The Working as One approach
In the programme there has been a deliberate effort to start small, for example with one ward or team, before scaling more widely – with the hospital flow improvements now spreading across both medicine and surgery specialities, and the intermediate care improvements rolling out across all community hospitals and locality-based reablement teams. Working as One focused on transforming three areas around UEC which together would lead to improved outcomes for people, better experience for staff, and financial system benefit: Community urgent response and front door: Better use of services in the community – with effective referral routes to support the right people to stay at home and improved ways of working at the hospital front door that help more people return home that day. Hospital flow and decision making: Reduced time for people in hospital through better co-ordination of health and care teams and a collaborative discharge hub supporting the most complex patients quickly to their ideal next step. Intermediate care and access to care packages: Improved availability, flow and outcomes through rehabilitative care in the community. Increased intermediate care capacity to smooth discharge from hospital (or step-up from community) into care in the most suitable location. Better availability of long-term care packages reducing delays in onward progression.
OUTCOMES
To date, the programme has achieved the following: 21% reduction in emergency length of stay 50% reduction in length of stay in short stay units Acute medical unit now supports as many people with 40 beds as it did with 60 Hospital occupancy reduced from over 105% to the low 90s The improvements on discharge have seen the NCTR queue reduce by 80 people This performance translates to £27m operational value for the system. As well as investing in the occupancy improvement, operational savings have allowed the system to sustain a planned 40 bed reduction via acute reconfiguration and using 50 fewer P2 beds than previous years, all while absorbing increased front door pressure.
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