Expanding NHS Capacity in Response to Urgent Winter Pressure on Directory of Services

Across a series of recent oral evidence hearings, the House of Commons Health and Select Committee has heard from a range of healthcare experts on the growing elective backlog and NHS waiting lists, which have now hit an all-time high of 5.8 million patients. Throughout the sessions, the Committee has been advised of the intense pressure facing the NHS to continue the COVID-19 response, whilst balancing elective care demands; not to mention the growing concern for NHS services as we head into the winter season where demand increases significantly with the onset of cold weather and flu.

As COVID-19 cases continue to rise, despite the success of the vaccine roll out, NHS staff and leadership are urging the government to implement a so-called ‘Plan B’ – which includes the re-introduction of measures such as mandatory face coverings - to relieve pressure on NHS services. Daily UK hospital admissions for COVID-19 have surpassed 700 over the past few weeks, compared with data from 2020 showing less than 150 daily cases. Whilst the NHS is not currently suspending services, there is concern that the rise in cases is impacting staff - who were already struggling with unsustainable workloads pre-Covid – and their ability to deliver patient care.

One way that the NHS has been able to innovate and manage pressure on services is through the Directory of Services (DoS) - a central directory that is integrated with NHS pathways. It supports clinicians, call handlers, commissioners and patients by providing real time information about available services and clinicians across all care settings that are available to support a patient as close to their location as possible. Fundamentally, the DoS reduces the burden on urgent, emergency and secondary care settings by reducing unnecessary ambulance call outs and hospital referrals.

The DoS concept is one that is particularly critical in the winter months, as the rise in generally low-risk illnesses such as common flu and norovirus can be fast and effectively handled using the service rather than using acute and primary healthcare resources. However, this service is also at risk of being overwhelmed if capacity is not urgently increased.

Following the announcement of the Health and Social Care Levy and the Comprehensive Spending Review, the government has outlined nearly £6 billion in funding to support the NHS in tackling the backlog.  This includes provisions for surgical hubs, Community Diagnostic Centres, and for the improvement of digital infrastructure in the NHS. Whilst this is a positive start in the NHS’ ability to effectively manage and relieve pressure on primary and acute services, Vanguard urges the Government to further invest specifically in rapid modular solutions such as urgent treatment centres and minor injury units.

Vanguard has seen first-hand how a modular minor injuries unit (MIU) can relieve pressure on A&E services – which could serve as a lifeline for the NHS as we head into the winter months. Vanguard delivered a modular solution for the Royal Infirmary of Edinburgh, who were experiencing severe delays in their A&E unit seeing 70 fewer patients a day than optimum. Fundamentally, patients in A&E were often waiting for treatment for injuries that would be better handled elsewhere.

Vanguard’s solution saw an MIU fitted that could work alongside the A&E department to better handle patients and speed up access to appropriate treatment. The service runs 24-hours-a-day, seven days a week and to date, more than 3,500 patients have received treatment for a range of injuries and conditions that are better treated in the MIU than in A&E. The outcome has been a reduced waiting time for the A&E department and ability to see more patients, while MIU patients have enjoyed quicker and more suitable treatment for their injuries.

Solutions like this should be rolled out as a priority over the coming months to support the NHS. Increasing capacity using standalone units fundamentally relieves pressure on primary and acute settings by diverting patients to other means of treatment, whilst bolstering the response capability of the DoS. Critically it can help to reduce the spread of COVID-19 and patients are less likely to come into contact with others while waiting in A&E. As we approach winter and attempt to avoid a ‘Winter Crisis’, the Government’s focus must be on fast but pragmatic solutions for increasing capacity and relieving pressure on services.