We also learnt of plans to develop accountable care systems (ACSs) to take forward the work of the new care models and develop integrated care at scale. One of the lasting impressions for me was the time we spent in The Frimley Health and Care System where Andrew Morris is chief executive of Frimley Health NHS Foundation Trust and lead chief executive of the sustainability and transformation partnership (STP) and ACS. Andrew spoke passionately about the improvements in care that have been achieved by the new care models and other initiatives and the impact they are having on local hospitals.
Most importantly as a result of this work, for the first time in the 29 years Andrew has served as a chief executive, demand for hospital care has fallen. This is evident in flat A&E attendances, and falling emergency admissions and GP referrals. To be sure, local hospitals are still busy but unlike in previous years their workload is manageable and staff are working under less pressure. The downside for the foundation trust is that it is losing income by not treating as many patients as planned but this is a nice problem to have as the Frimley system looks ahead to becoming a fully-fledged ACS with a system financial control total.
Many changes in care help to explain how the system has been able to bend the demand curve for hospital services. They include improved access to GPs, the ability to deliver more effective services in the community and to support people in their own homes, mental health services that are more accessible and oriented around patients’ needs, and changes in A&E that enable patients to be treated and sent home instead of admitted to hospital. The challenge will be to sustain these gains and to extend them to those parts of the Frimley system that have not been involved in work on new care models to date.
In Frimley and elsewhere, Don and I were struck by the energy and commitment of clinicians and others in leading improvements in care. Andrew Morris observed that these improvements are happening from the bottom up in contrast to many previous reforms which have been promoted from the top down and have often failed to engage front line teams. We saw evidence of this everywhere we went alongside growing involvement of patients and users. Many of the changes taking place go well beyond mainstream health and care services and draw on the contribution of volunteers and a wide range of community assets.
As the new care models approach their third anniversary in 2018, there is much to celebrate. As national funding and support comes to an end, I am confident that their work will continue and in many cases be extended. ACSs and STPs provide an opportunity to lead this work and to demonstrate that rising demand for hospital care is not inevitable if clinicians and managers are willing to embrace new ways of working. Patients and staff both benefit from the changes we saw, demonstrating that innovation is alive and well in the NHS and is producing tangible improvements in care.
May I suggest you and Don go to Northumbria Healthcare NHS Foundation Trust to see how things are done up there.
I did last week and was amazed to find that this Trust employs most of the social workers who used to be employed by the Northumbria Council.
People talk about integrated services this Trust actually does integrated service in real life.
To find out more before you book your train ticket please read the Trust annual report.
Their ALoS for emergency admissions is 36 hours. They do not have a Delayed Transfer of Care issue i.e. 0% not the 3.5% national target.
They also do hips and knee replacements on a day case basis. See this video https://www.youtube.com/watch?v=e8QSAtSGTog