As the NHS outlines plans for new expert rapid response teams, that will be on hand within two hours to help keep older people well at home and avoid hospital admissions, the Deputy Director for Urgent Community Response explains how she is leading some of the most significant changes to primary and community care in a generation:
The beginning of 2020 is another exciting year for me.
It’s a year since I was eagerly awaiting the publication of the NHS Long Term Plan – nine months of hard work cumulating in some major paragraphs. For those not working in policy it was probably a less momentous occasion. Although I used to read major NHS publications when I was a frontline nurse, I can’t say I awaited them eagerly!
Having worked in the community or been associated with community care for my whole career, to have been instrumental in the success of creating the first ever community national target is a major achievement. The new target is two-hours for crisis response and two-days for reablement or restoring independence and confidence.
I’m mindful that this is only a major achievement if it is implemented in a way that improves outcomes for people, rather than hitting the target and missing the point.
The policy for ageing well over the last year has really started to take shape and it’s very exciting to move on to the next phase of implementation.
As a policy team we have spent the last year talking to people and refining the definitions. When will the clock start for someone waiting for a crisis response in the community and when does the clock stop when care has been received? How will policy look and feel in reality? Through lots of discussions, webinars, communities of practice and some heated debate with many people, it’s clear there isn’t a consensus. There isn’t a right or a wrong answer. There are some practical considerations about what can be collected and what makes sense to a clinician providing care as well as what is right for the person receiving the care.
As most of us know, theory is all very well and good, but we need to see how this works in practice which is where the newly announced accelerators come in. One for each region selected from 40 applications from 37 areas (STP’s) across the country. These sites have been chosen to demonstrate some of the variety and complexity of community services across the country.
Some areas already have well established services and will be leading the way in “tweaking” and expanding their services while others are developing services from scratch. What unites them is their enthusiasm to make the policy a reality and help us design the way forward so that by 2023-24, the new community services targets are a reality for people accessing care.
So, in the #YearOfTheNurseAndMidwife I reflect back on my career as a nurse. Over 30 years ago, did I ever dream of leading health policy? Nope. I was set on a career in nursing, assuming naively that would be a career at the frontline seeing patients.
Now in health policy, I see how my nursing career has shaped my thinking and consequently my passion and enthusiasm to get this health policy right. Within our programme we talk about new power and old power. Old power being driven by the top, new power shaped by all, no matter what your role.
We cannot deliver this by writing a document. We can only deliver this if people providing care believe this is the right thing to do, that by receiving care in two-hours helps keep people in the best place for their needs maybe after a fall, or with a urine infection and dementia needing extra support.
I remember some amazing relationships I had as a district nurse. The local pharmacist who would advise me and still sends me a Christmas card and letter 30 years on! The home care colleagues who were the eyes and ears for spotting early issues with people in their care, the GPs and practice nurses all working together in the best interests of the people receiving our care.
Community and adult social services have continued to work quietly in the background while other programmes and areas have received high profile policies. That has enabled a culture of creativity, but also a culture of variation.
With the new standards and the accelerator sites and working with people across the country, we will be able to offer a consistency of response that I would want for my mum and dad.