Page last updated: 28 April 2023



Flow throughout the system is crucial to help services provide timely and effective person-centred care. There must be enough capacity to manage demand.

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The flow of people in and out of services needs to improve if integrated care systems (ICSs) are to provide effective, joined-up care for people.

Currently, the healthcare system features several barriers that create difficulties throughout an ICS. Barriers to accessing social care can result in delayed discharge for people. This, in turn, makes it difficult for other patients to access inpatient care, which affects provision of urgent, elective and cancer care. Finally, this affects access to timely primary and pre-hospital care.

ICSs must use their autonomy to seek and provide solutions that dismantle these barriers.

Useful resources

DHSC guidance on hospital discharge and community support

Royal College of Emergency Medicine’s Winter Flow Report

BMJ Journal: Six ways not to improve patient flow: a qualitative study by Sara Adi Kreindler

Future Healthcare Journal: Possible futures of acute medical care in the NHS: a multispecialty approach 

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Examples of good practice and innovation

Working together to improve flow
Walsall Healthcare NHS Trust

The trust introduced several measures to maintain flow and reduce ambulance handover delays. They created:

  • the Walsall Together partnership of health, social, voluntary, housing and community organisations
  • a highly functional discharge lounge
  • multi-specialty Same Day Emergency Care (SDEC) units
  • culture and leadership that engages services from all specialties.

Listen to ECIST’s (Emergency Care Improvement Support Team) podcast: Ambulance Handover Improvements at Walsall Healthcare on YouTube

Long length of stay Wednesdays
Barnsley Hospital NHS Foundation Trust

This trust holds 'long length of stay Wednesday' meetings each week to discuss:

  • people who have been hospital inpatients for longer than 7 days
  • identify barriers to safe discharge.

As part of this, they use:

  • a SAFER flow bundle from NHS Improvement (this is a practical tool to reduce delays for patients in adult inpatient wards)
  • a length of stay dashboard with executive oversight.

Listen to ECIST’s (Emergency Care Improvement Support Team) podcast: Managing risk in the emergency department on YouTube

Discharge to assess (D2A) service
South Warwickshire NHS Foundation Trust

South Warwickshire's D2A pathway is for people who are medically fit to go home, but are waiting for results, routine tests, physiotherapy or home care packages. They commission local care homes and individual practices to provide additional temporary care to help people access the care they need to step down to returning home.

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