Better Lives: Wigan masterplan to tackle A&E corridor waits and bed shortages

That is the message coming from the Better Lives programme, which involves Wigan Council, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) and NHS Greater Manchester Integrated Care Board.

They have joined forces in a new way of working to transform care and provide more independence for residents.

The programme covers a range of areas, from how to ease pressure on Wigan Infirmary’s A&E department to how to support people to live in their own homes.

It is hoped the changes will improve health and care outcomes for Wigan residents through a more integrated and efficient system.

The Better Lives programme was co-designed by partners in Wigan, after issues with urgent and emergency care, and it is now being implemented.

Mary Fleming, WWL’s chief executive, said: “I think it was really evident that commissioning more general and acute beds was not going to address the problems of Wigan borough in future.

"We have the highest percentage of older people in Greater Manchester, we know people attending A&E are more complex cases and we know more people from deprived areas come to A&E. We have had an absolutely awful period of keeping frail, elderly people on the corridor, so we needed to do something different as a borough.”

She said all three partners had made “significant investment” in Better Lives.

"I think it’s a really exciting programme,” she said. “It looks at keeping people out of hospital, offering them a different solution, working with communities to really understand what they need, especially in deprived areas, creating an offer that helps them to help themselves and live better and longer in their own homes.”

Alison McKenzie-Folan, the council’s chief executive, said: “We are doing some great work together in terms of supporting people not to go to A&E and looking at how we redesign some of our work around care in the community, whether that’s specialist care in specialist beds or whether it’s working alongside our health and care sector to think about how we do that differently in the community

"We have got some amazing care homes, amazing offers with supported living and independent living. We are trying to help people stay at home with support.”

One of the first things the Better Lives programme addressed was patients waiting in corridors at A&E.

Mrs Fleming said: “I made sure that once a week at least I went onto that corridor and apologised to patients and their loved ones. It was really hard to do, but it was important that I did that.

"Leaders from across the system have been to A&E to have a look and were supportive of what was going on.

"We had to get that corridor care down and the congestion in A&E, because it was a concern for staff and it was a real poor experience for patients who had to wait. They were generally frail, elderly people. It wasn’t because they weren’t ill, it was because they were actually less ill than other people so they waited.”

WWL put members of the community team at the front of A&E and in two assessment units, so they could speak to patients and find out if there were ways to help them away from the hospital.

This is already making a difference, with an average of 3.81 admissions avoided per day.

Freeing up space in A&E means WWL can provide somewhere for the therapy team to work with patients needing rehabilitation, allowing them to return home to recover and free up beds for other patients.

It is one of the ways Better Lives is looking at improving discharge times, with organisations also working together to make sure any adaptations needed in people’s homes are done quickly.

There is no waiting list for home care, so patients are not waiting in hospital for arrangements to be made.

For people who cannot or do not want to stay at home, 95 per cent of care homes in the borough are graded as “good” or “outstanding”.

The next phase of Better Lives will look at intermediate care, reducing the reliance on in-demand hospital beds and providing care elsewhere.

Coun Keith Cunliffe, deputy council leader and portfolio holder for adult social care ,said: "WWL, for the size of this borough, has a very low number of beds. We haven’t got enough beds to cope with this level of population.

"But we have a population of 330,000 nearly. There are 330,000 beds in this borough and people sleep in them every night. We need to enable people to sleep in these beds, rather than concentrating on the small number of beds at Wigan Infirmary.”

Technology plays an important role in Better Lives and a system visibility dashboard shows the three partners the current situation and where pressures may be building.

A range of technology can help people in their homes, such as bed sensors and fall sensors, while carers could use AI to help with administrative work, allowing them to spend more time with people.

WWL also has its pioneering virtual wards, which provide an extra 60 beds by patients being closely monitored at home, using technology.

A virtual hub was created in the first care home eight weeks ago, to support residents and prevent them going to A&E, and this will be rolled out across the company’s five other care homes. It is hoped this can be done in all of the borough’s care homes within 12 months.

Work is also being done in deprived parts of the borough, with conversations already taking place in Scholes to find out why people go to A&E and what support can be offered to prevent it.

This new partnership is seeing the organisations come together to help people address more than health issues, but also other matters affecting their lives.