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How providers are delivering in the toughest of times

Trusts have faced unprecedented pressures this winter. Increasing demand in emergency care and mental health services, long waiting lists for planned care, balancing Covid-19 and non-Covid care, staff shortages, delayed discharges and bed capacity are all major concerns.

But we mustn’t forget to shine a light on the extraordinary work trusts are doing in the face of these pressures. The way in which trusts across all sectors – hospitals, ambulance, community and mental health services – are innovating and adapting to overcome barriers and deliver for patients and service users.

For the second year running, as part of our NHS Providers’ annual conference and exhibition in November, we launched Providers Deliver live, part of our Providers Deliver programme, to do just that. This year we featured eight innovations.

University Hospitals Coventry and Warwickshire NHS Trust responded to high rates of poor mental health and isolation through a narrative inquiry model. The use of story circles empowers participants to engage with their own experiences and those of others. This has helped to form new communities for long term condition cohorts, enable bereavement support, create compassionate cafes for staff and tackle poor mental wellbeing in young people. There have been early indications that this has reduced admissions, increased social inclusion, and improved wellbeing, including among students.

Tameside and Glossop Integrated Care NHS Foundation Trust worked within its community to maintain immunisation of young people during school closures through the pandemic. Timeliness of vaccinations is incredibly important to keep school-aged children safe, but the pandemic meant that important immunisations were delayed. The trust sourced two sites to deliver drive-through immunisations for young people, after noting the success of Covid-19 drive through vaccination clinics. The initiative has had a fantastic response from the community and excellent take up, keeping children and young people safe.

Stockport NHS Foundation Trust improved support for their older population through a new acute frailty unit. After piloting a frailty intervention team, the unit was launched, providing rapid patient assessment, diagnosis and support by a multi-disciplinary team in the most appropriate care setting.  Since opening, there has been a positive impact on patient experience, and an increase in same day and second day discharges.

Central and North West London NHS Foundation Trust piloted an app to help support those with long Covid outside of hospital. The interactive app is the first to enable assessment and utilise a therapeutic approach to support people with their Covid recovery. The tool is one of self-management across mental, physical and emotional wellbeing. Patients are carefully assessed first, and then connected to a clinician interface to monitor progress. The feedback has been positive, with 80 patients in Camden and over 3,000 patients nationally using the app by November.

South Central Ambulance Service NHS Foundation Trust worked with military co-responders during unprecedented pressures to meet demand. The armed forces were able to respond to emergency calls to administer lifesaving skills prior to the arrival of an ambulance, as well as to distribute personal protective equipment. The trust used its dedicated team of educational mentors to train and develop skills while the equipment and vehicles are funded through the trust’s charity or the trust itself. By November, there were three deployments. During the first two of these the military provided an additional 26,773 operational hours, of which 12,000 were frontline, treating over 7,000 patients.

University Hospitals of Derby and Burton NHS Foundation Trust launched a virtual ward model and helpline to provide support to respiratory patients in their own homes. The ImpACT+ service is a multi-disciplinary team, who tailor care to individual needs. Alongside clinical advice to patients on how to manage their conditions, the team also has been offering emotional and mental health support to ensure a holistic care package. As a result, fewer patients are needing to be re-admitted to hospital wards.

Southern Health NHS Foundation Trust placed specialist nurses within the NHS 111/999 control rooms to help in cases involving mental health crises. The service delivers a 24/7 enhanced mental health clinical assessment and triage and refers people into appropriate services. By November, the team had responded to over 30,000 contacts. Typically, only around 1% required ambulance dispatch – a reduction of 90%, and there has also been a significant reduction in primary care endpoints, and a 100% reduction in emergency department attendances.

Northumbria Healthcare NHS Foundation Trust worked with North East Ambulance Service and Fujifilm to pilot a portable x-ray system to reduce avoidable admissions into hospital, and to deliver care outside of hospital settings. The response team identifies calls where an x-ray at the scene has the potential to make a significant contribution to the patient’s diagnosis and enhance their treatment pathway. During the pilot, there were 56 calls, of which 52 had imaging on scene and 27 avoided admissions to hospital with follow-up in the community. A patient survey showed that 100% of patients rated the service as very good with 100% also feeling that they were treated with respect and dignity. All patients felt they were involved in decisions about their care and allowed them to be empowered in their own journey.

We, at NHS Providers, are proud to highlight these outstanding examples of how trusts are meeting demand, overcoming significant challenges and improving patient experiences and outcomes. They serve as a timely reminder of just how resourceful trusts are when it comes to delivering care, and how they will continue to innovate and apply their ingenuity to overcome each and every challenge that comes their way.

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