Victor Adebowale: Commissioning person-centred care for vulnerable groups

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  • Posted:Wednesday 24 February 2016

Victor Adebowale, Chief Executive of Turning Point, discusses the important role of pharmacy in working towards developing integrated community-based care for vulnerable people.

This presentation was filmed at our event Commissioning person-centred care for vulnerable groups: what role does pharmacy play? on 24 February 2016.


The story I'm going to tell you is one which refers to Turning Point and just so that you know Turning Point really are inspired by possibility, we operate in 240 odd locations, we employ well near as dammit 4,000 staff, our turnover this year will be £130m, we work across mental health, learning disabilities, substance misuse, some primary care stuff. We’re interested in reversing the Inverse Care Law. I love what I do, that’s why I’ve done it for 15 years but, or and, but I'm in one of our substance misuse services, a few months ago, and this chap walks in and he’s coughing and he’s got a substance misuse problem, der that’s why he’s there I guess. And we in our services, some of you will work with people with substance misuse challenges won't you? Yes? And in most communities there are some of the illest people walking, would you agree with me? The next one down you are in hospital, do you know what I mean?

So this is coughing, he’s got a bit of a cough, and we employ GPs, I'm not sure I’m allowed to call them GPs but they’ve gone to medical school and they’re the smartest people in the room, better A levels than me and all that sort of stuff, and they are… so we got these specialists and I see one of them and I say, “This chap’s coughing and he looks rough, what do you think’s wrong with him other than the fact that he’s got a substance misuse challenge?” And the doc listens and say, “He’s probably go bronchitis” And I say, “That’s great, in a way, he’s come here with these substance misuse challenges, his cough and I'm probably going to prescribe something”. Antibiotics, that’s the thing isn’t it that you prescribe for bronchitis these days? Our clinician said, “We can't really, we can't do that”. I said, “Why not?” “Well we haven’t got a contract to prescribe antibiotics”. I said, “What’s going to happen to him then?” and he said “We’re going to send him to his GP” and I said, “Well what happens if he doesn’t go to his GP? What’s the chances of him going to his GP?” “About 2%”. “So he’s not going to go to his GP is he? So what’s going to happen then?” “Well he’s going to get worse isn’t he?” I said, “What’s going to happen then?” “He’s probably going to end up in A&E. I said, “How often does this happen”. “Well we’ve got over 2,000 clients, 1,995 times”.

And I thought well that’s the opposite of integrated community based care isn’t it? It’s like that’s insane. That is negative value transfer. That, what I’ve just described, happening to that individual has got to stop. We could replace him with my mum who’s got complex issues. The point being that there should be no wrong door and every service should reverse the Inverse Care Law which simply states those people in need of health and social care the most get them the least. That’s what I mean. That’s what we should all mean when we talk about, well in my view the future of the NHS but person centred care for vulnerable people and indeed integration place based health. It starts there and builds out, which is a problem for the NHS because the NHS is process driven.

If you want to put your hand up if you haven’t been in a session in a meeting with a load of NHS England or CCG people where your thought has been what’s the intention behind this process? You with me? What’s the intention? And that should drive the change.

For Turning Point one of the reasons I accepted this gig was because we work with 776 pharmacies across the UK so I wanted to say thank you frankly because we’d be stuffed without you and so would our clients, so you don’t hear that very often do you? Thanks. We have all the panoply I think of pushing towards some of the big shifts in both pharmacy and the delivery of care to vulnerable people. Pharmacy is challenged by basically the growth of, and which I think is a good thing by the way, but I think it’s a challenge to the pharmacy business model, of the electronic age. What can be done with patients? They’re not just passive recipients of a prescription anymore, they’ve active participants and want to be active participants in their own health even people who are ill as some of the people that Turning Point work with, actually don’t want to be done to they want to be done with, but that is a very big shift I think in how we all have to operate and in particular how pharmacy has to operate. The whole panoply of 24/7, electronic prescribing, the work that we’re doing with pharmacists to measure and to help us construct conversations with the NHS about who is going to be in and out of their acute care, their A&E, the expensive stuff, that’s the kind of stuff that we’re working with.

In doing that both pharmacy and Turning Point is actually trying to innovate, you’re trying to innovate so a lot of people think that if you innovate what you’re doing is you do is that you publish what you… we’re very good at that, we publish papers and shove it all out there, “do this”, “do that”, “best practice”, “tool kits”. This stuff falls like snow and lasts about as long. The fact of the matter is most innovation works because the people who innovate take over the people who don’t. That’s how it works actually.

The other myth is that you go through two stages of innovation. You practice the new thing, the new toy, the new service until it’s perfect, and then you roll it out. Wrong. You roll it out and practice at the same time. The fact of the matter is pharmacy operates where people are in a really real way, people do vote with their feet, people do experience pharmacy and they actually talk to pharmacists probably. This isn’t an evidence based statement, I'm just going to tell you. I think they’re more comfortable talking to their pharmacists in many cases than they are talking to their GP. I certainly think it’s true of my… it could be that I’ve just got a nice pharmacist and not a very nice GP, I don’t know. But I just think there’s that notion that we could be learning in situ, real time, what works, building qualitative and quantitative evidence and actually innovating and showing the system what it could be.

My point is that pharmacy has a unique position in its presence in the community and its relationship with individuals and I think that you have to ask yourself the question, honest question, why aren’t we more influential in the policy? Why haven’t we… I know it’s a difficult question to ask yourself, but how can we show the NHS, how can we present them with a vision, a practical ground of vision of what integrated community health and social care services would be?

Thank you very much.


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