An NHS fit for the future has been unveiled as one of the government's six national missions. In this article, Sophie Coles considers a challenge within the health and care system and argues that Radical Place Leadership is a vital component of an integrated strategy to address delayed discharges.
Delayed discharges. Bed blocking. Delayed transfers of care. No criteria to reside. All readers will be familiar with these terms, I am sure. Whether due to the area in which you work, or from the many news publications on the issue. Despite the best efforts of system partners and leaders, discharging medically fit patients from hospitals in a timely way remains an ongoing challenge for the health and care system.
I have no doubt that all system leaders dream of a silver bullet, a quick fix, an easy answer,
an overnight solution or a magic formula for this monumentally challenging problem.
A significant financial problem that cost the UK approximately £2 billion in 2021-2022. 2022-2023 figures remained significant, with a parliamentary report highlighting research from two years prior, which reported that delays were costing the NHS approximately £27,000 per hour; an additional financial burden of £587 million per annum. The snowball effect feels like it has moved with unstoppable force since the early 2000s. The once manageable issue, is now a systemic crisis.
I trained as an Occupational Therapist 20 years ago, and even then, as a young clinician, I was so aware of the detriment to people remaining in hospital for longer than was medically necessary. The effects are not only physical; muscles decondition, mobility reduces, but has significant effects on mental health. Delays in discharge are also linked to higher mortality risks. The problem for the health system doesn’t simply come to a stop when people who were delayed in being discharged finally transition into a social care service; the unintended consequences around negative health impacts have often already occurred.
So can the snowball effect be reduced?
I wholeheartedly believe in the power of positive thinking. Not naive or wishful hoping. I believe in creative, radical solutions and truly considering the value of people and place.
The idea of place leadership - where local leaders across public, private, and voluntary sectors collaborate to address complex social challenges - is indeed an increasingly relevant approach in the UK when addressing issues like delayed discharges, over-occupied hospital beds, and inadequate social care resources.
However, while place leadership can be a powerful framework, it should absolutely not be viewed as a silver bullet. Instead, it should be viewed as a component of a broader, integrated strategy to address these deeply rooted issues.
What is Place Leadership?
Place leadership involves mobilising a wide range of local stakeholders to take joint responsibility for the well-being of a specific geographic area. It is about collaboration beyond organisational silos (don’t they drive us mad!), with an emphasis on collective decision-making, shared resources, and community-driven solutions. Consider for a second if you will, your sports team of choice. You get beyond excited to watch them play and are ready to watch the amazing unique skills that each player has. Their differences and strengths when brought together mean they achieve victory. Place leaders are like coaches who create the strategy, ensuring all players work towards the same objective. Successful outcomes depend on collaboration, coordination and shared goals; all of which are central to place leadership.
Addressing delayed discharges, bed occupancy, and social care shortages
These issues are part of a larger systemic problem involving health and social care, housing, and community support. Here are some ways in which I think place leadership could help address these challenges:
1. Coordinated, Cross-Sector Solutions:
- Delayed discharges are often caused by gaps between health and social care services. Patients may be ready to leave hospital but have nowhere suitable to go if community-based care or rehabilitation services are unavailable.
- Place leadership can foster collaboration between the NHS, local councils, housing authorities, and voluntary organisations to ensure that patients can transition seamlessly from hospital to community care. This requires pooling budgets, data, and resources to create integrated care pathways.
2. Strengthening Social Care Capacity:
- The lack of social care resources is a persistent issue, exacerbated by workforce shortages and funding constraints. Place leadership can help local areas design workforce strategies that attract and retain social care staff, tailored to the specific needs of their communities.
- By leveraging local networks, place leaders can also mobilise community and voluntary groups to supplement formal social care services, providing additional support to those who might otherwise remain in hospital beds.
3. Community-Based Interventions:
- Hospital bed over-occupancy often results from a lack of preventative care and support in the community. Place leadership can shift the focus toward community-based interventions, such as early intervention services, support for carers, and the development of ‘home-first’ care models that keep people out of hospitals in the first place.
- Local leadership can also advocate for funding and resources tailored to specific community needs, enabling more investment in primary and social care services that reduce the demand on acute hospital beds.
A Part of the Solution, Not the Whole Answer
Place leadership is not a panacea but can be a significant part of the solution to delayed discharges, bed occupancy issues, and social care shortages. It enables a holistic, community-driven approach that breaks down silos and leverages local strengths.
However, its success depends on overcoming governance challenges, securing sustainable funding, and ensuring that all stakeholders are genuinely committed to collaboration.
This absolutely requires not only local leadership but also supportive national policies that provide the flexibility, resources, and incentives needed for place-based solutions to thrive.
If you'd like to discuss the themes of this article, please contact Sophie.Coles@mutualventures.co.uk
Comments