An indepth analysis of problems facing many A&E departments points to issues with patient flow as a result of insufficient staff in non-clinical managerial and other roles.
The A&E crisis; what’s really driving poor performance, published by Reform, aims to identify the true nature of the problem facing emergency care so the crisis can be tackled.
And it supports the argument that delayed discharges are a big cause, but disputes the theory that these delays are wholly as a result of problems in social care.
Instead, Reform’s analysis of data released by NHS England for delayed discharge of patients who were deemed medically fit to leave hospital during December 2022 finds that, in 43% of cases, the reasons for this lay within the responsibility of the NHS.
Despite the popular myth that the NHS has too many managers, it is actually under managed
Largely, this is an operational issue – such as delays to the discharge summary being written, take-home medicines provided, diagnostic tests, and transport.
And these factors are all down to the vital role that managers play in co-ordinating discharge so that patients can return home as quickly as possible.
“Despite the popular myth that the NHS has too many managers, it is actually under managed and, given the complex logistics involved in delivering healthcare, it is odd that NHS managers make up roughly 2% of the workforce, compared to 9.5% in the UK workforce as a whole,” the report states.
The Reform analysis believes long hospital stays may be driven by internal failures of co-ordination.
While focus is continually placed on the numbers of frontline clinical staff, which are increasing in numbers, there has not been a commensurate increase in the number of managers in the system.
It is odd that NHS managers make up roughly 2% of the workforce, compared to 9.5% in the UK workforce as a whole
And, in spite of their increasing numbers, the productivity of clinical staff is diminished if they are having to perform administrative tasks that managers would normally take care of.
The analysis also believes that challenges in management may be contributing to the high levels of variation in performance being seen between NHS trusts.
Where other factors remain constant, shortcomings in operational management, such as failure to manage admissions, bed flow, and discharge appropriately can have a major impact on performance.
You can read the full report here.
