A "fundamental rethink" of how health and care services look after people with complex illness will be needed to solve issues such as ambulance handover delays and the difficulties hospitals have discharging patients.
That's according to the new chief executive of the North East and North Cumbria Integrated Care System (ICS) Samantha Allen - who told ChronicleLive about the ICS's drive to take "high impact steps" to tackle these issues in its first 100 days of officially existing.
The ICS - and the Integrated Care Board (ICB) which controls the NHS purse strings in the region - came into being on July 1 this year, replacing clinical commissioning groups across the region and theoretically heralding increased collaboration both across the region and between the health and social care sectors.
This comes as both the NHS and social care face acute staffing crises and with delays at both the front door - A&E - and back door - discharge suites - of our hospitals. Hundreds of "medically-fit" patients cannot be sent home from hospital due to a lack of community provision, while A&E performance standards are hitting record lows.
Though North East hospital trusts are not suffering as badly as some of their counterparts around England, the County Durham and Darlington NHS Trust has been particularly hard-hit. More than 160 people spent 12 hours or more on trolleys at the trust's A&Es in July, while just 45.8% of patients were seen within four hours.
Speaking before the July data was revealed, Samantha Allen highlighted that delays at A&E and in ambulances outside of A&E were inherently connected to issues across the health and care system. She said: "This isn't just delays in emergency departments. it's not any one person's fault. This is very much a system issue."
The ICS had - even before its official launch - been working with NHS bodies including North East Ambulance Service and the region's acute hospital trusts to identify problem areas for ambulance handovers and raise performance.
She explained that the NHS centrally had set ICSs a challenge of making ten "high impact" changes in their first 100 days of operation, adding "The sorts of things we are doing include making sure that in in hospitals, we've got integrated discharge hubs.
"So we've got social workers, nurses, and occupational therapists all working alongside each other. |That's reducing the delays between referrals to organisations, but we're also, at the point of admission, planning for discharge as well. Because sometimes when it comes to getting somebody home, we need to make sure they're home has all the right adaptive aids and everything they will need in place.
"So we're looking wherever possible to ask how can we reduce the amount of time that it puts these things into place?"
Ms Allen said the much-publicised issue of ambulance handover delays - which see ambulance crews unable to handover patients to A&E staff due to pressure in emergency departments, and therefore unable to get back on the road and to their next calls - were a "symptom of a system under chronic stress".
"There are things we're doing to reduce ambulance handover delays, and there's not one clinician or paramedic that I've spoke to, that wants to see these increase . But actually, if we're going to really tackle this, we've got to have a fundamental rethink about how we care for people with chronic comorbidities and our frail population.
"We need to really rethink about how do we care for people with these chronic comorbidities in a way that keeps them well, and wherever possible supports them in their home and in the community."
Delayed discharges have been a growing issue in the NHS, exacerbated this year in large part due to the impact Covid-19 has had on sickness levels in social care. Ms Allen said the most important thing was to recognise that staying in hospital longer than necessary was an issue for patient and the NHS alike.
She said: "These are people. It could be my mum or dad, brother, or sister. Nobody wants to stay in hospital. We also know the evidence says that for every day people are staying in hospital, they're deteriorating. As well as their muscles wasting, it's not good for people to have prolonged stays in hospital.
"So working together with all the agencies to do what we can to get people home quicker is really at the heart of this and what that then means is actually hospitals have got the space when people come into the emergency department if they need to be in hospital.
"We have to get the right care at the right time in the right place. That's what we're striving to do, but [the current situation] is a symptom of a system on distress,"
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