Coping through winter - six strategic priorities for NHS organisations

11 December 2020

by Tom Hampshire Partner

Email +44 (0)7957 496863

The initial NHS response to the coronavirus (COVID-19) pandemic has been immense. Nationally there was a clear focus on the vital need to create additional ventilated bed capacity to look after patients. But this didn’t come without a price, and other priorities have understandably slipped.

We are now fully into winter, and have second and potentially third peaks of the pandemic to deal with before vaccinations have a material impact. In many ways, the NHS has more experience and better systems in place than before, but the situation is now quite different and there is a need for a different approach. Organisations must think about how they ensure key areas of care are balanced with COVID-19 demands, in particular:

  • a workforce that is more experienced, but also fatigued, especially on the front line;
  • concurrent normal winter pressures plus potential backlog from delayed access to care;
  • a backlog of elective care that cannot be ignored, and needs to be prioritised wherever capacity is available
  • the opportunities and demands of emerging vaccines;
  • an unprecedented economic position and despite significant new investment, finite funding;
  • potential disruption due to a departure from the EU Transitional Period without a clear trade position;
  • planning for future resilience

From our experience of working closely with trusts and systems throughout the pandemic, we believe there are six priority areas for organisations as they head into winter 20/21:

1. Dynamic whole system bed capacity management

Demand for bed capacity, whether for COVID-19 patients or other needs, is hard to predict and highly volatile.

In health systems, beds have been managed by a number of organisations and have typically had separate operational management with static admission/discharge protocols and criteria.

With extended waiting lists, and risk of harm to non-COVID-19 time-critical conditions, pausing elective work is no longer a credible option and systems will need to work together in a more dynamic and agile way.

2. Optimising the use of a flexible workforce

NHS staff responded with great professionalism to the pandemic. But a significant proportion of the workforce are fatigued, and pressures from quarantine, unpredictable shifts and childcare mean a robust and resilient model for deploying staff needs to be in place.

A structured, agile and resilient workforce model is required to best employ external support (bank/ agency/ volunteers) to fulfill staffing requirements whilst ensuring control over costs and delivering good governance.

3. The opportunities and demands of emerging vaccines

Health systems will need to be clear on how they’ll distribute and provide the right vaccines to the population - both in terms of logistics, but also prioritisation and targeting. Vaccines can provide a path to recovery but how they’re precisely targeted to at-risk groups and frontline key workers will determine how quickly the impact can be reduced. The alignment of co-ordination between local appointed vaccination hubs, primary care, local authorities and others to national requirements such as supply chains, reporting will be critical and leaves significant risk of gaps in responsibility.

4. Elective recovery

Through the pandemic, elective waiting times have increased significantly. Ongoing COVID-19 requirements such as donning/ doffing PPE and separating care settings mean that delivering elective treatments will continue to be difficult.

There is a risk that patients will wait excessive times with potential risks for health outcomes, economic productivity and public acceptability/ support for the NHS. Increasing capacity will be a core component, but intelligent prioritisation of lists and using clinical review time in very targeted ways will also be needed to solve this new national issue.

5. Digital care delivery

During the pandemic, the UK population has undergone a huge channel-switch, moving from face-to-face to online interactions in areas such as retail and socialising - and also accessing services, including healthcare.

However, due to the speed required, some of the technology used was implemented rapidly. More sustainable solutions need to be identified to ensure that these changes can become business as usual, e.g. virtual outpatients.

6. Delivery framework

Overall, organisations need to ensure they’re on top of delivery, cost and outcomes throughout the second wave:

  • Governance - they’ll require the ability to make rapid but appropriately controlled decisions that are then acted upon across care systems. A highly responsive approach is needed with dynamic system governance in place;
  • Finance - financial controls and processes need to transition so that they’re enablers of dynamic capacity and resource re-prioritising, ensuring that value is claimed from every pound spent;
  • Agile strategy - organisations and systems need absolute clarity on how they’re going to deliver, the choices they need to make and how to refine their approach as new information becomes available.

We’ve developed a simple self-assessment tool to review organisations against these key areas. Get in touch if you’d like to find out more.

by Tom Hampshire Partner

Email +44 (0)7957 496863