The squeezed NHS is responding to difficult times by innovating

Times are hard for the health service: performance is on the decline, the money doesn’t add up, morale is low, there are finite resources and increasing demand. Is it a perfect storm? Or a very long winter of discontent?

NHS Providers has published its new report, The State of the Provider Sector, which gives a clear appraisal — and the picture is, in places, quite gloomy. But we also show how hospitals, mental health, community and ambulance services are responding with ingenuity in such challenging times.

The findings in the report are drawn from a wealth of published data alongside the largest ever survey of NHS trust chairs and chief executives, carried out just a few weeks ago. We had responses from well over half of NHS trusts across England. They raised important concerns, including worries over the workforce and sustaining quality of care at current levels.

Quite rightly these are the conclusions that will capture the headlines. The NHS is seven years into the longest and deepest financial squeeze in its near-70-year history. But amid fears over staffing and funding, it is important not to overlook the work trusts are doing to deal with these challenges, sometimes with great success. In pulling together this report, we have been struck by examples of innovation and improvement. This has spurred us to search for the kernel of gold in this situation.

The key to finding that kernel is to think about patients and service users: they should be at the heart of NHS reform. So whether it’s delayed transfers of care, A&E admissions, or mental health crisis care, it is the combination of improving an individual’s experience and making the system work better that can prove a successful approach.

Overcoming delayed transfers of care is a strong reason to focus on what is keeping mainly frail, elderly people in hospital when they are medically fit enough to leave. At Oxford University hospitals, providers have struggled with one of the worst rates of delays for the past five years but under new leadership and new approaches, Oxford has halved its delays. In effect it grew its own social care provision.

It did this firstly through better collaboration with social care providers and secondly by creating its own social care workforce and capacity. This means people can be discharged straight into the community. This not only provides a better and safer experience for patients but also frees up hospital beds, which improves the flow of patients and generates capacity for planned elective work.

Sometimes navigating the myriad health and care organisations must, to a patient or service user, feel like finding your way through a maze. The whole process can be daunting, frustrating and woefully inefficient.

Southwark and Lambeth Integrated Care Programme (Slic) decided its situation just wasn’t slick enough. It embarked on a “radical” join up of services across the local NHS and local authority social care systems. So GPs, community healthcare, social care and local hospitals came together and put the patient first. Over the past four years the Slic approach has not only stabilised the number of hospital bed days used — quite a feat in the face of exponentially rising demand — it also led to a 61% reduction in the number of nursing home placements.

In terms of mental healthcare, Surrey and Borders partnership has worked with local charities and commissioners across the south to launch Safe Havens — a drop-in service that provides out-of-hours help for anyone experiencing a mental health crisis. It has close links to Frimley Park hospital and provides a safe alternative to using A&E. Six months after opening, the service has helped to reduce psychiatric admissions by 33%. Not only is that a better experience for a service user, it also helps to prevent the ongoing call on expensive resources.

We know that hospitals and other services are running at capacity levels well beyond those of other western economies. We know that the NHS is now missing most of its key performance targets. And we know that it interacts with more than five million patients and service users every week.

But that shouldn’t blind us to what’s happening. With these and other projects, services and programmes that consider the quality of individual experiences and the needs of the wider system together, NHS trusts are innovating, improving care and driving efficiencies. These are the kernels of gold.

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The squeezed NHS is responding to difficult times by innovating