Of all the challenges facing NHS trusts, capacity is one of the biggest.
As the population grows and ages, hospitals often struggle to maintain high levels of patient access.
This can rear its head in many different ways, making a simple, catch-all solution seem unlikely.
But unlikely is not synonymous with impossible and, as The Shrewsbury and Telford Hospital NHS Trust (SaTH) has found, one simple solution can make all the difference in a variety of scenarios.
Hospitals up and down the country are now at capacity, even at quieter times of the year, so when demand naturally peaks in the winter, or when facilities close for maintenance, trusts face either mounting backlogs of waiting list patients, or the need to outsource to private providers
As the baseline demand for healthcare increases, trusts are struggling to cope with natural fluctuations in activity.
Hospitals up and down the country are now at capacity, even at quieter times of the year, so when demand naturally peaks in the winter, or when facilities close for maintenance, trusts face either mounting backlogs of waiting list patients, or the need to outsource to private providers, losing funding and, crucially, control of the patient pathway.
However, there is an alternative: flexible infrastructure.
Billed to play an increasingly central role in future community-focused healthcare systems; flexible infrastructure can also deliver more-immediate solutions, allowing trusts to temporarily increase capacity on site at times of high demand and to meet a variety of needs.
Over a three-year period, SaTH has developed an award-winning partnership with Vanguard Healthcare Solutions to tackle capacity issues, with some remarkable results.
By embracing the concept of flexible infrastructure, together they have been able to not only complete critical refurbishment works without causing delays to patients, but also clear a backlog of waiting list patients and create medical capacity for the busy winter period. So how did they do it?
Endoscopy refurbishment
Initially, the partnership began with the specific goal of keeping activity up during refurbishments to the endoscopy facilities.
With an intelligent partnership, creative solutions to age-old problems are by no means impossible
SaTH intended to provide separate recovery wards for men and women at the Royal Shrewsbury Hospital. This required major development work, meaning vital facilities had to be temporarily closed, with real potential to slow access to endoscopy services.
The trust approached Vanguard to provide a solution, which was the installation of a state-of-the-art mobile endoscopy suite in the hospital grounds to accommodate patients displaced by building works in the main hospital.
The Vanguard unit was installed and ready to receive patients in just 18 days, coinciding with the peak of the building works.
In the 30 days it was on site, over 200 patients were seen who would otherwise have had to wait for treatment or travel further afield.
This continued level of endoscopy services, coupled with the newly-efurbished recovery wards allowed the trust to achieve its goal.
Clearing a backlog
In the same year the trust had built up a backlog of patients waiting for maxillofacial and orthopaedic surgery and, although it could have outsourced to other healthcare providers, finding those with the capacity to take on patients proved to be difficult.
The trust was also keen to maintain control of its patients’ treatment and their overall experience, recognising that most patients prefer to be treated at their local hospital.
At that time, the percentage of patients being seen within the NHS 18-week Referral To Treatment (RTT) standard was:
- 38.6% for oral surgery
- 66.1% for trauma and orthopaedics
- 82.4% overall
Having learnt from its previous experience with flexible infrastructure, the trust approached Vanguard again to come up with a solution.
Facing a bigger-scale challenge than the endoscopy unit was able to overcome, Vanguard chose to install a full mobile visiting hospital on the grounds of the Princess Royal site for a total of 134 working days. In that time, the trust was able to see 742 patients who had been on the waiting list for over 18 weeks.
By the end of the contract, the percentage of patients being seen within the 18-week standard was dramatically improved:
- 85.2% for oral surgery
- 92% for trauma and orthopaedics
- 91.3% overall
Winter surgical capacity
A year and a half later, the trust found that increased winter demand had the potential to cause recently-cleared backlogs to sky-rocket once again.
Demand for treatment fluctuates drastically throughout the year and, unsurprisingly, peaks in the winter.
Hospitals often dedicate extra ward space to medicine over the winter months. However, as the winter of 2015/16 approached, the trust faced a major challenge, with insufficient space to cope with the predicted influx of patients.
With an intelligent partnership, creative solutions to age-old problems are by no means impossible
The trust recognised that flexible infrastructure could again provide the additional capacity necessary to overcome the challenge and, on the advice of Vanguard, made the decision to move one of its elective orthopaedic wards into a newly-installed mobile clinical ward. In so doing, the trust released a hospital ward for medical patients. Over 400 patients were treated during the time the unit was on site and elective emergency access increased.
With an intelligent partnership, creative solutions to age-old problems are by no means impossible.
When the NHS reconfigures its services, flexible infrastructure will play a more-central role in the delivery of community-focused care.
Trusts can utilise mobile facilities now to solve a variety of more-immediate challenges. By thinking outside the box and embracing a truly-flexible solution, Trusts can manage fluctuations in demand, without compromise.
