Uniting health and social care

Strata Health UK Chief Executive Clint Schick discusses how simple, cost-effective access and placement tools will enable joined up working in 2021 and beyond

In June 2021, NHS England revealed how it will measure integrated care systems’ (ICSs) performance to determine the level of support and oversight needed.

The move to an ICS structure is critical to realising efficiencies in how health and social care operates. The idea is that, by uniting all health and care providers in a region, efficiency, quality of care, and sustainability will be improved.

ICSs will be judged on a range of approximately 70 metrics, with performance against these measures resulting in various levels of support and scrutiny from the centre. The first of five oversight themes is Quality, Access and Outcomes, which encompasses 44 of the metrics – all of them centred on delivering long-awaited changes in system efficiencies and patient outcomes.

Strata Health has two decades of experience in optimising the logistics of access, placement and system flow and have analysed what we feel are the six most significant opportunities for digitally supporting the delivering of these metrics in 2021/22.

1. Primary and community service response times: Improving discharge and reducing delayed transfers of care

A longstanding theme within discharge planning is discharge-to-assess or D2A. It is finally becoming a mainstream goal of hospital discharge standard operating procedures. D2A strives for a rapid discharge home to enable patients to recover in their normal environment. By doing so, patients can then request supportive services as needed with a clear idea of the help they need to remain in their home. The key to getting this right is (once home) we must enable patient access to services from pathway 0 (used for patients who need minimal support) right through to pathway 3 (patients who require bed-based 24-hour care even when they leave hospital) – building up just the right support packages from social prescribing to social care to health intervention, and then enabling patients to be placed into those services.

Doing so can avoid the outdated process of prescribing a standard package of care just because “that’s what’s always been done”.

Strata Transition (Transfer of Care) is a transparent access and placement tool that spans the entire ICS and enables D2C and the onward support required after D2C to be managed electronically, greatly increasing efficiency.

2. Restoration of elective and cancer services

It is important to maximise elective activity and transform the delivery of service, which can be done by:

• Managing waitlists (including new ways of delivering care in the community).
• Increasing referral treatment levels (cancer care).

Waitlists are longer than we have seen in recent memory and are set to continue to grow into 2022, with estimates that we will have a situation in which one in every six people in England is waiting for NHS care. To manage waitlists effectively, services must do two things: first, create logic that determines who should be prioritised next for treatment; second, deliver care in the most efficient way, balanced against limited resources and utilising new technologies such as remote consultation when feasible.

By supporting bespoke matching algorithms, Strata Matching helps logically manage waitlists, increasing the referral quality and throughput of appropriate and vetted referrals.

Strata Waitlist/Capacity can present available capacity and/or expected wait times, further supporting a reduction in waitlists across the NHS.

3. Outpatient reform: Avoidance of up to a third of patient appointments

ICSs are charged with reducing the number of unnecessary outpatient appointments under the theme of Quality, Access and Outcomes.

The traditional model has been for patients to attend outpatient appointments on a fixed schedule – a six-monthly review, for instance – regardless of their condition. Under the ICS oversight framework, organisations are asked to find ways to avoid unnecessary and inappropriate appointments. This will mean enabling patients to have a say in their own care plan. Patient-initiated follow-up means that outpatient review following surgery, or for short or long term conditions, is not on a fixed schedule. Instead, care is tailored to a patient’s individual clinical needs, circumstances and preferences.

We also must make it easier for GPs and care triage hubs to access advice and guidance from specialists about whether a referral is necessary. Patients and care triage hubs will need to be given better access to tools that enable them to better manage their own health. That will include the ability to refer themselves to early intervention long before an outpatient appointment becomes necessary.

Strata Choose creates patient access to self-referrals and/or triage hubs that can stream requests across to social prescribing pathways (pathway 0), escalating to health and care intervention if required) pathways 1-3).

4. Integrated urgent care services

It is important to reduce avoidable A&E attendances by directing patients to more appropriate downstream services.

Directing patients to appropriate services rather than to A&E by default is key. However, referral pathways must be in place and available in advance of A&E presentation. This then means that avoiding A&E is not simply being diverted to an urgent care centre, but being supported to avoid such services entirely and remain in the community.

Strata Matching and placement and Strata Transition can support the development and management of such pathways.

5. Mental Health: Delivering transformational care to investment standards

Mental health pressures within our health and care system are growing. Whilst there has been a much-increased focus on mental health, with the recognition it needs to be given the same priority as physical health, more must be done to allow citizens to access these services. This is particularly the case given the pandemic and lockdowns, which are increasing the need for mental health support.

Strata Health has two decades of experience delivering transformational care within mental health and addiction services. Strata PathWays for mental health is a cutting edge, award winning platform to enhance access and placement to care.

6. People will get more control over their own health through NHS personalised care

Social prescribing and unique patient referrals will increase the autonomy of patients.

Pathway 0 – for patients who do not need large amounts of support when leaving hospital – is key to capitalising on community support, which is often imperfectly used as present. This is perhaps the greatest ‘yet to be optimised’ resource that we have as a lever to battle demand outstripping supply.

The full suite of Strata PathWays tools enables health and social care professionals to easily see the capacity of local community services, ensuring patients can be quickly matched with and referred to the right support for them. This maximises efficient use of community support and helps ease the strain on other health and social care services.

The creation of ICSs, and their impending statutory basis, offers a real opportunity to deliver a much more cohesive health and social care system. Strata is here to help deliver that reality. To find out more, visit www.stratahealth.com.

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© 2019. This work is licensed under a CC BY 4.0 license. 

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Clint Schick

Chief Executive

Strata Health UK

Phone: +44 (0) 333 002 0233

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