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There are no certainties in life, the saying goes, other than death and taxes. But in the NHS, there’s perhaps one more item that can be added to the list: come winter, things are going to get really very tricky.
Each and every time the temperatures begin to drop, the demand on our hospitals begins to rise, and headlines start to be dominated by the phrase “winter pressures”. A&E departments become overwhelmed, hospital beds become full, and clinicians often struggle to deliver the high-quality care that is their constant aim.
Last time around things got so bad that the chief executive British Red Cross spoke of a “humanitarian crisis”. It is a phrase more commonly associated with natural disasters or war, but it does give a sense of just how overwhelmed NHS emergency services have become.
No-one expects this winter to be an exception. Clinicians are already talking of overwhelmed emergency departments, despite December having only just begun. The reality in any case is that most A&Es are now stretched year-round. Winter has become particularly difficult, but there are few times which could be regarded as easy.
The factors behind this crisis are multi-faceted, complex and not easily addressed. An ageing population, continuing constraints on funding, a lack of non-A&E options for people who are not seriously ill but who do need urgent attention, lacking capacity in social care, – all have been cited as contributory factors.
There is no one solution which will immediately address all of these issues. But could technology assist in each instance? That’s the question at the heart of an investigation which has recently been launched by techUK. Through the winter, the industry body is holding a series of events exploring whether technology could help avert future cold month crises in the NHS.
The investigation will look at everything from apps to wearable tech to hospital computer systems, and will publish findings in the middle of next year. But already this winter a new national technology and data project is aiming to improve the way in which the NHS manages the winter months.
The emergency care dataset (ECDS) officially began to be collected back in October. It’s a new set of information which A&E departments have to collate and then submit to central bodies. The idea is the data can then be used to construct a detailed national picture of exactly what is happening in at emergency departments across the country.
The idea is not a new one. Hospitals actually have been submitting data on what happens in their A&Es for many years – in fact, the dataset which ECDS replaces was first developed in the 1980s.
But the ECDS is more comprehensive than anything that has come before. It contains no less than 108 separate pieces of information – including patient demographics, clinical information and details of referrals and discharge – and the aim is for it ultimately to be submitted daily.
That constitutes a huge amount of information being updated hugely frequently, but the increasing computerisation of hospitals makes it much less burdensome that it would have been in the past. Many will have computer systems which can automatically collect and submit the information.
Because while the NHS may be short of beds and money, it is certainly not short of data. And the hope is that sophisticated analysis of that information may offer detailed insights which explain just why a specific hospital’s A&E department is under such pressure. Other datasets could also offer insight into how to better do other things – genomic data, for instance, could help develop new, more tailored medication.
There will be obstacles to be negotiated along the way. Patients will need to be reassured that their information is going to be kept safe, particularly with cyberattacks a real and present danger. We will need to find ways to store this information in a cost effective fashion, and in a way which allows secure but easy access to researchers across the country and the world. Many would argue that cloud is a valuable option here – indeed, it’s already being used as an important plank of the 100,000 Genomes project.
But there is little doubt those obstacles are worth overcoming. We may not be able to avoid death or taxes, but winter pressures might – just might – be doable.