As NHS winter pressures set in, Professor Matthew Cooke explains how insourced teams can enable existing teams and resources to focus on increasing pressures and enable vital services to continue.

Each year, winter brings additional challenges to the NHS with increases in admissions (both in both numbers and length of stay), as well as increases in the severity of respiratory illnesses.

Historically, the NHS has prepared by changing the elective-emergency balance as well as increasing absolute capacity. This year, additional challenges are complicating the planning with long waiting lists providing less flexibility and continuing high staff sickness and turnover decreasing capacity.

NHS England has outlined steps for increasing capacity and operational resilience with, among other recommendations, a focus on increasing bed capacity by 7,000 through a mix of new physical beds and virtual wards. It also stated the need to “support good working relationships with the independent sector, building on the success so far, and facilitating patient choice”.

As we head into the colder months, the focus at Xyla Elective Care, a specialist independent provider, turns to how it can best help the NHS with the inevitable increase in winter pressures.

This includes supporting with insourcing services to enable existing teams and resources to focus on increasing pressures, or managing services to enable them to continue.

NHS workforce challenges

Finding the workforce to support extra (often out-of-hours) clinics and procedure lists can be challenging. As we emerge from the worst phases of the pandemic, there is a backlog of staff wanting to take breaks from their careers whether by retiring, reducing their hours, working abroad, or taking a career break. The remaining staff are exhausted. This combination of factors is resulting in an overall vacancy NHS rate of 9.7 per cent and 11.8 per cent (as of 30 June 2022) within the Registered Nursing staff group (46,828 vacancies).

Staff sickness rates remain high (due both to increasing Covid rates but also due to increased mental ill health) and will likely increase as usual in winter with anxiety, stress, and depression being consistently the most reported reason for sickness absence. In June 2022, the overall sickness absence rate for England was 5.2 per cent.

Extra resource for outpatients and pre-procedure assessment

By working collaboratively with an independent provider like Xyla Elective Care, NHS organisations can benefit from a fully managed service that creates additional capacity which doesn’t impact on the current workforce.

Evening and weekend clinics can utilise existing NHS estates at times when they are underutilised. They not only benefit NHS Trusts, but also provide flexibility for the patients to attend outpatient appointments outside of their working day. It also allows Trust staff to work more core hours, helping to improve their well-being.

For those Trusts with limited available physical capacity, the independent sector can provide alternative solutions in the form of additional, alternative clinical space known as modular units on the Trust’s premises in a matter of weeks to support the mobilisation of further capacity for outpatient clinics.

Insourcing can provide an opportunity to introduce or reinforce new ways of working that can increase efficiency. For example, it can be used as a catalyst to create one-stop clinics, enable remote consultations and implement digital pre-operative assessment.

Maximising day surgery

An examination of the NHS RTT Data for June 2022 shows that Ear, Nose and Throat (ENT) and Ophthalmology are two of the specialities with the biggest waiting list challenges, with their numbers collectively reaching over 1.1 million.

As many of these cases can be undertaken as day cases, it may be possible to address such delays despite the pressure on inpatient beds. One clear strategy for organisations is to ensure they are maximising day case work.

The physical resources are often separate and so are usually not the rate limiting factor, but staff have other commitments that may increase in winter so this is a prime area where insourcing can support to maintain or increase this pathway despite winter pressure.

Urgent care

Traditionally, the NHS has used the private sector for non-emergency work, to both decrease waiting lists but also to free staff so they can focus on emergency care over winter. But there are also opportunities for insourcing to directly support urgent and emergency care.

The pandemic has seen the mainstreaming of remote consultations in primary care and in elective secondary care. But opportunities still exist in urgent and emergency care, for example offering a remote consultation rather than an emergency department attendance.

Urgent Treatment Centres (UTCs) are being widely adopted, often within Emergency Departments (ED). Having a flow of patients that is physically separated from the ED and has separate dedicated staffing allows the ED staff to concentrate on the most serious cases. Xyla Elective Care has now established an insourcing offer to strengthen existing UTCs and to support the establishment of new services within a few weeks

Fully managed services

Trusts often have reservations about handing over a full service to an external organisation, especially if it is done at pace so it can be established before winter. It is important first and foremost to understand each service in detail, including how patient pathways are delivered and to identify key areas along the way. The model of care and the governance arrangements in place are always agreed by both parties and made clear to all staff.

Xyla Elective Care work with key staff, reviewed by the individual NHS Trust, to ensure the patient pathway is delivered safely. Each service is delivered with a nurse in charge, as well as specialist consultants, allied health professionals and any other support staff needed for that service.

The nurse in charge is not only responsible for managing and coordinating the service, but also ensuring the clinical quality and data collection. This is then regularly reviewed with the NHS Trust. One key sign of success is when NHS staff can only be differentiated from insourced staff by the name badge and uniform they wear, not by the way they work or the quality of care they provide.

By establishing better working relationships between the NHS and the independent sector, NHS organisations will benefit from the wealth of additional insourcing support which will not only help to decrease waiting lists this winter, but also provide additional capacity to reduce pressure on NHS professionals.

To find out more about Xyla Elective Care’s insourcing services, visit:

Professor Matthew Cooke, Chief Medical Officer, Xyla Elective Care