Our view
The cold temperatures and wintry weather over the past few weeks act as a stark reminder that the NHS is already extremely busy dealing with seasonal pressures. In our annual survey tracking the state of the sector, 96% of trust leaders said they were extremely or moderately concerned about the impact of seasonal pressures over winter on their trust and local area. The most common reasons for concerns related to financial constraints and staffing provisions. Patient safety was also mentioned as a key concern this winter, given increasing demand and capacity constraints.
Data published by NHS England in November shows the already stretched operational position across the NHS, as trusts leaders enter what they fear could be the most challenging period of 'winter pressures' in their career so far. Impressively, the NHS is delivering more in terms of planned physical care, with high levels of activity across consultant-led treatments, diagnostics, and cancer care. However, higher than ever levels of demand across the urgent and emergency care pathway, coupled with vast waiting lists across community and mental health services, highlight that all health and care systems are already running 'hot' in autumn and pose a persistent cause for concern. Despite local efforts to prepare and innovate to prepare for winter, as set out in this month's case study, this national data only confirms the fears many trusts leaders hold about the risk that they, and their staff, are managing over the coming months.
Walsall's Integrated Front Door service helping to prevent admissions and improve patient care
Kerry Sansara, Community Lead, Integrated Front Door Service at Walsall Healthcare NHS Trust discusses how the Integrated Front Door service is improving patient care and referrals into community services.
The Integrated Front Door (IFDS) Service is a community team based within the acute setting to facilitate discharges where the patient requires follow-up or continued care within the community setting. The service was launched December 2020 as a pilot scheme part of Walsall Together. The aim for the service is to prevent hospital admissions from the front door, to expedite discharges to reduce lengths of stays but to go further and ensure community pathways are utilised to prevent hospital re-admissions where possible. The team itself acts as a 'front door' providing an alternative to A&E for patients who can be cared for in the community. This is achieved with integrated working between multi-disciplinary teams including frail elderly service (FES), community nurses, pharmacists, therapists, ambulance services, other community services, social care, volunteer services and most recently virtual wards.
The team comprises of a service lead, four band 7 team lead specialist nurses and two band 6 clinical community sisters. The service runs over a 7-day period working 8am until 8pm.
The team will see and assess any patients from the age of 18 who can otherwise be cared for in the community and do not need an acute admission. Since launch we have dealt with a wide variety of patients from frail elderly patients to young homeless adults. As a service we are also able to initiate emergency crisis care for 72 hours to help keep the patient safe in their own home.
The band 7 team leads will scope our emergency department for patients that we believe can be cared for back in the community. They will also attend the board rounds in the Emergency department, acute medical unit and short stay medical ward. Our band 6s will scope the wider inpatient wards to assess and review for early expeditated discharges on to community pathways. The band 6s work closely with our intermediate care services to ensure ongoing social care needs are put in place prior to discharge.
We have numerous services that we step patients down to these include our specialist teams such as respiratory, heart failure, continence, frailty case managers and the enhanced care home team. Our biggest success of late is the virtual wards via our care navigation centre, this service has enabled us to safely allow patients to receive the care in their own home whilst still be monitored.
Since our launch in December 2020, we have avoided over 5,000 admissions to an acute setting by assessing these patients' stability and safety to be placed onto a community pathway. We have also successfully expedited over 1,800 earlier than planned discharges from the wider inpatient wards with ongoing community support. From January 2024 we have been monitoring our 30-day readmission rates and these figures show that over 90% of the patients we deal with in the acute setting each month, have not returned to hospital and are being managed successfully by community services.
The service would not be as successful as it is without the amazing work being completed by our community services in Walsall Healthcare NHS Trust.