Patient flow is the battleground for the future of the NHS in Wales

The NHS in Wales is facing mounting pressures, and progress is lagging behind the rest of the UK. People in Wales are struggling to access health services, staff have been described as ‘dead on their feet’, and waits for care continue to lengthen.

65.7% of A&E patients were seen within four hours in July, compared with 66.4% in June, and 53% of people are waiting over 26 weeks for treatment. Yet despite these record-high waiting times for patients requiring care, thousands of medically fit patients remain in Welsh hospital beds due to delayed discharge.

In 2015, Wales outperformed England in key metrics of their health service performance. 88% of cancer patients began treatment within 62 days of referral, compared to 84% in England, and while England reduced their social care spending by 11.5%, Wales cut theirs by just 0.8%. Now, both countries face the same unprecedented challenges caused by increasing demand and the impact of COVID-19.

So, how can the NHS in Wales overcome these pressures and reclaim the success it once had? To deal with the problem, we need to identify the cause. Not just in Wales, but across the UK, poor patient flow is a leading cause for record-high delays and waiting times. The Welsh Auditor General said: “Some health boards told us that they can have several hundred medically fit patients occupying hospital beds at any one point in time.”

The Welsh Government recently released their programme for transforming and modernising planned care and reducing waiting lists and have also announced their work to improve urgent and emergency care. Whilst the plans set out by the Welsh Government are helpful, they don’t clearly address one of the leading causes for these delays and record-high hospital waiting lists – patient flow.

We recently conducted a survey with hospital and care staff from across the UK, with respondents telling us that they believe almost half (43%) of patients on hospital wards meet the NHS’ criteria for hospital discharge, meaning they are well enough to leave hospital. With NHS Wales facing unprecedented pressures from the COVID-19 pandemic to a workforce crisis, almost one in five UK hospital workers (17%) reported patient flow as the biggest problem they face.

Therefore, we suggest that NHS Wales unlock patient flow by implementing steps that focus on:

Collaborative planning

• Active collaboration between hospitals, social care, families and providers from the moment a patient is admitted to hospital is critical. A system that works for patients needs hospital teams, social care services, families and providers working and planning together as early as possible. Our survey showed that in 31% of cases, hospital discharge is not discussed until treatment nears completion.

System redesign 

• We need to adopt integrated system design and innovative care delivery models. To address the multi-faceted delays to patient flow we must bring together knowledge and skills from across the entire health and care sector. Discharge is everybody’s business.

Digital infrastructure 

• Building on the digital infrastructure enables more effective case management, better monitoring of complex cases and ensures adequate resource is available by addressing inefficiencies.  Digital technology also helps us manage and measure patient flow across the system.

Family involvement 

• We shouldn’t wait until patients are better before engaging with their family and next of kin. 92% of staff agreed that engaging with the patient’s family and carers early on makes a successful discharge.

With unrelenting pressures being felt across the system, accelerating patient flow is the immediate and glaring opportunity to create sustainability in NHS Wales and ultimately, protect patient outcomes.

We hope that Welsh health boards will clearly set out how they will address poor patient flow. Without this, we cannot hope to move patients efficiently in and out of hospital on a national scale.

Find out more about our work with front-line staff and senior NHS leaders to uncover the patient flow challenge, and how Xyla can help you to optimise patient flow, here.