At the launch of our report Reimagining Community Services, Matthew Winn responds to the messages in the report from the perspective of a chief executive of an NHS community trust.
This presentation was recorded at a breakfast event at The King's Fund on 23 January 2018.
Welcome everybody and I’m Matthew Winn. It says I’m Chief Exec of Cambridge Community Trust who work across lots of East Anglia. I have for many years chaired the National Community Services Forum and I suppose I want to just touch on some things between both of those perspectives.
I’ve read this report and it was rather frustrating because everything I wanted to say I kept on finding in sections as I went through and it is a great report in terms of the whole policy, the whole history on community health services. It is a little bit depressing though, dare I say, for me because I read it and when I looked at the litany of policy and I looked back to the beginning of the NHS and saw initiative after initiative after policy after policy even up to the Five Year Forward View, I sat there thinking, well fabulous, but the intent has not been backed up by the reality of change, policy, initiatives, funding to actually make a difference. Therefore I think our national rhetoric is sadly not being reflected in what we do on a local basis, which is one of the King’s Fund key elements.
I think, as it says, it is high time that we brought community services in from the cold. They are a very hidden set of services. I still have to spend lots of time explaining to people what my job is and what my organisation does even though we will touch on millions of lives across the year in a really important way and that’s both our fault as providers and as commissioners, but it's also that national narrative about what are community services up to?
The report in section five has some really important things and I guess, for me, it resonated about the top down and bottom up approach and if I think about a bottom up approach, especially for us providers whether that’s from statutory organisations, voluntary etc, I think there are a few things that we must take into serious consideration. The elements on standardisation both in how services are commissioned, but in how we provide them, I work really hard in our organisation with my teams to make sure that whether it’s from Great Yarmouth down to Dunstable, which is our geographical scope, that actually we are standardised in our approach, whether it would be about our health visitors, whether it would be about our sexual health nurses, our consultants. They always have to be contextualised into the local geography, for demography, for language, for ethnicity, for religious issues but actually we should be demanding much more of ourselves to say, “Actually, we can compare and contrast and know that we’re doing a good job,” and of course that’s underpinned by data. So that’s a really key thing I think the report says is that we need to get better on both our data, our standardisation and so then we can drive improvement by using proper data and real time.
I suppose the second area is for me leadership, leadership at a national level but also, as it says, on a regional and local level. It’s great to have national directors, we’ve got one in the room, the medical director for acute care. We have no national directors for community health. We have very little infrastructure in NHS England, NHS Improvement, Public Health England, wherever it is, on 10% of the NHS expenditure and, whilst that might be viewed as tokenism, it’s important because actually if we really want to make waves about making community health a really good sector that thrives, works in partnership with organisations like Sam’s then actually it needs the push and it needs a coherence both in strategy, policy and leadership to actually do that.
Then it needs investment, but I would say, and I may be lynched by my colleagues, we should only be investing in integrated care not just in a single set of services because we really need, in scare resource time, to understand that our money is going into places, whether new or recycled, into things that make the maximum impact on local residents, not just willy-nilly throwing it at a district nursing service or a health visitor service. It needs to be targeted and it has to be integrated.
I think the other reflection from me is also for us all is to focus on the totality of what we do. So I was looking … my Trust has the pleasure to work in Luton and of course Luton and Dunstable Hospital is one of the few organisations that is meeting its 95% target every single day, but they’re not an island and when you look at the data for Luton residents, so probably 220,000 population, each day on average about 160 Luton residents are going to the hospital. About 60 of those are probably admitted each day, but behind that there are probably… if in adult services only in my organisation there are four to 500 interactions with patients happening on a daily basis. There are probably one to 2,000 primary care interventions happening probably more, there are 1,250 care home beds where people are actively being supported each day and there are probably around two to three to 4,000 packages of care coming in from domiciliary agencies.
So our system is four to 5,000 interventions happening each day but the discourse is about 160 people and the target. Now don’t get me wrong, that’s a really important target and those 160 people are really important, but we’re not talking about the gearing of four to five to 6,000 interactions each day in one locality and its impact that it might have on those people but also what it might mean on their utilisation of acute care. The telescope lens is in the wrong direction I would argue and I think the report is really clear that we probably and we should do something about that.
I think my final point looking at it is also then about the community health care sector. Again earlier I said we’re a hidden sector, we are, we don’t shout a lot and we are probably too timid in coming forward and demanding that actually 10% of the NHS expenditure deserves a better focus, both nationally and locally. One thing we are doing, so quick plug, is that we’re bringing together all the different representatives in networks. We have three community networks, or did have three community networks, straddling all our representative organisations. We’re obliterating that and creating one community network that will represent the sector and we do want leaders to actually engage in that and say, “This is really important.” There are flyers outside for people to look at that more and actually get involved, because if the leaders in the sector don’t stand up and be counted and talk about what it needs, then we can’t expect other people to take notice and do something about it.