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New care models point to a better future for patients and staff

Is rising demand for hospital services inevitable? Chris Ham, Chief Executive of The King’s Fund, celebrates the work of new care models that are successfully bending the demand curve.

Last week I had the privilege of visiting new care models in Dorset, Hampshire, Surrey and Buckinghamshire in the company of Don Berwick, international visiting fellow at the Fund. We met clinical and managerial leaders working to improve patient care by providing same-day access to GP appointments, integrating community services in localities, aligning these services with general practices, redesigning mental health services in association with service users, and strengthening specialist care by concentrating services on fewer sites where this will deliver better outcomes – to name but a few of the examples we saw.

We also learnt of plans to develop accountable care systems (ACSs) to take forward the work of the new care models and develop integrated care at scale. One of the lasting impressions for me was the time we spent in The Frimley Health and Care System where Andrew Morris is chief executive of Frimley Health NHS Foundation Trust and lead chief executive of the sustainability and transformation partnership (STP) and ACS. Andrew spoke passionately about the improvements in care that have been achieved by the new care models and other initiatives and the impact they are having on local hospitals.

Most importantly as a result of this work, for the first time in the 29 years Andrew has served as a chief executive, demand for hospital care has fallen. This is evident in flat A&E attendances, and falling emergency admissions and GP referrals. To be sure, local hospitals are still busy but unlike in previous years their workload is manageable and staff are working under less pressure. The downside for the foundation trust is that it is losing income by not treating as many patients as planned but this is a nice problem to have as the Frimley system looks ahead to becoming a fully-fledged ACS with a system financial control total.

Many changes in care help to explain how the system has been able to bend the demand curve for hospital services. They include improved access to GPs, the ability to deliver more effective services in the community and to support people in their own homes, mental health services that are more accessible and oriented around patients’ needs, and changes in A&E that enable patients to be treated and sent home instead of admitted to hospital. The challenge will be to sustain these gains and to extend them to those parts of the Frimley system that have not been involved in work on new care models to date.

In Frimley and elsewhere, Don and I were struck by the energy and commitment of clinicians and others in leading improvements in care. Andrew Morris observed that these improvements are happening from the bottom up in contrast to many previous reforms which have been promoted from the top down and have often failed to engage front line teams. We saw evidence of this everywhere we went alongside growing involvement of patients and users. Many of the changes taking place go well beyond mainstream health and care services and draw on the contribution of volunteers and a wide range of community assets.

As the new care models approach their third anniversary in 2018, there is much to celebrate. As national funding and support comes to an end, I am confident that their work will continue and in many cases be extended. ACSs and STPs provide an opportunity to lead this work and to demonstrate that rising demand for hospital care is not inevitable if clinicians and managers are willing to embrace new ways of working. Patients and staff both benefit from the changes we saw, demonstrating that innovation is alive and well in the NHS and is producing tangible improvements in care.

Chris leads The King’s Fund’s work. He rejoined the Fund in 2010, having previously worked here between 1986 and 1992.

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.

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