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Health care mark three

As the King’s Fund publishes a report on the Primary and Acute Care System Vanguards today, its Chief Executive gives his views on the impact of innovation within the NHS:

Over the past two years I’ve encountered two versions of the NHS.

Version one is an NHS under severe pressure from growing demand for care at a time of constrained resources. We’ve seen this on TV many times during the recent winter as hospitals struggle, despite the best efforts of hard-pressed staff.

Version two is an NHS finding ways to innovate despite these pressures. I’ve seen this in the work The King’s Fund has done with the New Care Models programme over the past three years. Nine areas, identified as primary and acute care systems (PACS), have led innovations to integrate care and improve population health.

Many innovations focus on services in the community: improving patient access to general practices, establishing integrated teams to meet the needs of high-risk patients, and supporting residents in care homes to avoid hospital admissions. Isle of Wight established an integrated care hub, bringing together all parts of the emergency and unscheduled care system. Other areas have enabled GPs to seek advice and guidance from specialists more easily.

Some PACS have extended beyond mainstream health and care services. In Morecambe Bay, a local GP has worked with schools to introduce the Daily Mile which builds time into the curriculum for exercise.

Morecambe Bay has also worked in Millom, an isolated community of 8,500 people in south Cumbria, to create a population health and wellbeing system, using community assets to support healthy living. The energies of residents are channelled into strengthening local services in partnership with NHS organisations. An advanced community paramedic plays a key role in the system and a community-led recruitment campaign has helped fill GP vacancies.

In North East Hampshire and Farnham, safe havens offer a drop-in service for people with mental health needs in town centre locations at evenings and weekends as an alternative to A&E. People with experience of mental illness support staff delivering the service. Small changes make a difference. An example is providing wrist bands to people in crisis, signalling their needs to staff at times when it’s difficult to talk about their needs.

The most ambitious PACS are working to become integrated care systems for their communities. In Northumberland and Salford, NHS Foundation Trusts now provide hospital and community health services, working closely with local authorities to align these services with adult social care. GPs are increasingly involved in this work. The aim is to break down the silos that create barriers to care being joined up around the needs of patients.

A number of ingredients have made innovation possible. Additional funding received by PACS has released staff from other roles to develop new care models and pay for associated costs. Clinical and managerial leadership have been central to the work that has been done, and patients and communities have played an important part in some areas. Local authority involvement has been notable in a few places, facilitating the focus on population health as well as on integrated care.

The new care models team in NHS England adopted a facilitative approach that encouraged the testing of different models in different areas, offering advice to PACS when they needed it. They requested regular progress reports and challenged staff to demonstrate the impact of their work. PACS leaders met regularly to share experiences and develop a community of practice focused on learning and development.

Data collected by NHS England suggest new care models, including PACS, appear to be moderating demand for hospital care more effectively than other areas. They have not discovered a major breakthrough in how to deliver care – they have made many small changes in care, illustrating that ‘aggregation of marginal gains’ applies in health care as well as sport.

There is sufficient evidence to suggest that version two of the NHS holds part of the solution to version one. Of course, there is a compelling case for the NHS to be allocated extra funding and to address growing staff shortages, but on their own they will not provide a sustainable solution. Doing things differently through new care models is also essential.

The focus on operational pressures will surely continue but this must not be at the expense of a commitment to transform care at scale through sustainability and transformation partnerships and integrated care systems. This is best done by building on the work of the new care models and moving to large-scale change across whole systems.

The progress made by the best of the PACS offers hope of a better future. Let’s call it version three.

Chris Ham is currently Co-Chair of the NHS Assembly, Chair of the Coventry and Warwickshire Health and Care Partnership, and non-executive director of the Royal Free London Hospitals NHS Foundation Trust. He is emeritus professor of health policy and management at the University of Birmingham, visiting professor at the London School of Hygiene and Tropical Medicine and Senior Visiting Fellow at The King’s Fund where he was Chief Executive between 2010 and 2018. He is an expert adviser to Carnall Farrar.

Chris is the author of over 20 books and numerous articles on health policy and management. During his career, he has worked at the universities of Leeds, Bristol and Birmingham from where he was seconded to the Department of Health to work as the Director of the Strategy Unit between 2000 and 2004. He works at the interface between research and policy drawing on evidence to inform decision making.

Chris has advised the World Bank and the WHO as well as the governments of New Zealand and Sweden. He has served as an advisor in the UK to the Audit Commission, the House of Commons Health Committee and the National Audit Office. He has also been a board member of the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research.

He is a founding fellow of the Academy of Medical Sciences, a fellow of the Royal Society of Medicine and a former vice-president of the Patients’ Association.

Chris was awarded a CBE for his services to the NHS in 2004 and a knighthood for services to health policy and management in 2018. He was made an honorary fellow of the Royal College of Physicians of London in 2004 and an honorary fellow of the Royal College of General Practitioners in 2008. He became a companion of the Institute of Healthcare Management in 2006.

Chris is a regular contributor to radio and TV and writes for the national press on issues concerned with health policy and management.