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

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

In an operating room at Addenbrooke Hospital in Cambridge, Andrew Myles undergoes a prostatectomy. The procedure takes a relatively long time, but thanks to groundbreaking robotic surgery, the 59-year-old only needs one night in a hospital bed.

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

A few hours later, back on the ward, Myles tells a nurse that he feels fine except for a little pain in his abdominal area, joking that he has suffered “six stab wounds”.

Such new ways of working help Addenbrooke’s treat more patients and deploy staff more effectively against the backdrop of a National Health Service grappling with a record 7 million waiting list for hospital care, dangerously overcrowded emergency rooms and one of the highest waiting times 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 generosity at a time of generally tight spending constraints. But he also warned the health department: “We want Scandinavian quality alongside Singaporean efficiency, both better outcomes for citizens and more value for taxpayers.”

At Addenbrooke’s, the healthcare crisis has brought changes. While some, such as robotic surgery, involve technological advancements, many of the interventions are surprisingly simple and inexpensive. Most have merely called for a more flexible mindset among staff and a willingness to overcome the normally rigid divisions between the different parts of the health and care system – which raises the hard question why in a famous centrally run health service they have not been adopted everywhere .

Roland Sinker, chief executive of the Cambridge University Hospitals Trust, which also includes Addenbrooke’s and an M&A lawyer and strategy advisor before joining the NHS in 2005, divides the productivity challenge facing the service into two parts: “how can we do more with what we have?” received” and “innovation”.

Both targets can be seen on a recent morning at 07:15 in the Day Care and Overnight Accommodation Department. The patients here are all in strong enough underlying health to be treated and discharged after just one night, despite some, like Myles, undergoing major surgery.

Graham Johnston, the operations manager, said he and his colleagues are “pushing”.[ed] the envelop” by redefining the concept of “generalist” surgical care and also including some cases that previously required more specialized support.

Dr.  Nushan Gunawardana talks to family doctor Dr.  Tim Wright via zoom

Dr. Nushan Gunawardana talks to family doctor Dr. Tim Wright via Zoom © Charlie Bibby/FT

Operations Manager Graham Johnston

Operations Manager Graham Johnston © Charlie Bibby/FT

In order to discharge complex patients so quickly, nurses had to be ‘retrained’ to deal with a wider variety of conditions than they would normally encounter in a short-stay unit. This initiative has helped the hospital reduce the backlog of patients waiting more than two years from 170 a year ago to just one today.

Elsewhere, new partnerships have been forged between different parts of the health system. Frustrated with the cumbersome administrative process of referring patients to specialists, Dr. Tim Wright, who works for a large local family practice, and Addenbrooke’s neurologist Dr. to discuss cases, often solving problems without the patient setting foot in the hospital.

According to Wright, data collected since the pandemic had shown at least a 60 percent reduction in the number of letters GPs sent to counselors asking for advice, and a 15 percent reduction in hospital referrals.

Sinker said he believed “those kinds of developments are incredibly powerful and useful, and it’s not ‘the university hospital telling GPs what to do with neurology patients’. It’s hearing from GPs [about] what they are dealing with, what is coming up, how can we help them do more?”

A similar transformation has taken place in the endoscopy department. Concerned about how many suspected cancer patients went undiagnosed within the 28-day national target, gastroenterologist Dr. Gareth Corbett came up with a way to simplify the system.

Previously, the department’s protocol required hospital doctors to review all patient outcomes after being referred by a primary care physician. Corbett’s idea was to reduce the role of consultants in that process, first by adopting the diagnostic referral based on trust, without the need for another layer of approval, and second, by training nurses to looking at the scans and biopsy results, the vast majority of which come back clear. Only if it concerns the nurses do they ask for a review of a result by a consultant.

The improvement was immediate, Corbett said. From the first week of the new way of working, “more than 85 percent of referrals met their target of 28 days.” He described the changes, which have caught the attention 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

Roland Sinker, CEO of Addenbrooke © Charlie Bibby/FT

Not all interventions are that simple. In the radiotherapy department, oncologist Dr Raj Jena explained that when a patient receives curative radiotherapy, it can take up to two hours to mark the tumor to ensure that the healthy tissues around it are shielded from radiation as much as possible.

He has worked with Microsoft to create an AI program using data from previously treated patients on the ward that “does a lot of the work in the background so that when the oncologist sits down to begin this task, it most of the hard work is done”. It is “the first cloud-based medical AI device actually written from within the NHS and can be deployed in the NHS for free,” he said.

The impact on productivity is clear, he suggests. It has enabled him and his colleagues to move “approximately 13 times faster in preparing for a curative radiotherapy treatment,” removing one of the major obstacles to getting patients through treatment faster and in larger numbers. “AI like this is key to workflow acceleration,” said Jena.

As the NHS faces the prospect of rising inflation that cuts further into budgets, Sinker says he is applying the lessons of the pandemic: “protect frontline staff, empower frontline teams to innovate in a way they want [by getting] out of the way, and reach out and find partners to help you get things done.

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