Themes
- Culture of continuous improvement
- Integrated front door services
- Addressing health inequalities
Background
Walsall Healthcare NHS Trust (Walsall Healthcare) provides local acute and community services to a population of approximately 260,000 people. The trust is the only provider of acute services in Walsall, offering inpatient and outpatient care, as well as delivering a range of community health services from 60 sites across the area. Some of the community services provided by Walsall Healthcare include urgent community response (UCR) and home-based care, enabling those with long-term conditions and people living with frailty to receive care in their own home.
Walsall Healthcare sits within the second most deprived integrated care system in England, and the local authority borough is in the most deprived decile across the country. This creates significant population need and operational challenges, and it has driven the trust and system partners to think differently about how they deliver care to better suit the needs of their local communities.
In response to historical concerns around emergency care, the trust has spent the past five years developing a whole pathway approach to care both internally through the NHS trust and through the Walsall Together partnership (Walsall Together, 2023). This place-based partnership is made up of multiple system partners including Walsall Healthcare. Since the development of the partnership, significant improvements have been made to UEC performance, emergency access standards and ambulance handover times. Trust leaders are clear this is a result of integrated interventions supporting admission and attendance avoidance and a commitment from all organisations to return people to the community when it is safe and appropriate to do so, as well as internal improvements delivered within the trust.
A multi-pronged approach to delivering care in the right setting
Walsall Healthcare has various community-based initiatives across the whole care pathway. This includes a care navigation centre which supports people to speak to the right professional first time, and UCR teams which allow people to receive care rapidly in their own home, preventing the need for an ambulance conveyance wherever appropriate. Where an ambulance conveyance does happen, the trust has an integrated front door team within the emergency department (ED) which is predominantly made up of experienced community trained clinicians. Having these staff working within the hospital is hugely beneficial as they have a strong understanding of the types of individuals who do not need to be admitted to an inpatient hospital pathway and would instead benefit from a community-based service.
This team is fundamental in preventing admissions at the front door, keeping UEC demand to a minimum, and supporting ward staff to discharge patients who no longer fit the criteria to reside. Through the intermediate care team – a multi-disciplinary team made up of a range of health and social care professionals – they can discharge patients quickly via a streamlined process. Working under one manager and a shared financial decision-making structure, the priority is getting an individual out of hospital safely and appropriately and then consideration is given to how their ongoing care will be funded.
The impact of these initiatives is clear. Metrics around the proportion of non-elective admissions with a zero-day length of stay show the trust is performing in the highest decile across the country, whereas metrics for those that are non-electively admitted overnight show the trust is in the lowest decile across the country for admitted length of stay.
The value of culture and continuous improvement
Trust leaders emphasise that this is all made possible by the commitment of staff across the trust and Walsall Together partner organisations to provide the right care in the right place at the right time. One of the crucial enablers is the culture of improvement and collaboration across the trust and with wider system partners, along with a real hunger from staff to continually review and improve the way care is delivered in every part of the pathway. Staff are encouraged to constantly refine models of care to ensure people are receiving the best possible support in the most appropriate setting.
Another key enabler to the work of Walsall Together is the level of confidence and appetite for risk between the trust and system partners, particularly the local authority. Joint ownership of issues is vital to supporting the whole pathway approach ensuring organisations take a patient focused view of delivery rather than just a service perspective.
Leaders at Walsall Healthcare believe the trust between partners springs from humility; each organisation within the place-based partnership recognises and respects the vital role of their partners and endeavours to support each other where possible. For example, the trust is clear that if they do not support a patient in the right place, there is a risk that their health will deteriorate unnecessarily.
This is not only bad for the individual but will also have knock on impacts for the package of care social care partners need to provide post discharge, resulting in additional demand on an already stretched sector. It is therefore vital that each partner takes accountability for how they can best support patients, both for the benefit of the individual and to reduce pressure across the care pathway.
Tackling local health inequalities
Given the nature of the local population within Walsall, which includes areas with high levels of deprivation, the Walsall Together partnership has a strong approach to tackling health inequalities. Although Walsall Healthcare has statutory responsibilities to address health inequalities, the trust recognises these cannot be tackled by one organisation alone. The work of the place-based partnership has enabled the trust to work collaboratively with partners to address issues around access to perinatal services, smoking cessation and diabetes, including community champions employed with lived experience.
Walsall Together has a particularly strong focus on the importance of housing as a wider determinant of health. One of the key partners in the place-based partnership includes the Walsall Housing Group which enables the partnership to include access to some of the most vulnerable people in the borough (the Core20 population), through which it has developed several initiatives including work for health employment support, diabetes prevention support and a reduction in the number of asthma admissions for children and young people caused by damp homes.
How to go further, faster
Leaders at Walsall Healthcare believe the trust between partners springs from humility; each organisation within the place-based partnership recognises and respects the vital role of their partners and endeavours to support each other where possible. For example, the trust is clear that if they do not support a patient in the right place, there is a risk that their health will deteriorate unnecessarily. This is not only bad for the individual but will also have knock on impacts for the package of care social care partners need to provide post discharge, resulting in additional demand on an already stretched sector. It is therefore vital that each partner takes accountability for how they can best support patients, both for the benefit of the individual and to reduce pressure across the care pathway.