The fairy godmother service of the NHS

To mark Ageing Well Takeover Week, the first national director for community health looks at how the NHS Long Term Plan is bringing care systems together:

I am responsible for the Ageing Well elements of the NHS Long Term Plan, which I’ve heard described as a “Cinderella portfolio”.

We talk a lot about older people, but we’re not exclusively about people with frailty. We support people living with lots of needs, people who may be struggling and need the connected work of health and social care organisations so we can actually serve them better.

So, if by Cinderella we think of the Fairy Godmother, being able to magic humble pumpkins into carriages and turning errant rats into stallions, it’s certainly reflective of some of the alchemy our teams produce in their work on the front line.

The Long Term Plan talked about community health, social and primary care working together. It’s no fluke that this was the beginning of the Plan.

The implementation plan described community services as a foundational element of local systems; put the rest of your plan in around having really great community health, primary and social care and voluntary sectors working together.

We’ve never had that in a national plan before. This is backed by a new guarantee that over the next five years, investment in primary medical and community services will grow faster than the overall NHS budget. This NHS ‘first’ creates a ringfenced local fund worth at least an extra £4.5 billion a year in real terms by 2023-24.

We have, for once, the intent, the enthusiasm and the money all coming together to give us a real opportunity to do something different.

One of the main changes in our sights is being proactive in understanding people from their own perspective and wrapping support around them. We want to shift the national discourse away from just hospitals to embrace the hundreds of thousands of NHS colleagues supporting people in their own homes wherever that is.

We do need to break down all those very bizarre boundaries we’ve put up over the years. We refuse each other, we refer to each other. We decide a GP hasn’t referred to the right team, so send it back and ask them to start again. Why? They’re clinical colleagues.

Why aren’t we talking about finding a solution for the issues rather than hiding behind our referral patterns? That’s what Ageing Well is about – breaking down those oddities about how we organise care to do something better. We will do this through three key areas:

Improving the responsiveness of community health crisis services:

Joint community standards mean by the end of the NHS Long Term Plan, we’ll be offering seven days a week, twenty four hours a day, the ability to respond within two hours in someone’s home. That includes care homes if people are in crisis and don’t need to go to hospital. We’ve a heck lot of work to do to get that right and increase our capacity. The new national standard will be two hours for us to actually see the patient, to see the person in their own homes and to do something different.

Guaranteeing NHS support to people living in care homes:

We’ll implement the Enhanced Heath in Care Homes (EHCH) vanguard model across England. Many areas have already implemented parts of the framework, but we want to make sure that every person living in a care home has the same access to NHS support as everyone else, to stay well for as long as possible.

Implementing ‘anticipatory care’ for complex patients at risk of unwarranted health outcomes:

Anticipatory care is just a term. In practice it’s changing how we move to anticipating those that need our support in a more proactive way. So that means not waiting for the referrals to come in, that means segmenting our population, that means using our data to understand our local populations, that means us, primary care, our acute colleagues, social care, mental health teams, knowing who are the hundred thousand people that we should be proactively supporting.

Some of them in an intense way, day by day, some of them maybe weekly, monthly – whatever is appropriate to them. But hand on heart, do you think we know that in every system across the country? I can say that with some certainty because I know it’s not true.

So that’s our challenge. About how we understand our communities and go about changing the way that we deliver care, not based on referrals, but based on what people need and how we can support them to be healthy and to maximise their independence and keep well.

Matthew Winn

Matthew Winn is the NHS England and Improvement Director of Community Health and Senior Responsible Officer (SRO) for the implementation of the Ageing Well programme in the NHS Long Term Plan.

He is also the Chief Executive of Cambridgeshire Community Services NHS Trust and has led the organisation since 2007.

Previously he worked in London in roles in Acute Care, local government and Primary Care Trusts.

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