Redeploying staff to manage adult continence service waiting lists

Case study summary

Key learnings from a community nurse-led taskforce:

  • Value in working flexibly to support and re-deploy skilled ‘shielded’ staff to support their colleagues and patients in different ways.
  • Dedicated teams of redeployed nurses making a huge difference is a specific targeted area.
  • The introduction of virtual assessments has supported a reduction from 1600 people waiting for a first appointment to only 20.
  • Virtual services are improving processes without affecting the quality of service provided

Background to learning

During the pandemic, the normal running of services has been challenged by the requirements for social distancing, the redeployment of team members to other services, sickness, or self-isolation of staff due to Covid-19. We have also seen that patients have avoided presenting to services due to their fears of mixing beyond their household.

This case study covers how a community nursing team worked with the Adult Continence Advisory Service to consider how services could be provided to manage the large waiting lists that have developed due to the pandemic.

Learning and advice to be shared

The Continence Team are a small team of seven people. During the pandemic, system pressures and requirements to self-isolate challenged and disrupted its delivery of services.  As a result, a waiting list developed for services such as annual assessments and bladder scans at home.  The Community Matron at Northamptonshire Healthcare NHS Foundation Trust provided clinical support and leadership and co-ordinated a taskforce team to help reduce waits for care.

The wider community nursing team supported this service by supplying a taskforce of ten nurses who were shielding or working differently from home.  Service adaptations were made with the aim of delivering safe care and the right outcomes, whilst reducing waits for a first appointment.

  • Virtual clinics provided by the taskforce nurses and patients were offered with telephone assessments to discuss their needs and to develop care and treatment plans. The team also offered an advisory service for the wider multi-disciplinary team, communicating with GPs and others to optimise the care of patients.
  • Healthcare assistants, with appropriate support, carried out bladder scans in patients’ homes where this was needed, following appropriate PPE guidance.
  • To support this way of working, a single point of access hub was established to support streamlined referrals and ordering processes.  This created time and space for nurses to focus on delivery of virtual clinics and more urgent cases.

Would it be beneficial to keep this change?

After initially pausing some care during the first wave, all organisations are working hard to restore and maintain services, even during subsequent waves of transmission.

Through restructuring the continence service delivery, patients were able to choose virtual assessments/reviews. This supported reducing the number of people waiting for a first appointment from over 1,600 to only 20.

Teams have capitalised on the temporary availability of resource from a pool of shielding/isolating staff.  Although similar pools of staff will not be available beyond the pandemic, the work of the team shows what can be achieved when a group of nurses are able to be deployed to support a targeted area.

This flexible way of working has engaged ‘shielding’ nurses who may at times feel frustrated when they have not been able to carry out their normal duties. It has also supported patients to have more control over their conditions and treatment options. Throughout the pandemic organisations have continued to find creative ways, supported by technology and new models of care to deploy the skills and knowledge of colleagues across systems whilst also maintaining the safety of patients and practitioners during pandemic working.

The NHS People Promise reflects what matters most to staff and includes the promise to work flexibly – through different and flexible working practices.  This responsive approach shows the potential to continue to engage staff through appropriate adjustments and for the development of flexible roles that fit the lives of our nurses.

Case study by Laura Clifford, Community matron, Northamptonshire Healthcare NHS Foundation Trust. For further detail on this case study or to connect with Laura, please contact england.1professionalvoice@nhs.net