Improving patient flow to help tackle the elective backlog

Patient flow will be one of the big challenges for NHS managers over the coming year. Ensuring that patients move swiftly through a hospital is vital to avoid blockages at accident and emergency – including ambulance handover delays – and to make best use of available bed capacity. Without this, trusts will struggle to meet the target for increasing elective work and reducing the backlog of patients needing procedures.

Small scale building projects can play a part in this – and, with capital in the NHS limited, many trusts will not be getting larger investments. These smaller projects can provide an extra ward or bay, more cubicles in accident and emergency and additional intensive care unit space.

And a smooth-running facilities management team can also help to improve flow – with porters available to transfer patients at short notice and cleaning designed to turn beds around as soon as possible.

An HSJ webinar, in association with Sodexo Healthcare, looked at all these issues and more. King’s Fund analyst Danielle Jefferies set the scene. “Pretty much every part of the emergency pathway is blocked at the moment,” she said. This included ambulances waiting to handover patients, waits in A&E and for beds, while difficulties in discharging patients meant bed occupancy was high. These were affecting staff and patient experience and trusts’ ability to do elective work.

Healthcare Estates and Facilities Management Association council member Nick Phillips said: “Some of these issues would be system wide issues, but there are some first principles you can look at in how people work and move around hospitals. Are there estate barriers to those? Often it can be that there are choke points – more so during the pandemic when we have had restrictions on space.”

Putting patient flow at the heart of design and resourcing correctly could help, he said. And, while it was undesirable for patients to wait for hours in A&E, making space more user friendly could ease that journey.

But estates and facilities teams could also aim to “work smarter” with an emphasis on matching demand for their services with the resources available across the day, and using systems which tracked when jobs were completed, he continued.

Rochelle Gee, head of property services operations at Buckinghamshire Healthcare Trust, said the trust - working in partnership with Sodexo - had introduced systems to give intelligent data throughout the day which could help with having the right number of porters to meet demand, for example. This had led to changes in how the workforce was deployed which had delivered benefits but also challenges: “We have gone from very traditional methods of doing things from having dedicated teams to making sure that a bigger team could get to where they are needed,” she said.

Simon Lilley, director of marketing and strategy at Sodexo Healthcare said there was “no silver bullet…but there is an opportunity for marginal gains.”

At a system level as integrated care systems emerged, there might be opportunities for less siloed working and for firms like Sodexo to support over a wider area. But at a more local level it was important to make sure clinicians were working at the top of their licence and not doing things which others could do. Sodexo had been involved in test centres during covid which meant that NHS clinical staff did not have to be used, he added.

And there was “smarter working” such as had been mentioned: Sodexo had introduced a new portering system which had increased the number of completed tasks by 26 per cent – which had a direct impact on flow.

There was evidence that this chimed with what patients wanted: a poll carried out by Sodexo showed that 93 per cent of patients believed a good experience in hospital would quicken their recovery and 50 per cent believed that a clean environment would help even more than their procedure, he said.

He drew a parallel between the importance of support services in the airline industry where turning round airplanes quickly was due to people like cleaners and the impact healthcare support services could have on patient flow.

Any NHS organisation is likely to be collecting huge amounts of data which could offer information on patient flow and how to improve it. Ms Gee said Buckinghamshire was working with a number of partners – including Sodexo and NHSX – to pilot using data from different sources to do this.

But there may be other ways in which partnerships can help to tackle some of the issues around flow. Many trusts have large maintenance backlogs which they would struggle to tackle with the capacity available, said Mr Lilley: could support services organisations provide help with this? And could they have a role in areas such as collecting information and recording data on patients’ hydration?

But what about capital? Some chunks of money had been channelled towards improvements in areas like A&E but is there a challenge around smaller capital investment projects, suggested HSJ chair Alison Moore.

Mr Phillips pointed out the new role of ICSs in this – with ICS based plans for capital and trusts working together to ensure that all available capital was used in a year - but said there was still not enough capital to progress all the projects.

“On the smaller things there is money available but the route to the money is bureaucratic,” he said. “We just need to get local systems more streamlined so that money which is available gets to the frontline more quickly.”

Ms Gee said Buckinghamshire had a really challenging estate. Sodexo was about to invest some money in their A&E department as part of their long-term partnership with the trust. This would make the area easier to clean but also created a better environment for patients and staff. This sort of relationship could lead to anything from building new ICU units to car parks, said Mr Lilley.

And there were other areas where support services organisations could help. “We are able to work with both existing and new hospitals to advise them on what volume, what types of clinical technology they need in their hospitals – everything from chest pumps to scanners,” he said. This extended into management, repair and maintenance and auditing of the technology once it was installed.

He suggested there was a core set of services which the NHS would expect a company like Sodexo to deliver but its offering now went beyond this and included new services to meet the NHS’s changing needs.

One example of this is a concierge service which Sodexo provides for staff at Buckinghamshire Hospitals – as well as some long stay patients in the hospitals – to sort out everyday problems for them. And there were opportunities for companies like Sodexo to provide non-clinical support to both patients at risk of admission and those who needed support at home if they were to be discharged, he said.

A recording of the session is now available. 

For those who had previously registered for the webinar, click here to view the on demand recording.

For those who have yet to register, click here and complete the form. Details of how to access the on demand recording will then be sent to you via email.