Spring In-Brief 2019 - Flipbook - Page 8
Continued from previous page.
Mental health delayed discharges
The Commission on Acute Adult Psychiatric Care found
that issues with bed occupancy and supply were strongly
influenced by delayed discharge due, in large part, to
availability of appropriate housing. This means people are
inappropriately in hospital, incurring high costs and
experiencing greater levels of restriction than are
appropriate, which can have a further negative impact
upon mental health. It found that those with suitable
housing were significantly less likely to experience
delayed discharges. The Commission’s report even
suggested that the NHS itself develop supported
accommodation to provide step-down placements for
people with mental health problems being discharged
from hospital.
Will all of this new evidence lead to anything changing at
a national level? Whilst the evidence base is still
developing, the link between health and housing has
been on the national agenda for a while now. The
inclusion of social housing in the 2014 Care Act got the
ball rolling, followed by NHS England publishing guidance
on the subject as recently as last year. Recent
publications such as The Memorandum of Understanding
to Support Joint Action on Improving Health through the
Home (published by Housing LIN) are supported by NHS
England.
It therefore seems more likely that the evidence base
follows the policy direction, rather than vice-versa.
Nevertheless, as the evidence base grows, practitioners
and policy makers will be able to draw on these
resources in order to decide which housing-related
interventions to provide support for and ultimately make
effective decisions when allocating finite resources.
Oliver Tee is a Consultant at Niche
specialising in Evaluation.
Oliver.Tee@nicheconsult.co.uk
Niche Investigations
– shining a light on
services for 10 years
“The most useful
consultancy we have
ever had”
Acute Surgical Consultant
8
The NHS must start scoring goals!
Imagine you’re a professional football player. Each
Monday morning your manager replays a recording of
your team’s performance over the weekend. With your
team-mates you watch carefully your team’s positioning,
tactics and execution of planned routines. But your
manager is only really interested in one thing – why you
conceded goals. You endlessly go over why each goal
went in – who didn’t pick up the opposition runner, whose
tackle was badly timed, who didn’t communicate properly
with the rest of the defence.
So one Monday morning you ask “Boss, shouldn’t we also
be looking at how we scored goals too?” Your manager
looks nonplussed, and asks “why would we want to do
that? It’s your job to score goals, just get on with it! I’m
only interested when things have gone wrong….”
Sounds absurd? But maybe it also sounds a little familiar.
Because thinking about quality improvement in the NHS
risks becoming dominated by working out why we let
goals in – the serious incident inquiries, the special
measures, the inspections, the endless firefighting and
sitreps. These matter, of course they do; no-one could
seriously argue that the NHS shouldn’t understand and
work to reduce the causes of poor practice. Just as noone would seriously argue that a professional football
team shouldn't understand why and how it concedes
goals.
But do we pay enough attention to the other half of the
pitch? Which clinicians/teams/units/services are
consistently achieving the best results? Where are the top
decile in outcomes – however we want to define that?
Where are the top decile in patient experience? How do
they achieve those results? We may sometimes hand out
awards and recognition, we may sometimes ask clinical
or management leaders from those organisations to sit as
national advisers – but do we do the real root cause
analysis of their success? How much was just good
fortune, and how much was due to the specifics of
resources, training, working methods, relationships,
patient mix or any other factors? Do we even do it locally
– just why is your best service your best service? How do
you know?