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The Chief Nursing Officer for England previews a new winter framework aimed at ensuring patients do not spend any time longer than they need to in hospital:
The last few months have been exceptionally busy in the NHS and I want to acknowledge all the hard work that has gone into planning for the challenges of winter.
Ensuring we build resilience in ourselves, our teams, in and across organisations is essential so we manage the months ahead with maximum certainty and confidence in our ability to provide safe care.
In 2018, we will celebrate the 70th birthday of the NHS. 70 years ago this year, Dr Richard Asher (1947) wrote in the British Medical Journal of the dangers of going to bed and described how every system of the human body is adversely affected by the deconditioning effects of staying in bed. He did so in a period of the NHS’s history when there was nothing like the level of system intelligence, both physical and organisational, that we now take for granted.
This year a number of key performance indicators are in place locally and nationally to predict surges in demand, stress, and response of the health system. In partnership with NHS Improvement, NHS England will be working within a winter operating infrastructure; which has a local, regional and national presence, to ensure we coordinate intelligence and action to maximise support when needed.
Public Health England colleagues will be a core component to further evidence-base our understanding of the effects of environmental changes on morbidity and mortality so we can predict service demands more accurately.
Amidst the changes that have occurred over the last 70 years of the NHS, the constant that has not changed is time, which is the real connecting currency of healthcare. While our time is busy and important, our patients’ time is sacred. It is a currency that manifests in many ways, from access targets and waiting lists, to staff running around looking for equipment. Even 70 per cent of the NHS budget is about time, because staff salaries reflect the amount purchased of their most precious commodity; their time.
That’s why I am proud to sponsor the impressive global work in England led by Professor Brian Dolan who is the Founder of the time-valuing movements that are #endPJparalysis and #last1000days, the latter of which I commissioned as a poem by Molly Case earlier this year.
#EndPJparalysis is a remarkable campaign that has swept across the country. It reminds us that for those over 80 years old, a week spent in bed can equate to 10 years muscle ageing, a loss of 1.5kg of muscle mass and a 20 per cent reduction in aerobic capacity. It can also lead to a five-fold increase in the risk of requiring institutional care and, in one study by Lim et al (2006), some 47 per cent of delayed transfers of care related to deconditioning.
In July 2017, in the North of England alone, if every patient was discharged just one day earlier it would have released 2,707 bed days for other people, saving the NHS £5.6million.
So let’s use the privilege we have as leaders to give back the most precious gift we can to patients; the gift of time. Leaders can ensure environments are created where people move around in their own clothes. Environments where every day is green not red, because every action taken is purposeful and ensures it takes the patient one step closer to safe discharge. Let’s make giving back time by enabling our patients to return to the place they call home our challenge. It’s one where every member of our clinical teams can have an impact and make a difference.
We will be publishing a framework to further enhance winter arrangements in the coming days. Creating cohort environments for patients who are medically fit for discharge is going to be a clear ask alongside ensuring we increase the ability to use all available care home beds, where appropriate, so patients do not spend any longer than they need to in hospitals.
I ask all nurse leaders to look at how therapeutic environments can be strengthened in all ward environments, with a specific emphasis on using #endPJparalysis to do this.
Professor Brian Dolan will be working with leaders from NHS England and NHS Improvement through a series of webinars and information about how to access tools and resources to support you further. The current NHS East of England 100 day, 100,000 patient day #endPJparalysis campaign is also providing us with great learning for a national campaign we are planning for next year; I’ll announce more on that later.
I am grateful to everyone for the efforts to date in preparation for the challenging months ahead.