The NHS is working through one of the greatest challenges it has ever faced. With the pandemic still part of everyday life, we need to reduce the constant pressure on the acute sector. Future plans must be based on a coordinated approach that makes the most of a wide range of partners, including the voluntary sector.
Up to 7 million people are thought to have missed out on care during the pandemic, many from more deprived areas. The health system is still in a critical condition, with high rates of COVID-19, hospitalisations and waiting times rising. This perfect storm is ultimately widening the health inequalities that have come into even sharper focus during the pandemic.
The challenge is too great to leave up to the acute sector alone to solve. Every part of the health and care sector has a role to play, from primary and social care to councils, housing and the voluntary sector. The solution must lie in greater collaboration to unlock capacity and avoid preventable admissions.
Developing wrap around care models to help manage population health
Although the current payment by results system does not always lend itself to more integrated system working, Integrated Care Systems (ICSs) can provide an opportunity to broaden partnerships and collaboration, to help pave the way for change.
There is a case for developing health and care services that wrap around traditional care models, promoting healthier living, tackling loneliness and other areas that can impact on hospital admission.
The mental health sector is already leading the way by working with other providers and some London trusts are investing £1m annually in new contracts with the voluntary sector to strengthen support in the community.
Worcestershire County Council has also been working with the local NHS Commissioning Group and the voluntary sector since 2015, to tackle hospital admissions by providing personalised support to older people to deal with loneliness. Social isolation and loneliness reduce older people’s quality of life and are linked to poor physical and mental health outcomes.
Over five years, the Reconnnections service in Worcestershire supported more than 1,500 lonely older people with a majority reporting a marked reduction in their feelings of loneliness and others seeing increased independence and improvements in health and wellbeing. Once the model was shown to be successful, the service developed a relationship with Independent Age, a leading national older people’s charity, which had the resources and capability to scale up the work. The scheme has now been rolled out to two other sites – Barking & Dagenham and Havering and Guildford and Waverley.
Supporting the whole health system with greater range of partnerships
ICSs cover larger populations than individual CCGs which means they have an opportunity to link up with a broader range of organisations. Rather than pushing back on acute trusts to accommodate a growing need for services, let us work with other non-NHS partners to support the system.
Seeing healthcare with a broader view rather than simply through the lens of an acute hospital, can help to provide a more proactive health service and avoid more hospital admissions through good population health management. Being able to target those who need care before they reach the acute stage is vital, as is proactively creating a healthier population through promotion and education.
Organisations in the voluntary sector can offer an in depth knowledge of the communities within which they work, highlighting where and what care is needed as well as being able to increase the capacity of the health and social care system.
While quality and money is always likely to be top of the agenda for improvements to the health service, we know that people who are well-integrated into the community, who exercise and are careful with what they eat, generally do better. Therefore, promoting healthier lifestyles through a range of organisations and working in a truly integrated way will introduce good population health techniques, helping people to live independently for longer and reducing the significant pressures that are being felt across the whole system.
CHKS Advisory Board:
Charles Waddicor is an independent healthcare consultant, non-executive director and board member who sits on the CHKS Advisory board, part of Capita Healthcare Decisions. A former primary care trust CEO for NHS Berkshire and National Professional Advisor for the CQC, Charles has a wealth of experience in senior management and leadership in both the NHS and Local Government. He has substantial experience in the role of chair of NHS and not for profit boards.