Opinion: the government is failing to successfully address the excruciating NHS crisis

Max Parmentier, Co-Founder and CEO of Birdie, an at-home healthcare technology platform, shares his opinion on ways the government could better take the reigns and help assist with the current traumatic NHS and social care crisis. 

In the last three years the NHS have been struck by a global pandemic and a spiralling cost-of-living crisis which makes it fair to see why the organisation is on its knees. With thousands of vacant positions and a major lack of supplies, health staff are crying out for help more than ever.

In January 2023 the government tried to relieve pressures off the health institution by providing them with £250m to accelerate hospital discharge in a bid to resolve the ongoing catastrophe. The NHS plans to use most of this money to buy thousands of existing beds in care homes, making more space available within hospitals. Following this, GPs and community nurses will care for the discharged patients within the homes.

We certainly welcome this measure as a first step to tackle the NHS and social care crisis. However, we still expect more clarity on how this injection of funds will bolster community care – an area that has been largely neglected.  

With around half of all hospital delays being the result of ‘simple discharges’ – cases that require no further outpatient treatment – beds in care homes won’t do much to reduce a major cause of delay. Either way, care homes may not even have the extra space in the first place.

Alongside this, the government have also attempted to improve the efficiency of the NHS’ technological process in an attempt to relieve current pressures. The NHS has been designed on a concept of ‘integrated care’ – partnerships of organisations that come together to plan and deliver joined up health and care services.

At the beginning of the year, the government merged NHS Digital with NHS England, which will now run national IT systems that may accelerate discharges within the service.

Whilst technological progress is always welcome, neither of these actions will address the greater underlying problem: a lack of cohesion between the NHS and the social care system. Older adults currently occupy 70% of emergency room beds, meaning a way of solving the bed blocking problem would be to discharge these patients, however the lack of care home bed spaces makes the plan unfeasible.

Together, the government, NHS and care providers must find other ways of assisting with the harrowing health crisis. These are my suggestions:

Preventative care  

If there are too many people in hospital beds, the most logical solution is to try and prevent them from getting there in the first place.

The government have announced some measures to adopt preventative practices, now it must get serious about it. Older adults occupy most A&E beds and 40% of their admissions could have been avoided if we had detected the early signs of deterioration. A vast amount of fall detection and early warning of deterioration schemes have been initiated, but none have been expanded. The NHS must lead these initiatives and gain the appropriate funding to support care providers in administering them.

Care at home

Birdie has been advocating for several years for a healthcare system that is more integrated to leverage the network and care capacity at home, instead of hospitals. We’ve been excited to see the government jumping on the idea in recent months.

The Prime Minister has pledged to create 3,000 ‘hospital at home’ beds before next winter hits, with the aim of caring for an estimated 50,000 people from home. However, the government must now follow through on this commitment by facilitating the cohesion between health and social care data.

At the moment, the way these institutions share information is disjoined. As such, efficient integrated care systems processes that make hospital discharges more effective and preventative care possible, are lacking.

Accelerated discharge

In an ideal world, once somebody has made it into a hospital bed they would be treated and discharged as soon as possible. However, as it stands, one in seven hospital beds are occupied by somebody who could have been discharged sooner.

According to research by Age UK, the estimated cost of the delay of getting people out of hospital beds varies from £350 – £1,000 per day. In addition to this, long delays are causing negative impacts on older people’s physical health – lying down or sitting in a bed for too long can lead to up to 10% of muscle strength loss, therefore hindering independent living and increasing the likelihood of re-admission.

To solve this issue, Discharge to Assess programmes with staff visiting patients at home within the first week of being discharged work well. However, for them to be widely used they must receive more funding and governance.

In addition, hospitals must work closely with social care to leverage the local community care capacity when available – more often than not these providers are not involved in the conversation, or the lack of visibility delays the discharge.

Expand ‘virtual wards’

The idea of ‘virtual wards’ includes nurses checking on patients with specific conditions remotely – the project has succeeded so far, but the range of conditions covered are limited. The number of patients eligible for a virtual ward is also restricted as they are expected to measure their own heart rate, blood pressure and temperature.  

To unlock significant capacity in hospitals, the integrated care systems must increase the number of conditions treated with virtual wards and become more flexible with the care delivery model – a system that is led by a nurse and a physician that functions as a team and has the operational responsibility and accountability for patient care quality and overall efficiency of care delivery.

I have experienced numerous social care providers training their staff to be able to provide complex care, meaning they will be able to provide the full ‘hospital at home’ experience. As well as this, social care staff will be able to help take patients’ blood pressure and temperature, resulting in a vast amount of more people receiving the care they require.

Photo by Ehimetalor Akhere Unuabona and Levi Meir Clancy