Thinking outside the A&E box

KayHill have been fascinated by the issues that trend on social media and have often paused to think why that might be.  Around the winter holiday break, amongst the more predictable themes such as who was cool in 2014 ( #PeopleWhoMadeMy2014) and why Niall left One Direction (#reasonsniallleftonedirection) was #NHScrisis, discussing the rising demand for A&E services and the consequences of this.  Healthcare organisations attempted to use social media as a means of communicating to the public about utilising their NHS services more effectively.  Messages included choose well campaigns to infographics demonstrating use of A&E and what service they could have accessed as an alternative.

These seem to have had, at best, a mixed effect.  It made us think how well we get these important messages across.  For the public who need access to healthcare, A&E is easily the most signposted and recognisable healthcare resource in what is a very complex system to navigate.  The key is striking a balance to ensure those who need urgent care can access it easily but also preventing unnecessary attendance for things that are neither an emergency nor an accident. Why is it we don’t use our healthcare responsibly?  Could our NHS messaging, signposting and advice be confusing?

To add to the many anecdotes we are sure you have all read or heard, one of the team’s neighbour, Bob took ill just after Xmas.  Knowing that she was a nurse, his wife sent a text message early Sunday morning to say she was worried about Bob, he had a high temperature, was sleeping a great deal and the NHS online advice suggested she take him to A&E.  Audible sigh! We popped round (other half being a pharmacist) and assessed Bob. He was drinking fluids and hydrated, his temperature was responding to paracetamol, he was alert, was breathing okay and his colour was far more pink than blue. We reassured her that she didn’t need to rush him to hospital as it was highly likely he had a cold, probably viral in nature and very likely self-limiting.  It seems our healthcare messages are confusing, which may well be adding to the #NHScrisis twitter trend

Kayhill have been involved in redesigning urgent care systems and we understand the complexity of why demand is increasing in A&E.  We are living longer with more complex and chronic conditions that consume 70% of healthcare resource.  8 out of 10 contacts with the NHS take place in general practice but it isn’t coping. We know that the current model of healthcare (and indeed social care) delivery is unsustainable, and that we need to reconfigure services.  The Catch-22 is that we have a shortage of doctors and nurses in primary and community services to achieve the shift in models that are required and we have a shortage of doctors in A&E with the skills to manage people with chronic and complex long term conditions.

The Five Year Forward View emphasises the need for new models of care.  The FYFV stresses there isn’t a one size fits all option, nor a “thousand flowers bloom option” but that there are a number of  new care models that can be deployed in different combinations locally across England.  However, it is possible to transform urgent care systems. We know because KayHill worked with Warrington CCG and its system partners to transform its urgent care system.  Its vison was simple: to improve services and outcomes for patients and their carers, moving from a reactive secondary care centric system of unplanned care to one which is preventative, anticipatory and follows a whole person approach to management, treatment and ongoing support.  The A&E service redesign was one element of a whole system programme to integrate health and social care.  Two years into the transformational journey, secondary admissions had decreased by 8%.  The key ingredients to this change were

  • Understand the system and its issues- not just using reliable information but from the users perspective
  • The creation of & buy in of a whole system vision of what would be different
  • Clinical leadership- developing new models of care bottom up and clinically led
  • Strong patient engagement in design and execution of the strategy
  • Strong collective leadership

There is lots there that other organisation can learn from. Remember the quote from Atul Gawande in a previous blog?

 “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” 

Better: A Surgeon’s Notes on Performance