rates all together in one view is essential. New software makes it possible to look at whole health populations and include many of the risk factors. Air pollution for example is a crucial area to focus on both for older people and for the very vulnerable young. Combining data on air pollution together with long term conditions, data on care pathways and emergency admissions to hospital would be bread and butter to industry and retail. Why does it seem so difficult to apply the same principles to health and care?
The new NHS England ACS and STP Innovation Partner Framework due to be launched early this year could make a significant difference. As a One Stop Shop approach across health and social care for ACS and STPs, it needs to go hand in hand with innovations in digital, predictive analytics and other technologies to achieve real sustainable change. TechUk has been working with NHS England and others to bring about a new understanding of how to make better use of the complex digital, data and technology essentials in the new Framework.
Join the discussion on #ReadyforWinter
To see more blogs like this, please visit the Campaign Week landing page