The 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:
- 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.
- 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.
- 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.
- Information is being shared across all parties to aid the above.
The Leeds Care Record is our ambition and the pilot phase is underway.
- 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