At the launch of our report Reimagining Community Services, Sam Everington, chair of NHS Tower Hamlets Clinical Commissioning Group, draws on his experience in Tower Hamlets/Bromley-By-Bow to reflect on what it really means to bring together resources in the community.
This presentation was recorded at a breakfast event at The King's Fund on 23 January 2018.
Great report, goes way beyond community actually and I hope I’m going to illustrate this in a few moments, because actually within it is thread through a whole raft of solutions to the problems that are faced in the acute sector and the pressures in the acute sector.
So I wanted to start off, first of all I’m going to get you to put your hands up in a few moments, I’m going to give you two choices, okay, you’ve got a terminal illness you can die in hospital or you can die at home surrounded by your loved ones. Now put your hand up if you want to die in hospital. Yeah, not a single person and yet typically in this country about 50% to 60% of our patients die from terminal illness in hospital. What we’ve done now in Tower Hamlets and across the country if you look at one … I’m national adviser to new models of care, one of our new models have reduced death in hospital from terminal illness from 48% to 14% and you know the irony of this, it’s actually cheaper.
So what do we do in Tower Hamlets? The answer is we have a multidisciplinary team meeting every month that manages the 5% of our patients with complex care, housebound, terminal ill and just to give you one example actually, a taster of it, a patient on my mobile phone, because I give my mobile phone to all my terminally ill patients, gives me a call in the surgery in the morning and says, “Sam, can you pop round at some point my mum has just passed away about half an hour ago?” Listen to the tone of what was said there actually. This was somebody who was terrified of managing the death of her mother at home, listen to what she said and you hear something very different. So I went round about half an hour later, a Muslim family, so I had the death certificate, enabled them to be buried within 24 hours and sat down with this daughter and said, “By the way, your mum would give you such thanks today because you gave her the best gift in life and that’s a good death,” and her bereavement has been 100 times less too. This is entirely possible and it solves the acute sector problem and it’s done within a multidisciplinary team in the community. So we have psychiatrists visit us, elderly consultants, Macmillan nurses, all these people are part of a team.
The second example I wanted to give you which expresses the massive problem of, outpatients has doubled in the last ten years, outpatients attendance doubled in the last ten years. We plan to halve it in the next year or so and I’ll give you examples about how we’re going to do that and make the patient experience 100 times better. Just ask some of the elderly patients who have come in with hospital transport in the morning, usually picked up at eight o’clock for a ten-minute consultation and end up by coming home at five in the evening and if they’re lucky they get some grotty sandwich halfway through the day. That is such a typical example. So what did we do in terms of renal care? By the way, we’ve reduced attendance by fourth fifths by doing this. I send an eReferral to the renal consultant with my problem, with the patient’s problem. He looks in my notes remotely, I can look in the hospital notes and get all their results, he can look in my notes. He looks at my notes, he looks at the hospital blood tests, he sends back advice all sorted within two weeks without the patient having to go to hospital. That’s entirely possible in virtually every specialty. Why are patients with ulcerative colitis and Crohn's going out to hospital to have blood tests every six months? What’s going on? What’s going on?
So that’s the second example, and a great example of the IT intra-operability which is absolutely critical to this sort of working.
The third example is the Bromley-by-Bow example. Now if you take the Marmot principle, 70% of health and wellbeing is nothing to do with what we traditionally do in the NHS, it’s everything to do with the social determinants of how, somebody getting a job, somebody getting an education, somebody’s creativity or spirituality and the environment. If you tackle these issues actually you tackle people’s health and wellbeing and you move from when I trained all those years ago as a doctor, because I was taught to know everything, I was crammed full of knowledge and it was all about what the matter was with patients, actually it’s what matters to patients that’s critical. If you start focusing on that you will absolutely deliver people’s health and wellbeing.
So how do we do this and how have we put it … as chair of CCG how have we put it in every practice in Tower Hamlets? So on the desktop of a GP, referral to cancer, the standard referral forms, but a social prescribing referral form, and there are lots of boxes there, it takes seconds to complete. There’s a box which says lonely, stressed, repeat attender, financial problems, a whole raft of things, and it goes to the social prescribing team, who are motivational coaches, they’re not clinicians. Typically they’ll spend an hour … they’ll ring the patient, invite them in, cup of coffee, spend an hour with them and absolutely focus what really matters for them. Not that they’ve got a mental health problem, not that they’ve got addiction, actually what is the important thing in their life which is going to absolutely transform their care?
This social prescribing team then can potentially refer somebody to 1,500 voluntary sector organisations in Tower Hamlets. The doctors love it, it takes pressure off them, the patients love it, it focuses on what matters to them, the voluntary sector love it because they don’t need to market their wares and I, as a tough CCG chair, love it because actually it reduces the pressure on the NHS. It’s a win win.
Two more very quick examples. In Tower Hamlets eleven years life expectancy difference between rich and poor, 20 years quality of life expectancy. If you live in Tower Hamlets you can expect to hit the age of 75 at the age of 55. My point here is if you go down the traditional pathways you’re not going to solve the problem. There isn’t a magic bullet or a magic drug out there, this is absolutely to do with people’s lifestyle with what matters to them. If you look at how to prevent cancer it is happiness, lack of stress, we know that stress actually means you don’t repair your cells so well, it’s activity. Muir Gray’s research shows ten years loss of life if you’re inactivate. It’s gardening. There’s an added effect of gardening, of course we produced the Gardening and Health report here last year with Mary Berry, a lovely moment when I was on Women’s Hour with her. Gardening has an added benefit beyond activity, it’s about mental wellbeing. Smoking, alcohol yes, and a Mediterranean diet and if you just went away with that one message today you’re going to live a lot longer.
And finally, and my point with all of this, and this is why the report is so important and goes way beyond community, actually just some examples from across the country of the new models of care. A mental health trust that set up a café with its staff open seven days a week reduced acute admissions by a third. Williams here, from our team, he’ll tell you about Sutton care homes actually that reduced the length of stay in patients in hospital because actually everyone in the team, the whole team, is managing the care.
So fantastic report, goes way beyond community. Anyone from the acute sector please listen because actually here lies the solutions to your problem and let’s start and further movement of social prescribing that goes way beyond the traditional health care because therein actually really lies the solutions to people’s health and wellbeing.