Regular readers of the blog will recognise that I try and provide an honest update from around the Trust each week and most recently this has been focused on the unprecedented challenges facing our hospitals and community services and settings at the moment.
The past few weeks, the first of 2023, have been difficult. The pressure and demand on services – and indeed colleagues across all teams – has been immense.
Last month nearly 19,000 people came through the doors of our urgent and emergency care settings, which is the second highest number we have ever recorded in one month in the Trust. To put that figure into context it’s also 2,000 more than in September 2022, which is when we started to see the prevalence of ‘flu and other winter illnesses begin to rise. That is an incredible trajectory.
It has been very difficult indeed to manage but I have also spoken many times about ‘the spirit of ELHT’ and how, as a team, we find our way through these things, together. I wanted to share with you how I think we are doing this through some new and innovative initiatives, transforming the way we work to help support each other, our patients and their families.
Over recent months we have strengthened our community teams, who work tirelessly to support patients in their own homes, helping to speed up recovery and prevent an admission into hospital. This is known as a ‘home first’ approach and we are really starting to see the impact of this activity. Home first is at the heart of our coordinated response to stop unnecessary admissions and support the earliest possible discharge of every patient.
Towards the end of last year, our Intensive Home Support Service (IHSS) also started to provide a ‘front door’ service in our emergency pathways, which means colleagues identify patients who are well enough to receive care at home, in the hope they might not even need to be admitted to hospital for treatment at all. It’s a multi-disciplinary team, so they are able to provide assessment, treatment and agree a plan of care with the patient and their family.
It’s been a welcome addition to our Emergency Department (ED), as their intervention at the front door is saving patients many hours of unnecessary waiting but, to give some idea of how much this is helping us to manage very high demand, in November and December the team identified and assessed over 300 people, including those who had fallen, were suffering respiratory illness or were generally unwell.
The team has also developed some fantastic relationships and partnerships, not just across the Trust but also the wider health and social care system, to ensure patients can return home to receive the care they need rather than stay in hospital. It’s important to recognise that patients looked after by this team are in ED less time than others.
ELHT also has a dedicated Community Hub, based at Burnley General Hospital, that is now also supported by North West Ambulance Service (NWAS), and is midway through a pilot to identify patients who could be supported by the IHSS too. This trial started late last year so there have only been a small number of test days, but what we already know is that out of 65 patients reviewed through the usual call handler triage process, 48 were highlighted for IHSS intervention and our teams were able to get somebody out to the patient within two hours, reducing the need for most to even attend hospital.
The work with NWAS is helping health care professionals in care homes across Pennine Lancashire direct people to this two hour Urgent Community Response Service (run by IHSS) rather than rely on a paramedic crew attending – and we’re managing to deliver this rapid response on over 90% of occasions – which is a tremendous achievement and way in excess of the national 70% target. December saw record referrals, so word of this service really is getting out and starting to be used effectively.
Initiatives like this aren’t easy to identify, test or implement – so it’s great work by people to make changes that really matter and make a difference to the lives of local people. The results – whilst in the early stages in places – are brilliant and I want to say a huge well done to everyone involved in improvements so far.
Colleagues across the Trust have also worked hard to find ways to safely discharge patients as soon as they are well enough, as we know recovering at home is always the best option and it helps free up beds for those who need them most.
That focus on getting people home as quickly as possible is embedded across our hospitals and a dedicated Integrated Discharge Team is working hand in hand with our Community Hub and colleagues on wards. Between them, the care of every patient is scrutinised day to day to identify what else could be done to get them one step closer to their own bed.
Our well established, nationally recognised, ‘Home First’ team continues to speed up discharge by supporting aftercare needs, assessing people in their home to ensure they have everything they need and being that key contact with relevant services.
Of course, it’s not as simple as just sending them out the door. We need to make sure patients have the right support and care packages to continue their recovery at home, which might mean providing necessary equipment, arranging follow up care or the support of other services outside the hospital.
I am really proud of all these developments and in particular the close working relationships we have developed with other health and social care providers to make this happen.
So much unseen work is done behind the scenes to ensure patients can return home as soon as they are medically able by colleagues across the Trust in conjunction with local authorities, integrated neighbourhood teams, care home liaison nurses, mental health services and, actually, just too many other organisations to mention.
But I want to be clear this work is paramount to our success and to delivering the very best health outcomes for local people. Without it, we just wouldn’t cope in the current climate.
Of course, our work doesn’t necessarily stop when a patient is discharged as we are now supporting more and more patients at home too and we have an idea which involves creating ‘a hospital without walls’ by supporting a home or community-based response.
During Covid we introduced virtual wards, so we could provide support and consultations remotely. It proved so successful that we have continued to develop that concept to support other clinical conditions, again freeing up our hospital beds for those who need it most.
In the last quarter of 2022, over 2,000 patients were referred to virtual wards, or Hospital at Home as it is now called, for an initial assessment and only 10% were subsequently admitted to hospital. These are huge leaps forward which can only be good news for people seeking treatment for things like respiratory illnesses, frailty and musculoskeletal conditions.
And, lastly but my no means least, I want to mention our Intermediate Care Allocation Team (ICAT), which is made up of health and social care professionals and now available 24 hours a day, seven days a week.
This team works alongside District Nurses and Crisis Care who can support with a range of care services across Pennine Lancashire, as well as providing advice and support to care homes. This is now a ‘single point of access’ into all community services with the aim of simplifying what is available for those who are making referrals.
All of these areas are very much recognised by the Government as areas for the NHS to focus on and it’s great we’ve already identified them ourselves, which puts us ahead of the curve on achieving targets and continually improving performance.
As you can see, there is an enormous amount of work being done and we are not stopping there.
At ELHT we are very proud of our culture, we are open and transparent with our teams and actively encourage colleagues to help us find solutions to the challenges we face.
We're midway through a series of improvement weeks, where each directorate is looking at different aspects of patient flow to see how we can do things differently, more smartly or better. The power of that collective minds, with colleagues who are living and breathing these challenges every day is so powerful and we really are open to any ideas as we’ve not solved it fully yet.
However, the inroads we have made to transforming the way we work is a great start and is good news for all our patients who can be assured that every single one of us is committed to providing safe, personal and effective care.
Before I close today, I want to mention something that has been very difficult for ELHT – the recent death of our popular and much-loved colleague and directorate manager of our radiology department, Jonathon Priestley. Jonathon’s funeral was held yesterday and I was honoured to be able to attend with many, many people from Jonathon’s team and across the Trust as a whole.
It was a lovely service which ended with Jonathon’s own words. I have to confess this was the moment that broke me and many others who were there. It was heart breaking and sad beyond words.
I was pleased, however, to catch up with Jonathon’s wife Kelly for a moment afterwards and she was full of praise and love for everyone at ELHT who have done so much to support the family in the past few weeks.
Neil Fletcher, a close friend of Jonathan’s, has been amazing, I know, but Kelly also reflected on the vast number of other colleagues who have reached out and done everything they could to make this very sad time as positive as it could be for her and their daughter.
That is the ‘spirit of ELHT’ captured in essence, right there. No matter what – we come together and we get through the seemingly impossible.
I feel so privileged to have known Jonathon and I am so proud we have rallied around his family and wrapped our arms around them in this way at their time of need.
RIP Jonathon and thank you for reminding us what a great team we have at ELHT. Full of the very best people doing their very best for everyone.
Take care,
Martin