England’s top A&E doctor says we must seize ‘once in a generation’ opportunity to remake NHS and local government partnership
England’s top urgent care doctor has called on health and local government leaders to seize “the greatest opportunity in 70 years” to remake the NHS and local authority partnership and improve the health of their communities.
Professor Keith Willett said the two sectors had historically struggled to overcome their financial, cultural and operational differences preventing them from adapting to public need.
But changing health and care needs, the imperative of financial pressures, and the advent of integrated care systems means the conditions are right for a major shift in attitude.
Positive results from joint working over the past year has now cut hospital delayed transfers of care to their lowest level in over three years.
With 100,000 beds and 1.3 million workers in the NHS versus more than 300,000 beds and 1.5 million workers in social care Professor Willett said the two sectors were becoming increasingly interdependent.
“Many in the NHS and social care have no idea of the complexity of the other care system yet we are interfacing with them all of the time.
“You can’t understand the complex needs of people until you’ve listened to a patient or carer talking to their GP or ringing 111 or 999 for a local mental health response or to sort out a care issue for an elderly person who then ends up going into hospital.
“The NHS traditionally presents change from an evidenced-based and population-benefit perspective, and local government often sees such change from the individual constituents’ day to day life circumstances and their holistic social need.”
Professor Willett launched a new web film showing how a council in Sussex is working with the NHS to help older people stay healthy.
He said this illustrated how joint working is doable and predicted that NHS and local councils that failed to establish effective partnerships would face increasingly hard questions from the public. “The status quo is looking less and less attractive to more and more people,” he said.
Professor Willett also highlighted five other schemes, identified with support from the District Councils’ Network, where local authorities and the NHS had formed partnerships that had improved services in their communities.
These include health coaches, social prescribing health hubs and housing schemes to support people at home keeping them out of hospital (see below for more details).
Interviews with more than 50 council CEOs, directors of social care, public health, children’s services, local councillors and officers, Mayors and many others all stressed the benefits of taking a ‘place-based’ approach to the provision of services, talking about co-production, being engaged early, working as partners, building understanding of structures and constraints, using their experience and expertise effectively, giving clarity over the direction for sustainability and transformation partnerships and building mutual trust.
Professor Willett said the NHS, local government and clinical leaders often underestimated how much they needed to learn about each other.
He said: “There are 7,500 GP practices in the country but 8,500 domiciliary care providers and 80 per cent of whom are small family businesses.”
He highlighted the work of Surrey Heartland integrated care system which has a devolution agreement. “Remember, most of the social determinants of health status are in the realm of public authorities not the NHS – such as housing, public health, social care, economic wellbeing, family and children’s’ services,” he said.
Surrey has made a commitment to improving the first 1,000 days of someone’s life and working with partners to impact on the determinants of health such as healthy behaviours and environmental issues.
Its devolution agreement is backed by £15m for specific projects including support for managing winter pressures as a system and further support for integration and frailty projects. The system includes work on schemes like Home First at Royal Surrey County Hospital NHS Foundation Trust where adult social care is improving hospital discharge; the new HandiApp for parents of young children is helping them access the right services across the partnership, and they have aligned commissioning intentions across Surrey CCGs, the County Council and the Health and Wellbeing board priorities.
Through their citizen-led engagement programme they have also conducted an extensive piece of social research to understand their citizens’ health and care priorities and how they currently perceive services.
In the new film showing a joint health coaching scheme Dr Nick Harding, NHS England senior medical advisor, says: “Wouldn’t it be amazing to see health and care without boundaries, the NHS working with local authorities for the benefit of the local population – now that would change everything.”
Charles Lant, chief executive of the Wealden District Council, said their jointly funded health coach was an idea that came from a conversation he had with a GP which made him think about the issues the council could help with.
“My message to health colleagues is engage with your district councils because they have a lot to offer in terms of planning issues with healthcare infrastructure and leadership skills. To district councils you know there’s nothing more important than the health and well-being of your residents. The services you provide are a perfect opportunity to engage with healthcare colleagues to try to ensure the maximum benefit for the people you represent.”
Professor Willett recently interviewed local and county councillors for a webinar which offers NHS clinical leaders a fascinating perspective into how local government operates, their priorities, community accountability and how they approach and scrutinise NHS proposed changes to services.
The five schemes identified with support from the District Councils’ Network are:
- Wealden in East Sussex has a jointly funded NHS and council health coaching service, with local GPs prescribing community activities from the council’s not-for-profit leisure operator, including coffee mornings, singing workshops and walking groups. More than 80 patients have benefitted from expert coaching and many have improved mental health, increased physical activity, lost weight or reduced their medication requirements. 29 patients who regularly visited their GP in the six months before receiving coaching reduced these visits by 61% in the six months after.
- In South Norfolk, 187 patients have accessed the district council’s ‘Help Hub’ in its first six months, a social prescribing scheme under which patients who attend surgeries for non-medical issues can be referred for direct access to practical help and advice. 73,057 patients have access to social prescribing at present, in nine surgeries and by the end of January 2018, 12 surgeries will host the service; 45% of patients had their identified needs met in the initial appointment, where they received tailored information and advice; 98% of cases were not escalated to statutory services; 87% are contacted within two days; and there is greatly increased partnership working between GPs, other health professionals and district council services.
- In Blaby, Leicestershire, the county and district councils worked with the NHS to develop a housing support service, ‘Lightbulb’. This provides housing ‘MOTs’ to identify immediate housing safety risks and make adaptations such as ramps or room alterations, and tackle problems such as poor heating and hoarding. It also provides grants, advice and information about how to access wider support. They are also working with Leicestershire hospitals to support discharge and prevent readmissions. The project led to a reduction in use of some services by 66%, and lower A&E attendances and emergency admissions. 920 unnecessary bed days were also saved from the Bradgate Mental Health Unit, 89% of service users reported an improvement in their physical and mental health, 78% felt better about their home and 71% felt better able to get around their home and garden without the risk of falling. Last September, the scheme was estimated to have saved the NHS more than £435,000 and has been extended across the county.
- Schemes in different parts of Buckinghamshire – Wycombe District Council’s ‘Healthy Homes on Prescription’ allows medical or social care practitioners to refer patients for simple, fast-tracked housing solutions to support independent living at home. This could include a stair lift or central heating system. People with a long-term chronic health condition can apply for up to £5,000 without means testing to help support their physical and mental well-being at home, preventing hospital admission and GP attendances. It is already saving the NHS £53,476 and social care £132,984. And, by increasing uptake of physical activity by residents, nearby Chiltern and South Bucks District Council estimates that is saving local healthcare services more than £65,000, and yielding a further £365,168 in wider health benefits such as quality-adjusted life years.
- In Haverhill, Suffolk, a pilot scheme run by ONE Haverhill Partnership and St Edmundsbury Borough Council has seen more than 50 people with a low mood and long term health conditions benefit from a partnership to improve wellbeing and reduce isolation. GPs refer patients to meet a ‘LifeLink’ Coordinator who spends some time getting to know them and helping them connect with people and activities in their area.Patients value the chance to get out of the house, meet new people and learn new things. The programme will also help the NHS to prioritise resources by avoiding unnecessary repeat GP and other appointments, saving prescription costs and increasing employment opportunities for local people. The £130,000 project was funded by Public Health, Suffolk County Council and the Department for Communities and Local Government and builds on ONE Haverhill Partnership’s priority to improve health and access to services in the town
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