Our view
In our winter editions of this series, we will be analysing trends across the acute, ambulance, community, and mental health sectors, as well as interrogating the NHS England weekly winter situation report (sitrep) data. This data focuses predominantly on hospital capacity and factors that influence available capacity, such as beds closed due to seasonal illness and occupancy by flu patients. These metrics should be treated as a litmus for wider system pressures. Read in conjunction with the sector analysis, the interdependencies at play across the health and care system come into focus.
The wide range of data published in December gives a sense of the complexity and risk that trusts across England are currently facing. In an effort to increase planned care, activity across elective treatments, cancer care and diagnostics improved. However, the demand challenge continues to hamper any meaningful progress on headline metrics. Despite the elective waiting list decreasing for the second month in a row, the number of new ‘referral to treatment periods’ reached a record level, meaning that demand is higher than ever despite increased levels of activity.
Similarly, demand across urgent and emergency care is relentless, with the busiest year on record for emergency departments and a staggeringly high number of category 1 (the most serious) ambulance callouts.
Progress is being made across community and mental health, with a record September for community sector care contact activity and the highest recorded number of mental health care contacts attended. But increasing numbers of referrals mean waiting lists remain stubbornly high in both sectors.
The first two weeks of NHS winter data show that flu is having a significant impact on bed capacity – with NHS England calling it a ‘tidal wave’. It is likely that the impact of flu on the service will continue into Christmas and the New Year.
Increased prevalence of flu and norovirus in hospitals is a reflection of what is happening in the community. Primary care and community services are also facing challenges due to seasonal illness, with the likely knock-on effect an increase in staff sickness and reduced staffing levels across the NHS’s 1.2 million workforce, who are equally affected by high community prevalence. Maintaining patient safety remains the top priority for frontline staff and leaders alike.
Trusts have been braced for, and have planned for, a really hard winter. In a recent survey, almost all (96%) trust leaders said they’re worried this winter could be the most challenging of their careers. But we know that staff continue to drive innovation and improvement methodologies alongside the day-to-day challenges. Our case study this month showcases a tool, introduced at Barts Health NHS Trust, which has been proven to reduce infection rates. This example of innovation received a Health Service Journal award for patient safety, showing how trusts continuously strive to improve clinical care and patient outcomes.
Barts Health NHS Trust's 'BLISTER' system helping to reduce infection rates
Dr Edd Maclean, specialist cardiology registrar, discusses how the team at Barts Health NHS Trust have reduced infection rates by using a tool to identify patients most at risk of infection after receiving a cardiac device.
The rate of infection for patients with implantable electronic devices that regulate heart rate and rhythm - such as pacemakers and defibrillators - is on the rise globally. As technology becomes more complex, and people live longer with chronic health conditions, the risk of device infection following implantation or replacement increases significantly.
Clinicians from the Barts Heart Centre at St Bartholomew's Hospital, part of east London's Barts Health NHS Trust, developed the BLISTER score to determine which patients stand to benefit most from an antimicrobial envelope, a surgical mesh lined with antibiotics that is proven to reduce the risk of infection in the 12 months following a procedure.
Working alongside colleagues from the Royal Papworth and Guy's and St Thomas' hospitals, the team studied data from over 12,000 patients to determine the factors that increase the risk of infection.
The acronym 'BLISTER' represents different clinical factors that contribute to the overall score. Since adopting the BLISTER system, infection rates have reduced to below 1%, and the tool has delivered annual savings of more than £100,000. Their work was recently recognised with a Health Service Journal award in the Patient Safety category.
Device infection is a devastating complication with significant ramifications for patient mortality, quality of life, and healthcare expenditure.
The TYRX antimicrobial envelope is highly effective, but it is too expensive to use in every case. With this in mind, we recognised the need for a tool that could identify high-risk patients who may benefit most from additional technology.
Whilst the economic modelling behind the BLISTER score was complex, the score itself is very easy to use. An online calculator allows colleagues to generate a score at the bedside and posters in the cath labs prompt the team to risk assess every patient. BLISTER has therefore enabled all members of the multidisciplinary team to recognise and quantify the likelihood of infection risk. Device infection is at an all-time low.
The system has been endorsed by the British Heart Rhythm Society and trusts who demonstrate they are using the score can get the cost of the TYRX envelope reimbursed by NHS England. We know that BLISTER is being implemented in many different centres across the country, but for the score to become the gold standard it would need to be incorporated in international guidelines. The electrophysiology team are delighted to be recognised by the HSJ, and we hope this will further spread our Barts model to device patients across the NHS and beyond.