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If you were in need of urgent care, where would you go? – Toby Sanders

Fifty vanguards are leading on developing new care models which will act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system.

As we head into winter, they have come together today to jointly address an age old challenge – how to transform services whilst delivering the day job.

Don Berwick, renowned international authority on health care quality and improvement management, will share his views, offering an international perspective.

In the latest of our blogs from the new care model vanguards, Toby Sanders outlines how services have improved in one of the busiest areas for emergency care but the challenge now lies in making the system easier for patients:  

It’s a question which has become increasingly difficult to answer, especially as winter drives increased demand for services. Whether it’s a walk-in centre, A&E, NHS111, pharmacist or an out of hours GP, there are so many options it’s no surprise that many of our patients are confused.

In Leicester, Leicestershire and Rutland our patients have a wide range of urgent and emergency care needs, from a broken leg to severe tooth ache. Every day more than 650 patients access the A&E and other emergency services at the Leicester Royal Infirmary, making it one of busiest in the NHS.

Our population is diverse across the city and counties with many different communities and requirements for health and social care.

Over recent years we’ve set up some great new services to respond to these needs, many of which have been funded through our Better Care Fund.

Our acute visiting service gives our GPs the option to send an emergency care practitioner immediately to a patient who requires an urgent home visit. And we now have a crisis response team which brings together adult social care, community nursing and therapy, and mental health services for older people in crisis so we can help keep them in their own home.

Our older persons’ unit offers immediate geriatric assessment as an outpatient, while our falls service works with the ambulance and social care services, helping vulnerable older people to avoid hospital admission by attending sessions which improve their balance and address the cause of falls.

We’re also offering GP support to residents in care homes to treat their most vulnerable residents, along with many other new services.

But it has become increasingly evident that many of the services we have in place to support these communities are operating in isolation, not as an integrated network. Patients struggle to access care because, as we hear from our local Healthwatch as well as our own engagement work, they find the service fragmented and often aren’t aware of the options available to them, or how to choose between them.

Paramedics from our ambulance service and NHS 111 call handlers tell me that they also struggle with the best ways to refer a patient because not all services are available in all areas, and those that are can vary greatly in opening times and consistency.

Our vision as a vanguard is to simplify things for patients, and get them the care that they need, without having to worry about having to navigate a complex and sometimes disjointed system.

This model will bring together all our providers of health and social care to work as one network.

Patients in crisis don’t differentiate between clinical and social care, acute or primary care, and we don’t believe they should have to. The care they receive should be seamless and we want to provide a 24/7 clinical care advice hub – a new ‘virtual front door’ for all urgent health services where patients can access health and social care.

Another vital part of providing seamless care is ensuring parity of esteem for mental health is a priority. Our goal is that, wherever a patient accesses urgent services, we will have the facilities and staff in place who can treat any mental health issues with the same priority as physical ones.

So, for example, if a patient comes to our emergency department having taken an overdose, we won’t just treat their physical symptoms, but have a psychiatry team on hand to help support and treat their mental health, and refer them to the correct services.

One of the reasons that we were selected as a vanguard was the momentum that we have already gained in improving our urgent and emergency care services. Delayed transfers of care were one of our biggest issues last winter, and the work that we have done around the way patients are discharged from hospital means we are now among the lowest in the country.

We didn’t put ourselves forward to be a vanguard because we think we’ve got it all right already though. There are many challenges facing us, as there are nationally, and we applied because we know how important it is to keep our momentum going as we continue to try to make improvements.

Being a vanguard means we have the opportunity to further improve our services and the system, to draw on expertise from across the NHS as well as share our own experiences as we go along but most of all our vision is to keep improving, simplifying and getting things right for patients.


toby-sandersToby Sanders Managing Director (Accountable Officer) – West Leicestershire Clinical Commissioning Group

Toby Sanders leads the management support team and all aspects of the corporate running of West Leicestershire Clinical Commissioning Group (CCG). Toby also has a collaborative role with the two neighbouring CCGs as the lead director for East Midlands Ambulance Service, NHS 111, Out-of Hours Services, Arriva, Any Qualified Provider and Urgent Care Centres. Toby is also the Joint Chair for Better Care Together – the 5-year transformation strategy for Leicester, Leicestershire and Rutland (LLR) and also chairs the LLR System Resilience Group and Urgent Care Board.

An experienced Board Director, Toby previously held Deputy Chief Executive roles with the LLR Primary Care Trust (PCT) Cluster, and Leicester City PCT. Toby has also worked elsewhere in the NHS in acute hospital and strategic health authority roles and, before joining the NHS in 2003, worked in local government and management consultancy.

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