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 has been Chief Executive of The King’s Fund since April 2010.

He has held posts at the universities of Birmingham, Bristol and Leeds and is currently Emeritus Professor at the University of Birmingham. He is an honorary fellow of the Royal College of Physicians of London and The Royal College of General Practitioners.

Chris was director of the strategy unit in the Department of Health between 2000 and 2004, has advised the WHO and the World Bank, and has acted as a consultant to a number of governments. He has been a non-executive director of the Heart of England NHS Foundation Trust, and a governor of the Health Foundation and the Canadian Health Services Research Foundation.

Chris researches and writes on all aspects of health reform and is a sought-after speaker. He was awarded a CBE in 2004 for his services to the NHS and an honorary doctorate by the University of Kent in 2012.