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Doing more with less: how one hospital has adapted to NHS crisis

by Ozva Admin

In an operating room at Addenbrooke Hospital in Cambridge, Andrew Myles undergoes a prostatectomy. The procedure is relatively lengthy, but thanks to pioneering robotic surgery, the 59-year-old will require just one night in a hospital bed.

Watching through a monitor, surgeon Arthur McPhee explains that the high-tech procedure allows him to make smaller, more precise cuts, allowing Myles to be released the next day, four days earlier than surgery would have allowed. traditional.

Back in the ward a few hours later, Myles tells a nurse that he feels fine apart from a little pain in his tummy area, joking that he’s had “six stab wounds.”

These new ways of working are helping Addenbrooke’s to treat more patients and use staff more effectively in the context of a NHS struggling with a record waiting list of 7 million for hospital care, dangerously overcrowded A&E departments and among the longest waits in Europe for cancer treatment.

Surgeon Arthur McPhee

Surgeon Arthur McPhee © Charlie Bibby/FT

Andrew Myles recovering from his procedure

Andrew Myles recovering from his procedure © Charlie Bibby/FT

In his autumn statement, Chancellor Jeremy Hunt announced an additional £6.6bn for the NHS over the next two years, giving the NHS some largesse at a time of tight spending restraint across the board. But he also warned the health service: “We want Scandinavian quality along with Singaporean efficiency, better outcomes for citizens and better value for taxpayers.”

At Addenbrooke’s, the health service crisis has brought about change. While some, like robotic surgery, involve technological advances, many of their procedures are surprisingly simple and inexpensive. Most have only called for a more flexible mindset among staff and a willingness to bridge the normally rigid divisions between different parts of the health and care system, raising difficult questions as to why, in a famously centrally run health service, have not been adopted. Everywhere.

Roland Sinker, chief executive of Cambridge University Hospitals Trust, which includes Addenbrooke and an M&A lawyer and strategy consultant before joining the NHS in 2005, divides the productivity challenge facing the service into two categories: “How we can do more with what we have achieved” and “innovation”.

Both targets are on display at 7:15 am on a recent morning in the Day Case and Overnight pavilion. All of the patients here have strong enough underlying health to be treated and released after just one night, even though some, like Myles, undergo major surgery.

Graham Johnston, the operations manager, said he and his colleagues had a “push[ed] the envelope” by redefining the notion of “generalist” surgical care to include some cases that previously required more specialized support.

Dr. Nushan Gunawardana chats with GP Dr. Tim Wright via zoom

Dr Nushan Gunawardana chats with GP Dr Tim Wright about zoom © Charlie Bibby/FT

Operations Manager Graham Johnston

Operations Manager Graham Johnston © Charlie Bibby/FT

In order to discharge complex patients so quickly, nurses have had to be “trained” to treat a wider variety of conditions than they would normally encounter on a short stay ward. This initiative has helped the hospital reduce its backlog of patients waiting for more than two years, from 170 a year ago, to just one today.

Elsewhere, new alliances have been forged between different parts of the health system. Frustrated by the laborious administrative process of securing specialist referrals for patients, Dr. Tim Wright, who works for a large local GP, and Addenbrooke neurologist, Dr. Nushan Gunawardana, teamed up to introduce a system which allows GPs to connect directly with consultants via video link. discuss cases, resolving concerns frequently without the patient setting foot in the hospital.

According to Wright, data collected since the pandemic had shown a reduction of at least 60% in letters sent by GPs to consultants seeking advice, and a 15% reduction in referrals to hospitals.

Sinker said he believed that “those kinds of developments are incredibly powerful and useful, and they’re not ‘teaching hospitals telling GPs what to do with neurology patients.’ It’s hearing from GPs [about] what they’re facing, what’s coming up, how can we help them do more?

A similar transformation has taken place in the endoscopy department. Concerned about the number of patients with suspected cancer not receiving a diagnosis within the national target of 28 days, gastroenterologist Dr. Gareth Corbett devised a way to simplify the system.

Previously, department protocol required hospital doctors to review all patient results after they were referred by a GP. Corbett’s idea was to reduce the role of consultants in that process, first by taking the diagnostic referral with confidence, without the need for another layer of approval, and second by training nurses to see the results of scans and biopsies, the great most of which come back clear. Only when nurses are concerned do they request a consultant review of a result.

The improvement was instantaneous, Corbett said. Since the first week of introducing the new way of working, “the 28-day target has been reached immediately for more than 85 percent of referrals.” She described the changes, which have caught the eye of national NHS leaders, as “really low-tech” but acknowledges that some consultants needed persuasion to change entrenched ways of working.

Oncologist Raj Jena

Oncologist Raj Jena © Charlie Bibby/FT

Addenbrooke CEO Roland Sinker

Addenbrooke CEO Roland Sinker © Charlie Bibby/FT

Not all interventions are so simple. In the radiation therapy department, oncologist Dr. Raj Jena explained that when a patient is admitted for curative radiation therapy, it can take up to two hours for him to mark the tumor to ensure that surrounding healthy tissues are protected as much as possible from radiation.

He has worked with Microsoft to create an artificial intelligence program using data from previously treated patients in the department that “does a lot of the work in the background, so when the oncologist sits down to start this task, most of the heavy lifting It is done”. It is “the first cloud-based AI medical device to be written from within the NHS and deployed across the NHS for free,” she said.

The impact on productivity is clear, he suggests. It has allowed him and his colleagues to “go about 13 times faster in setting up curative radiotherapy treatment,” removing one of the main obstacles to moving patients through treatment faster and in greater numbers. “AI like this is the key to workflow acceleration,” Jena said.

As the NHS grapples with the prospect of rising inflation that cuts budgets further, Sinker says he is applying the lessons of the pandemic: “protect frontline staff, give frontline teams the opportunity to innovate the way they want. [by getting] out of your way, and seek and find partners to help you get things done.”

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