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Sharing learning for shared care

by Dr Nick Woodier

Dr Nick Woodier, HSIB National Investigator, reflects on the challenges associated with joint surgical care of patients and shares learning that can aid the NHS and the private sector as new national agreements come into force.

Earlier this month, NHS England and NHS Improvement announced that a new national contract between trusts and independent providers would be put in place to ensure that patients continue to get the planned care they need. The first national agreement was put in place back in early 2020 when the COVID-19 pandemic hit and support was needed, especially when it came to dealing with elective surgery.

HSIB investigation

The topic of the joint responsibility for surgical care was the focus of our first investigation into independent healthcare, and the report was published in October 2021. The investigation explored the patient safety risks that can emerge when setting up new surgical services and this is now particularly important as the new national agreement is put in place. It’s clear that, although NHS patients being cared for in private hospitals has been in place for many years, it is likely to continue to help tackle the fallout of the pandemic. This will also become even more important as the NHS moves to a more integrated model of care.

We saw in our investigation that if gaps appear in the surgical care pathway between providers then the impact on patients, families and healthcare staff can be profound. It became clear through the investigation that whilst the support of private hospitals is positive and is helping the NHS to tackle the unprecedented circumstances, there are certain important factors that make the difference in terms of making sure collaboration is effective and safer for patients during their surgical care journey.

A summary of the challenges faced during the the COVID-19 pandemic by collaborating NHS and independent hospitals. Challenges include geography, understanding the system, organisational relationships, systems and pathway integration, and workforce.
Local and regional collaboration to implement NHS surgery in independent hospitals

What can organisations do?

Organisations may now be asking themselves what they can do to plan for this different way of working and ensure that their partnerships with the private hospitals are as effective as possible. Our investigation highlighted that a useful exercise is for organisations to question themselves about the main challenges of collaborative working and identify solutions for successful collaboration. For example, to address multiple sources of referrals, ‘hub’ models were developed in some areas which were felt to be effective, for example with cancer care.

Here are some of the challenges broken down into questions that healthcare organisations might want to consider. We have also put all the pertinent information into a graphic in our report which acts as a quick reference and is available for all to download.

  • Are you geographically close to the private hospital and have you already established a relationship with them?
  • Have you examined the capability and capacity of the local private hospital? Would a certain surgery be too complex for them to support with current capability?
  • Are there any barriers to integration of the system and surgical pathways? This is everything from governance to how well IT systems work across organisations.
  • Is there anything you could do to create a more unified workforce to help independent healthcare staff who are not used to the complex needs of NHS patients?

Principles for safety

The point of our analysis isn’t to provide a hard and fast list, rather emphasise principles for safety that the NHS can work with – a organisation may not be able to change the geography of where the private hospitals are placed, for example, but by considering the impact that it may have on surgical care, they are taking a proactive step, equipping them to respond to current and future challenges to ensure the safe delivery of care for patients.

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