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What the emergency care plan should solve

by Kirsty Kirsty

Max Parmentier, Co-founder and CEO of birdie

The NHS is facing the greatest crisis in its history. It’s no secret that the organisation is crying out for effective solutions for urgent, emergency and elective care. To add to this pressure, this healthcare crisis and the parallel social care crisis are intrinsically linked.

The slightest spikes in demand on either side – spikes which are increasingly common – cause knock-on effects for A&E, medical providers, care providers and ultimately the whole population.

The Prime Minister’s emergency care plan to build 5,000 more hospital beds, bring 800 new ambulances and expand community care (backed by a dedicated fund of £1bn) is a welcomed first step in tackling the above. However, I’m most excited to see that the government recognises that one of the most effective solutions is to shift healthcare to the home of the patients – with 3,000 “hospital at home” beds to be created before next winter, and the aim of about 50,000 people a month eventually being cared for at home each month.

This important part of the emergency care plan puts a spotlight on the clear integration of the various branches of our healthcare system. Most excitingly, it allows us to leverage the extraordinary effectiveness of care at home – something we have been advocating for for several years.

Yet, there is still a need for more clarity on the propositions to bolster community care in general. At birdie, we believe the following should be prioritised, for genuinely impactful outcomes:

Hospital discharge must be accelerated

One out of seven hospital beds is occupied by someone who could have been discharged. This costs the NHS anything from £350 to £1000 per day. It is also a vicious cycle for patient recovery – as long hospital stays for older adults can lead to up to 10% muscle strength loss, hindering independent living and increasing likelihood of readmission.

While Discharge to Assess (D2A) programmes have been around for a long time, they have lacked leadership, funding and urgency. Proper governance and action is needed to make these the effective, supportive flow they should be.

Furthermore, hospitals must work with social care to leverage local community care capacity when available. Too often these providers are not involved in the conversation, or a lack of visibility in the capacity they have delays the discharge.

Open up virtual wards to more conditions

“Virtual wards” were originally set up for specific conditions, with a nurse checking in ‘virtually’ (online or over the phone) with patients. While this has already demonstrated significant benefits, this original set up is too limited in the conditions it covers, and adoption is hindered because patients are required to take their own bio markers, such as heart rate and blood pressure.

To unlock significant capacity in hospitals, we need to utilise an integrated care system to widen the number of conditions treated via virtual wards. We should also be more flexible in the care delivery model. At birdie, we have seen numerous domiciliary care providers training their staff to provide complex care – this is a fantastic demonstration of how we can effectively increase the capacity of virtual wards.

We encourage Integrated Care Systems (ICSs) to collaborate with domiciliary care providers to offer a full “hospital at home” experience, with qualified staff in the community delivering outstanding in-person care.

Be serious about hospital prevention

While the government has announced measures to bolster hospital avoidance measures, the pilots to address this, for instance avoiding falls, have been too sporadic and disjointed. Currently 70% of A&E beds are occupied by older adults – 40% of which should have been avoided if early signs of deterioration had been detected earlier.

Essentially, none of the potentially impactful prevention initiatives have been rolled-out further because of a lack of incentives and support at a government level. The NHS should be spearheading these initiatives at the Transformation Directorate, producing academic evidence and implementing the relevant funding incentives for ICS and other local bodies to roll them out.

Foster data-exchange

Health and social care data is still too siloed to be effectively used by ICS or other bodies to manage the population’s health, both on prevention and discharge. To truly make a change that will benefit the whole population, there needs to be an acceleration in sharing and standardising data across health and social care on top of the frameworks already implemented.

At birdie, we believe that the UK is uniquely positioned to become a leader in preventative, personalised healthcare at home. This would significantly improve the healthy life expectancy, free up capacity in primary and secondary care and drive healthcare costs over the medium term.

While we command the recent funding announcement, we urge the government to implement these measures in a timely fashion.

Image depicts Max Parmentier, Co-founder and CEO of birdie

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