Patient Flow : How Alamac is helping two Hampshire CCGs meet the urgent and emergency care challenge


According to NHS England figures emergency departments in England had their second-worst quarterly performance on record in the first three months of 2019. The figures reveal that the first quarter saw the most attendances at major A&Es as well as of patients waiting for longer than four hours. These patients often require more complex care needing attention from a wider range of specialists. Delayed discharges of care within the hospital often mean that patients who need to be admitted must wait until a bed becomes free on the appropriate ward.

North East Hampshire and Farnham CCG and East Berkshire CCG are part of the Frimley Health & Care Integrated Care System (ICS) which has been using Alamac’s unique Kitbag – a cloud-based tool for collecting, collating and triangulating information to provide an overview of pressures within the system and real-time A&E hotspots, while allowing it to drill down within each organisation to see where change needs to be made.


Getting to grips with a system-wide challenge

Frimley Health & Care Integrated Care System includes a wide range of health organisations, from acute hospitals, to community care, social services and ambulance trusts. To understand the pressure points in each organisation and to see where daily action is needed, it is essential to have real-time consistent and transparent data across the whole system.

Using Alamac’s Kitbag has given Frimley Health & Care ICS an overall view of all organisations, with each one agreeing their own triggers and thresholds. This builds a true picture of the state of services that day, enabling operational teams to take action to keep the system running smoothly.

Jayne Tunstall, is head of system resilience and urgent and emergency care and is transformation lead for North East Hants and Farnham and Surrey Heath CCGs. She says: “We don’t need to debate daily what system alert status we are on. We have an alert status that everyone has agreed on, abides by and takes appropriate action on.”Jane says that Kitbag is also useful for monthly meetings with the Urgent Care Operational Group (UCOG), where the data is examined for trends to help plan future services. By uploading data daily, sometimes twice a day, the ICS has a real-time reflection of how individual organisations are impacting on the whole system.

Rachel Wakefield is associate director of urgent and emergency care and specialist services. She says: “It’s important to know how the hospital is doing, the bed state, the number of patients going through and the number of patients that are waiting for discharge. We need to know the number of community beds we have in the system and how hard our out of hours system is working, the number of patients going through our walk-in system and minor injuries units.”


Customised data helps to meet the needs of each organisation

Creating change cannot be a one-size fits all approach. Certain areas may be more important to one organisation in the ICS than another, so the data needs to be more highly weighted when it comes to agreeing the alert status. Jayne says: “We agree the most important triggers and measurables that will be more highly weighted than other triggers, so it’s a true reflection on where the pressure are. If we need to change something immediately, I just contact Alamac and within 24 hours it’s changed.”


Expert support and analysis provide a critical friend for organisations

As part of the Kitbag, the Alamac team has become part of UCOG for the ICS, looking at the relay performance for the previous month and helping it to analyse trends and pressures in the system. Jayne says: “We also carry out a number of deep dives so Alamac is pivotal to this work from an analytical point of view.”

Once a course of action has been agreed, Alamac will come back to review the improvements or outputs. “That really helps our partners because Alamac has become a critical friend to have those conversations with,” says Jane. Rachel agrees and says: “This relationship has been built over many years and we can now look at trends over time to see what happens at certain critical times of year, for instance helping us with our winter planning.”


Using Kitbag for discharge planning

Rachel explains how Kitbag is being used to help the ICS get a better understanding of weekend discharges, which are lower than expected. Alamac teams work at the weekend to collect and review data on selected wards to investigate why these discharge rates are low.

“This gives us a bird’s eye view of what is going on and where the particular areas of concern may be and what particular components constitute a really good discharge so we can work on those and with our partners to improve that as we go forward,” she says.

Alamac experts also attend meetings, producing data and analysis in a slide pack, which can be discussed with all partners, highlighting trends and areas which are working well or need improvement.

Click here for more information on Patient Flow

To find out more about how we can help with you understand patterns and trends in urgent and emergency care please contact:

Sarah McGovern
Chief Operating Officer
07715 110 524
[email protected]


Karen Evans
Senior Delivery Partner
0777 244 3147
[email protected]