Community services, Health and social care, Patient experience

Services must evolve and revolve around the changing needs of patients; community services are the key, says Rob Webster

Rob WebsterThe 21st century NHS faces the biggest challenges of a generation. So why are we still using 20th century approaches to healthcare that ignore patients’ assets and 21st  century technology? Many reasons – financial flows; disjointed IT; and professional hierarchies.

But perhaps the biggest barrier is in our culture – one that we must overcome, and soon.

The NHS world-view portrayed in much of parliament and the media is a reductionist one; in this world, your GP looks after you and refers you to hospitals where you get treated and cured. So GPs should commission services from hospitals to make sure you get what you need and choose well.

This ignores the reality that people require care 24 hours a day, seven days a week, and that the diseases and issues of the 21st Century need a new approach based on partnership and self care.

In Leeds, we are seeing more children being born and gaps in parental capacity for the best start in life. Children with complex needs now survive into adulthood and need lifelong support. People have increasing mental health issues and co-morbid long-term conditions exacerbated by lifestyle choices. The older population continues to rise and dementia and related diseases are on the increase.

My staff work in this world, one where the power relationship between patient and professional is different to that in the GP surgery or hospital ward, and where partnerships come into clear focus.

My 3,000 community staff work mostly in people’s homes.

No-one changes their pyjamas because the district nurse is coming round, and the occupational therapist observes how you really live. If a family don’t like you they will ask you to leave.

If a partner in care fails then the family are failed and this is very obvious too. This brings valuable insights and assets from patients and families that we must use.

This will only happen if we invert the view of how our system operates.

We are looking at making community-based care the first option for NHS care, rather than ‘just’ the place for patient discharges for ongoing care. The expertise and culture that exists in organisations focused on community-based services can lead health economies to a genuine focus on preventative and ongoing management of conditions that patients live with every day.

Leeds Community Healthcare NHS Trust is a professional, ambitious, teaching and research based organisation that delivers very high-quality care. We will be a part of this change.

Alongside a change in thinking, five big things are beginning to happen:

  1. Services are starting to use the skills and abilities of patients and families to promote supported self care.

Their assets will replace those lost due to efficiencies. Medication, social prescribing, and genuine co-production all feature. Self care is what patients want to fit with their lives. As the banking industry has found, some people really like being in control. We should cede it to them always, unless they choose otherwise or capacity is an issue.

  1. Care is starting to be planned on the basis of risk.

We have the finest population data in the world – our GP lists. We must use them to classify risk and act sooner Our work in this area has begun in all practices.

  1. Teams are being integrated to deliver joined-up care.

There is duplication of effort and inconvenience for the patient built into everything from children’s centres to older people’s care. “Come together to deliver care around the family” is our aim. Our integrated early start and adult health and social care teams give us a chance.

  1. Information is being shared across all parties to aid the above.

The Leeds Care Record is our ambition and the pilot phase is underway.

  1. We want to embrace 21st century technology and how it is used in daily lives.

So why not ask a carer or new mum to video you while you explain something they will need to remember later on their smartphone? Or use the medical device alert (MDA) approved apps that are coming on stream? Stick to the information governance rules and do the better, simple, cheaper option.

What is clear is that across the whole NHS, we should be investing more energy and focus in services delivered in the community. The case has been argued by everyone from the NHS Confederation’s Mike Farrar to the Royal College of Physicians’ professor Tim Evans, and is supported by the Public Accounts Committee and representatives from across the political spectrum. This will help hospitals too.

These changes are essential to deliver the Mandate. I would have added one simple thing to make this a mandate for citizens, communities and the 21st century;”It’s your life, what happens to you out of hospital has parity.”

Rob Webster is Chief Executive at Leeds Community Healthcare NHS Trust

About NHSConfed .

The NHS Confederation is the membership body for the full range of organisations that commission and provide NHS services. We are the only body to bring together and speak on behalf of the whole NHS. We have offices in England, Wales (the Welsh NHS Confederation) and Northern Ireland (Northern Ireland Confederation for Health and Social Care) and provide a subscription service for NHS organisations in Scotland.

Discussion

11 thoughts on “Services must evolve and revolve around the changing needs of patients; community services are the key, says Rob Webster

  1. Rob as always spot on in your understanding and assessment – but why is it proving so difficult in so many areas to truly integrate care – have you any robust evaluations of the approaches you have taken in Leeds and would you be interested in sharing for a thought leadership piece I am doing on improving services for the frail elderly? You might want to check out our last research report on telecare and telemedicine which I believe can and should be used to support some of the service re-design you refer to.(www.deloitte.co.uk/centreforhealthsolutions)

    Posted by Karen Taylor | January 15, 2013, 11:07 am
  2. It is really important that we go back to the future and bring what people are using and are used to, into the world of NHS and Social Care and prevention. The trick over the next few years will be the balance of expectations from the current generation and future generations. When is the right time to play out the old and bring in the new? I suspect however difficult it is we must do this now but in a sensitive way. Remember when we force things on th epublic it does not always have the desired effect. Have walk in centres prevented a reduction in A&E attendances? Did NHS Direct reduce 999 calls? Will NHS 111? Absolutely it’s about the culture change, but of society, and the NHS cannot do it on its own.

    Posted by Andrew Irvine - Previous Exec at The Rotherham FT and now independent Consultant | December 20, 2012, 8:01 am
  3. Whilst it should be agreed extensive use should be made of modern technology, it should – and MUST – be remembered that not all people are comfortable or even have access to mobiles, tablets and a computer. Even for those that do, many patients will need re-assurance that their on-lines findings are the most appropriate. Indeed I know of one consultant who on occasion has been tempted to ask a patient who has detailed the treatment suggested by internet research, from which medical school they qualified. Yet Rob is correct and self care is to be encouraged.

    Posted by Pete Crutchley | December 19, 2012, 7:17 pm
    • Thanks Pete – this is why it is a cultural issue. I know of doctors who like the patient who has reseacrhed on the internet – somoeione interested and empowered – and others who hate it as a threat to power or the source of poorly evidenced inteventions. We need to work through this somehow.

      Posted by Rob Webster | December 29, 2012, 9:54 pm
  4. Rob is right in that we must utilise all the advances in technology and promote personal responsibility to make health and social care delivery more efficient, effective and give individuals the knowledge, support and tools WHEN APPROPRIATE – to self manage their health.
    However we must improve and ensure that we provide flexible, personal, assessment, diagnostic, monitoring and support for the vulnerable and frail in society (advanced dementia, long term conditions)
    We still have a long way to go but if the care is ‘needs based’, case managed and truly holistic for this group we may well be able to begin to make the changes needed for those who can ‘self manage’
    Marie Hudson. RN, BSc, QN

    Posted by Marie Hudson | December 18, 2012, 4:37 pm
    • Multiple scelerosis patients should NOT be denied CCSVI via the NHS as its unethical and siabled discrimmination . I was given another procedure at the time that was NOT clinically trialled yet given to me, so to refuse CCSVI does not make any sense what so ever. Over 25,000 worldwide have now had CCSVI

      Posted by LYNNE HEAL | December 18, 2012, 5:30 pm
    • Thanks Marie – I agree very much. We have done a lot of work on this in Leeds with service users and carers. They didn’t like the term “co-producing” that we used initially and preferred “Supported Self Care” – wanting to feel the support could be great or very little, depending on the need and preference of the individual.

      Posted by Rob Webster | December 29, 2012, 9:56 pm
      • NICE are known as NOT NICE am afraid many MS drugs are very dangerous and fatal after taken over a length of time .Many MS drugs have killed many . Too many have cosy relationships with pharmas who have made trillions from MS and too many are making commissions on also have uncovered the real truths

        Posted by LYNNE HEAL | January 15, 2013, 11:45 am

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