Exploring the impact of peak demand on people and partnerships

Demand for services peaks during winter, but it’s also crucial to prepare for heatwaves and unexpected events like pandemics. Despite challenges, collaborative efforts can and have led to innovative solutions when we all collectively work towards one common goal.

To explore the topic of peak demand, Partners in Care and Health, NHS Employers and Skills for Care organised two roundtables to discuss:

• the impact that peak demand has on staff behaviour across organisations
• support strategies for the workforce during peak demand
• ways to enhance staff and patient experiences during peak demand in social care and health.

On 15 May 2024 and 5 June 2024, we brought together partners from across the system including acute care, primary care, mental health, ICB, NHS health and wellbeing, residential care, domiciliary care, the voluntary sector, learning disability sector and occupational health.

In these discussions, partners shared perspectives on their experience of peak pressure and how it feels within their sector. 

The group identified key challenges, opportunities and recommendations to develop support across the system in this space by expanding on our thinking around creating a culture where integrated working can thrive. 

Focus group one

In our first focus group, the discussion highlighted key themes related to the pressures and challenges faced by health and care professionals during peak demand periods. These themes highlighted the significant strain on the healthcare system, affecting both patient care and staff wellbeing. The main themes identified were: 

Workforce and patient safety 

The group raised significant concerns about the safety of both patients and the workforce. They highlighted issues such as corridor care and long ambulance waiting times, which sometimes prevent staff from delivering high-quality care due to challenging working conditions. The group emphasised the need to ensure that patients receive appropriate care, even amidst staff shortages and increased patient numbers. It is also important for staff to work in an environment where they can deliver their job to their best potential. 

Staff behaviour, morale and safety

The impact that stress has on staff behaviour and morale is significant during periods of peak demand. This can lead to increased incidents and relationship issues across the system due to burnout and stress. This can result in patients experiencing longer waiting times and less personalised care. It can also result in decreased job satisfaction due to high patient to staff ratio causing frustration amongst the workforce. 

System-level challenges and inefficiencies

The group identified that we need to shift towards a collective effort and away from organisational silos and blame culture. The group expressed that there have been inefficiencies due to regulatory pressures and mismanagement of resources. 

Impact of peak demand and continuous high level of demand 

Peak demand creates a strain on well-being and relationships due to lack of breaks and being able to meet basic needs for staff. This leads to exhaustion amongst staff and for them to default to challenging behaviours due to continuous high demand.

Training, role clarity and financial constraints

The group expressed a need for joint training and clear role definitions to improve collaboration. However, financial constraints within the system impact staffing, morale, and the ability to be more innovative with solutions.

Focus group two

In the second focus group, recommendations were discussed which the system could focus on in this space. These are focused around enhancing trust, communication and collaboration across different sectors and levels within the health and care system. 

Strengthen trust and partnerships

This can be explored through fostering good local relationships where trust is established with health and care providers. Delegating tasks to trusted partners to reduce hospital admissions and resource use. 

Enhance communication and collaboration

Develop relationships through regular interactions to understand each other’s world’s, responsibilities and requirements. This can be done by creating opportunities for partners to meet and discuss challenges across the system. For example, primary care can often detect that there will be an influx to acute care through patients they are seeing. This could be communicated ahead of the peak demand so the acute workforce can prepare. 

Improve discharge processes 

We need to simplify communication between discharge teams and independent care providers. This can be done by removing unnecessary bureaucratic steps to expedite patient discharge. This can also be explored by taking risks and giving permission for risks to be taken so we can ensure people are in the right place at the right time.

Engage the voluntary sector

Rethinking the commissioning relationship with local voluntary organisations. Ensuring that we are reducing restrictions on contracts to make them more appealing to voluntary organisations. This can be done through aligning funding objectives with the needs of local communities.

Implementing reverse mentorship

Introducing reverse mentorship where social care and health workers mentor senior leaders from different parts of the system.

Next steps 

Partners in Care and Health, Skills for Care and NHS Employers have collaborated to discuss the outcomes of this work and have agreed to take the following actions to provide support during periods of peak pressure, addressing the impact on both people and partnerships. These actions include:

Expanding integration culture:

Enhancing our Six ways to create a culture for integration by incorporating practical how-to guidance through storytelling and scenarios that illustrate how peak pressure impacts services and how integrated working can foster a positive culture and behaviour.

Individual behaviour self assessment:

Developing a self-assessment tool focused on individual behaviour, encouraging self-reflection on how personal actions contribute to the overall culture within the system. This tool is designed to promote self-awareness rather than assign blame. 

Refreshing our integrated workforce thinking guide:

Updating our guide in alignment with the social care workforce strategy. This includes revising existing case studies and adding new ones to make the guide more practical and actionable.