Taking off together!

You can explore how a pathway can be improved to improve capacity and/or reduce pressure on frontline staff.

There are many reasons to set about improving a pathway but I focus on ones that can improve capacity and reduce pressure on frontline staff, for reasons that should be clear – in the days when waiting times are making the headlines on a daily basis, this is the number one priority of the NHS.

An example could be a new treatment that can be directly linked to shorter stays in hospital and improved patient flow – long recovery times are exacerbating the backlog and causing bottlenecks elsewhere in the system.

A joint project between Derby Hospital and the University of Nottingham discovered that, at acute hospitals at weekends, severely unwell patients are prioritised, which results in less efficient delivery of healthcare and use of resources compared with weekdays, as important step-downs in treatment are less likely to happen.

Their data showed that the frequency of switching from IV to oral antibiotics was 68% higher on weekdays than at weekends. Using prescribing data monitoring, the study identified and prioritised potential bottlenecks and targeted interventions aimed at removing them. Advanced clinical practitioners will now provide a weekend ward round to facilitate stepping down of clinical care.

All this facilitates patient flow, reduces length of stay, increases efficient use of hospital beds, allows patients to receive more timely treatment and less exposure to the risk of hospital-acquired infection, and cost savings will be made.

There’s absolutely nothing to stop you setting up a similar joint project to improve capacity and patient flow in your clinical area.

You can identify neglected patient populations, and improve patient communications and education for marginalised groups.

This is a big one, embedded in national and local NHS policy and fundamental to the drive to service sustainability. Our HSJ Health Inequalities Forum showed the costs involved in treating deprived patients groups runs into billions.

Perhaps it’s a patient identification issue, where you know that socio-economically deprived or BAME or older or disabled or rural patients – whatever the data show you – are out there, needing treatment, potentially at a later stage of disease progression.

Perhaps you know how many could benefit, you know what the knock-on improvements for particular service lines are and you know what could be the ideal scenario for outcomes.

You can share case studies from other areas where they have made service changes to address this successfully. There will be many decision-makers – clinical and managerial – that would be more than happy to engage on this.

Alternatively, helping the NHS to improve access to information for deprived patients – by coming up with accessible, culturally appropriate comms in the right language, or providing information services on diseases and treatment than don’t assume digital literacy, or spreading the word about remote diagnostic services – all of these can make a difference to your engagement, too.

‘The NHS needs private sector skills more than ever. It’s short-staffed, it’s exhausted and it lacks the bandwidth to grip service improvement’

You can help improve the quality of testing and ensure the right patients are diagnosed earlier in disease progression.

Industry often seems a lot clearer than the NHS on the specific parameters of diagnosis for the disease in its portfolio, and I’ve done lots of work with companies that bemoan the lack of precision in, say, diagnosing different COPD conditions accurately and getting patients onto the right pathway, or noticing particular complications that require a different medicine regime, for example, the patient also has pneumonia.

Another example was a major project I was involved in recently with clinicians specialising in muscle-invasive bladder cancer.

Here the topic was improving triage and diagnostics after patients had come on pathway, and ensuring that muscle-invasive diagnoses were being picked up at this crucial stage, so appropriate surgery could be carried out before drug treatment, so as to make that treatment more effective.

In this example the clinicians, with support from a pharma company, made a consensus statement about staffing, advanced diagnostic techniques and patient prioritisation that looks to now be influencing policy and the national GIRFT advice on managing bladder cancer.

Support pathways where your product can be used to manage patients closer to home, especially for long-term conditions.

Another big theme. Outpatient departments are being transformed; referral optimisation seeks to keep patients out of hospital if there’s no need – virtual wards are being rolled out, and one of the main aims of the local ICS plans is to support care closer to home, using multidisciplinary teams that can treat patients in community, primary or home settings.

Many long-term conditions patients don’t ever need to set foot in a hospital. They can be initially diagnosed in primary care, have that diagnosis confirmed by remote consultation, can be prescribed drugs to manage the condition by community pharmacy and be monitored remotely too.

You will be able to check quite easily if the products you represent fit this bill, and, if so, you can partner with the NHS to take a whole-system look at the pathway and ensure your medicines are being used in the best settings for the NHS – perhaps you have an oral option that facilitates this, or a medicine that can be taken at clinics or plans for remote management in home settings for which you could be instrumental in establishing a business case.

Engage in partnership work that brings all relevant stakeholders to a clinical area together – across systems and geographies.

Collaboration among NHS organisations is mandated by the Health and Care Act 2022 – secondary is supposed to work with secondary in provider collaboratives; primary is supposed to work with community and secondary in place-based partnerships.

Pharmacy is supposed to support primary care. Clinicians are supposed to form clinical networks and realise change from their patient-centric viewpoint.
We know it doesn’t work that way though, and many cultural and organisational barriers remain to getting the best minds and influencers together in a system – or across the country.

Industry can help by fostering such collaboration, through support for the right meetings and pushing your collaborators via the right agenda to make system-wide or even nationwide change.

Recently Wilmington Healthcare and HSJ have facilitated industry-supported missions to improve the status of medicines optimisation and care for patients with Huntington’s, by bringing together the right stakeholder groups to look at all the issues.

So, while the NHS remains in crisis mode, it’s important to stay upbeat about the enhancements and support the pharma industry can offer the service, and note that this is now a growth area. It’s good that both sides are working together – and the fact service improvements and better patient outcomes are being realised, a cause for celebration.