Surrounded by the Christmas trappings brightening the sterility of Yeovil District Hospital in Somerset, Eileen Johnstone is engaged in the less-than-festive process of receiving intravenous antibiotics for an infected knee.
Even over the holiday period an ambulance has arrived each day to ferry the 74-year-old from home to the “ambulatory emergency care unit”, where less sick and more mobile patients can be treated at the hospital in England’s west country.
Avoiding a potentially lengthy hospital stay has spared her husband Geoffrey, a retired teacher who is living with dementia, from an upsetting separation.
“It’s made a tremendous difference, certainly to my husband more than me probably, because he likes to see me, he likes to know where I am and I know that he’s safe when I’m home,” added the former nurse.
Behind Mrs Johnstone’s good fortune lies a striking turnround that carries lessons for the whole of the NHS.
Britons’ connection to their taxpayer-funded, free-to-use health service is as much emotional as transactional, a tight bond that has prompted UK prime minister Boris Johnson, fresh from winning an unexpectedly large majority in this month’s general election, to declare the NHS his top priority.
Earlier this month Mr Johnson enshrined in law a commitment to increase annual health service funding by almost £34bn by 2023/24, but inexorably rising demand after nearly a decade of historically low budget increases has led to a sharp deterioration in national performance. Many patients are waiting longer for diagnosis and treatment, even of potentially deadly diseases such as cancer.
While Yeovil hospital has entered winter — traditionally its most testing time — with trepidation, it has found a prescription that has left it better placed than most to weather the strains.
The data tell the story. Yeovil’s performance against a target that 95 per cent of patients should wait no more than four hours to be treated in an emergency department is the second best in the country and the average length of stay has dropped from 5.7 days to under four days, a massive boon given the chronic shortage of beds in the NHS and the cost to the system of keeping a patient in overnight.
The improvement is all the more striking against a substantial increase in the number seeking treatment — Yeovil’s emergency department attendance has risen 28 per cent over the past three years.
Simon Sethi, the hospital’s chief operating officer, explained that a highly critical 2016 report from the Care Quality Commission, the healthcare inspectorate, had inspired a reappraisal of how the hospital worked.
The NHS can be deeply hierarchical but in steering a new course Mr Sethi has chosen to place his faith in frontline staff. He singles out Julie Reeve, a nurse who came up with the idea for the ambulatory emergency care unit out of frustration that so many patients were admitted who could be treated as day cases, but struggled for years to persuade managers to support it.
Ms Reeve, a nurse consultant in emergency medicine, said that with the creation of the unit, “we are probably avoiding 250 admissions a month”.
The approach Yeovil has taken is seen as the way forward for the entire NHS. A long-term plan for the service, unveiled in January by then-prime minister Theresa May, set a goal that “the proportion of acute admissions typically discharged on day of attendance” should rise from a fifth to a third.
Not all Yeovil’s metrics are so positive. Like many English hospitals, it is in the red, with a deficit of £21.4m in 2018/19. In May, it received an overall CQC rating of “requiring improvement”, and its use of resources was deemed “inadequate”, even though the effectiveness of its care was rated as “good”.
Mr Sethi says that the changes introduced over the past three years have actually reduced the cost of running the emergency department as it has replaced expensive agency staff with permanent employees.
Meanwhile a separate initiative in Somerset, Home First, has bridged the gap between the NHS and social care, which often yawns wide in the English system, helping to reduce delays in getting medically-fit patients back home, or into a nursing home, so ward beds can be reserved for the truly sick.
Nor has Mr Sethi hesitated to import lessons from industry. A week spent shadowing a friend, a manager at a Marks and Spencer store, convinced him of the importance of assigning a particular focus to each day of the week to concentrate staff minds and energy. “Next steps Tuesday”, for example, yielded the insight that some patients were waiting four days after admission to receive an MRI, because scans for inpatients were only carried out on Fridays. Now many undergo their MRIs soon after admission, allowing speedier discharges.
Mandy Carney, associate director of urgent care, said: “If we create capacity on our wards then that in turn creates a better flow through A&E and those who need to stay in can be seen and triaged within the four-hour standard and be admitted to one of our hospital beds.”
On the Friday before Christmas, clinicians and managers met to assess the latest situation as they do three times a day. A screen behind them displayed an array of information including the “current bedstate” in each part of the hospital.
Heading into the weekend, the system was running hot, with a rise in respiratory cases, and surging numbers of sick children: “Our two areas of risk that we need to keep absolutely focused on is critical care and [paediatrics],” Ms Carney warned her colleagues.
Staff are under no illusions about how tough winter will be as the NHS copes with a growing and ageing population. Jon Tipping, the A&E department’s clinical director, who uses Zen meditation to ease the stress, marvels at advances in longevity even as he handles the resulting medical complexities. “I saw a lady who was 109 a few weeks ago. She still lived independently and she was really distraught that we weren’t able to send her home . . . She had a broken bone and couldn’t walk”.
With the support of senior managers, Dr Tipping has drawn up a business case for hiring more staff; a department built to receive 30,000 patients a year is now dealing with almost double that number.
Acknowledging the pressures on the frontline, Mr Sethi added: “There is not much more we can throw at our winter plans now . . . but we need to be clear about ‘what is our plan for next year?’ How do we make people feel like it’s not going to get tougher but it’s going to get better and better?”