How could an integrated care system approach help reduce hospital waiting times?

Hospital waiting times are a key metric in ensuring the standard of patient care, and rightly so. Could a holistic view of how hospitals and other healthcare organisations operate help improve waiting times across the UK? Using an integrated care system approach, where hospitals and community care services are planned and staffed in tandem, could help reduce how long patients wait to be seen by A&E departments, access routine appointments, or receive scheduled treatments. But what is this system and how does it work? 

What is an integrated care system?

An integrated care system (ICS) is a method of workforce planning that co-ordinates care and staffing across the different healthcare settings – such as GPs, hospitals, mental health services, medical and surgical specialities. Taking an integrated approach allows for smoother interaction between primary and secondary healthcare settings.  

The development of ICSs was based on a practical appraisal of the way people access healthcare – local and regional providers being the most common point of patient access. An ICS can respond to regional variations in the needs of the communities they serve, tailoring healthcare provision to healthcare trends in their population. 

There are currently 42 integrated care systems in England (as of July 2022). An ICS includes collaborative forums between bodies involved in the system of care – such as an Integrated Care Partnership (ICP) with local authorities, and Integrated Care Boards (ICB) who plan health needs, manage budgets, and arrange for the provision of health services in the region. 

Why should we move to integrated care systems? 

The BBC recently reported that the top performing A&E department in the country, Northumbria Healthcare, was successful due to the trust having an integrated care system. The trust runs both local hospitals, and community services.  

“This has allowed it to better plan care for patients, discharging them quickly when they do need to stay in hospital because the trust is in charge of their care once they leave.” Source: BBC 

Moving people into the right healthcare setting, like the instance above shows, means that resources for critical emergency services like A&E are being used as efficiently as possible. 

One of the major benefits to this could be a reduction in waiting times and delays. These are key metrics for the NHS and other healthcare providers for a very good reason – when in need of care, patients want to be seen quickly and receive the treatment and support they need to manage their conditions or return to good health.  

“To see the benefits of a holistic approach to healthcare, senior leaders within each constituent part need to recognise and challenge common behaviours that work for the part but not for the whole. This is a significant cultural challenge – it will require brave decision making to step outside of existing organisational barriers, particularly when it comes to measuring performance.” 

Jon Freegard, Principal Consultant, Skills for Health 

How do trusts achieve an integrated approach? 

Each trust and healthcare provider in the UK will need a unique approach. With a large and disseminated workforce, a broad range of required skills and specialities, and regulatory requirements, the challenges and opportunities for each region need to be considered.

It is worth noting that the success of integrated care systems relies on community hospitals remaining open. Community hospitals are small, local hospitals that provide services such as community beds, maternity care, minor injuries units, or X ray departments. 

Skills for Health have developed a number of tools to facilitate integrated workforce planning – including competency assessments, education and training tools or courses, and frameworks for progress across all disciplines. We work hand in hand to foster system-level thinking across organisations, to help trusts and healthcare organisations achieve better patient outcomes.  

Case Study: Berkshire West Integrated Care Partnership

Berkshire West Integrated Care System (BWICS) reached out to Skills for Health as one of the pioneers of the Six Steps Methodology. The Six Steps was seen as a way to standardise workforce planning across the system and brought together a wide range of inter-disciplinary and multi-agency bodies.  

They collaborated to use the methodology to identify issues and priorities across social care, community nursing, and community mental health, as well as pharmacy, neonatal, emergency, and cancer services.  

Some of the priorities they identified were:  

• Applying consistency within terms and conditions across different healthcare employment settings, which would reduce inter-system competition for staff.  
• Recognising the resident population as a potential pool of future workforce was seen as a key to removing a barrier to recruitment, as housing costs for people moving into the area were prohibitive. 
• Exploring new ways of working, and introducing new roles, to support transforming services to meet future needs. 
• Valuing staff and focussing on retention activities, to meet the national challenge of staff retention. 

Taking action on these areas at a system-level was seen as a way to stabilise the supply of personnel and improve conditions across the workforce – ultimately with the aim of delivering a better service with a richer depth of healthcare skills and experience to patients.  

Read the full case study.

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