With year-round winter pressure, NHS trusts exploring ways to overcome the challenge need to have a good understanding of cost and quality

BMA council chair Chaand Nagpaul recently highlighted the year-round pressure now being felt in the NHS and we know that many trusts are keeping winter pressure wards open far longer than previously.

One of the ways trusts have been able to counter the growing demand is by early recognition and appropriate care of the deteriorating patient along with efficient use of HDU/ITU units. This gives them the ability to reduce ITU demand and support outreach onto the wards reducing bed blocking by deteriorating medical patients and knock-on pressure on elective surgery capacity.

However, in order to make the most of HDU/ITU units they need to be adequately staffed and have the right mix of beds. This requires having an understanding of fluctuations and case-mix in demand plus the costs associated with each unit.

This is where the Harris unit economic analysis comes in. We have been working with trusts to help them understand how best to allocate resources. The Harris Unit clearly shows the link between cost and quality in each HDU/ITU unit. Trusts can use the analysis to ensure their HDU/ITU units are working cost-effectively, helping to reduce pressure when needed and release capacity for elective surgical referrals which may be revenue enhancing. The CQC has shown interest in this approach for both medical and surgical patients.

Our analysis also looks at mortality amongst patients with four or more triggers of avoidable harm (based on the IHI Global Trigger Tool). Where mortality is higher than expected amongst this group, we know there is inadequate provision to escalate and rescue patients.

Our hope is that more trusts find ways to overcome the challenges they will inevitably face over the summer by considering ways to reduce pressure and release capacity. This is just one solution, but we know it works.


  • 5 Jul, 2018
  • Kristian Low

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