SEISMIC changes within the NHS are now in motion, after the Government laid the foundations for the most significant structural reforms in a decade.
A white paper released in February, just as Covid was finally starting to relax its grip on the nation, outlined a statutory footing for the ICSs now in place across the country, and cemented Government plans to capitalise on the remarkable healthcare collaborations forged during the pandemic by driving forward more joined-up care.
The new model, announced within the recent Health and Care Bill, will see the legal formation of 42 integrated care systems, bringing providers and NHS commissioners together with key partners to deliver better outcomes in more innovative, efficient and cost-effective ways.
Before his recent resignation former health secretary Matt Hancock said the new blueprint would help shape a system that’s better able to serve people by ‘making joint planning and delivery of services easier’ and, in the long term, ‘addressing the needs of everyone, from children to older people, at different stages of their lives’.
However, for some, the health service’s new roadmap is simply further reassurance that they are already on the right track. From Worcester to Wokingham, South Yorkshire to South East London, projects which bring people together to deliver a better deal for patients are already in place.
VerseOne recently played an integral role in the development of a highly successful partnership project which is supporting communities – and changing lives.
VerseOne’s transformation experts recently joined forces with Herefordshire and Worcestershire Health and Care Trust (HACW), the social care sector, Worcester City Council, heritage organisations and even the local football club to create Life Stories, a pioneering digital memory book.
The smart platform allows people of all ages to share the milestone moments in their lives by creating an online journal using photos, videos, music and memories. Evidence has shown that recording our life stories can be therapeutic and help shape a sense of identity, particularly in people who have difficulty sharing this information themselves.
Although freely available to all residents of Worcestershire and Herefordshire, the application is now being used within clinical settings to stimulate and support patients with dementia.
Dr Natasha Lord, HACW’s Lead Older Adults Mental Health Clinical Psychologist, co-led the project which saw stakeholders come together to provide a personalised, accessible and safe space for users.
"We always knew that a digital Life Stories platform was going to make a difference to healthcare, however the pandemic has shown that this is even more necessary. Along with evidence that suggests that digital medium is even more powerful for triggering memories, a further benefit is that families will be able to update and provide valuable information to care in a timely manner when family members coming into hospital or a care home is limited as the platform is web-based. Bringing together mediums such as images, audio and video, potentially offer a more enriched experience and is more inclusive as it allows people who have communication difficulties to use alternative methods to writing memories.
"The platform is easily accessible and very intuitive, being developed with people at the heart and enables users to explore as independently as possible or with families or carers. We are already receiving feedback on the potential impact the platform can have and are looking forward to seeing what our research finds."
It is hoped that Life Stories will help patients with dementia and their families highlight information which is valuable to health and care organisations, too.
“In terms of integrated care, if a person living with dementia goes into hospital, their family may previously have had to come in with photos and mementoes to help staff learn more about them.
“But with Life Stories they can upload important photos and information to the platform via the cloud. It’s far more accessible, as it’s available anywhere online.
“Life Stories is also helping to bring health and social care closer together. I think older people’s services are already quite good at working closely anyway, but it is certainly supporting this.
“Having access to that level of detail wherever the patient is located will enhance relationships and enable people to give the best care. I’d like to see a quality difference and we are seeing that with Life Stories.”
“Overall, it’s been a brilliant project, and has extended the work we’ve already done,” Dr Lord added. “We’re now really excited to see how other people will use it too, whether it’s for enhancing the lives of their families or collaborating on community projects.”
Projects like Life Stories are needed more than ever. Sir Simon Stevens, NHS England’s boss for the past seven years, is set to step down at the end of July 2021, and his replacement’s in-tray is already overflowing.
Likely priorities include reducing huge operational pressures among acute providers, with A&E units across the UK at breaking point and the number of people waiting over 52 weeks to start consultant-led treatment peaking nationwide at more than 430,000 earlier this year – a figure not seen since 2007.
Secondary care has also seen a significant year-on-year increase in walk-in attendees, placing intense pressure on patient flow.
Add into the mix a huge referral and elective surgery backlog, 90,000 NHS vacancies, and emergency departments also facing the prospect of a winter battling pre-existing demands alongside a global pandemic, and you can see why many within the sector are keen to embrace radical change.
The situation in primary care is no better, too, with waiting lists rapidly expanding as GP surgeries and the services they provide slowly awaken. Last year, GPs referred six million fewer people for hospital tests or treatment, and one influential healthcare think tank has gone so far as to claim that figure could top 10 million by 2024.
Health chiefs hope ICSs and partnerships across providers – soon to benefit from the relaxation of existing rules on competitive tendering – will help the sector deliver new ways of working at ICS, place and neighbourhood level. A feature of the proposals will see clinical commissioning groups absorbed into integrated care systems by the end of the year, and statutorily dissolved in April 2022.
It is now a full lifetime since the NHS was established to provide treatment for acute episodic illness but, with growing numbers of older people also living with long-term conditions, it is straining at the seams.
Each new ICS, propelled by the spirit of partnership sparked by the pandemic, has been tasked with bringing hospital and community-based services, physical and mental health, and social care together to deliver joined-up and, where possible, place-based care for communities.
South Yorkshire and Bassetlaw (SYB) paved the way for the integrated care revolution when it became one of the first in the country to launch in October 2018. It now supports a population of 1.5 million across five interconnected places (Sheffield, Doncaster, Bassetlaw, Barnsley, and Rotherham), connecting 72,000 staff, including 208 GP practices and six acute hospital and community trusts.
Worryingly, life expectancy in SYB is no longer increasing; residents are now dying at a younger age and remaining in strident health for shorter periods. SYB has been tasked with addressing this inequality, allowing people to remain healthy and live well for longer.
To achieve this, place-based care partnerships have already been established, with local plans developed by clinical commissioners, hospital managers, doctors, patient groups and council officers.
Examples now operating at system and place level include:
- ‘Social prescribing’ schemes to support residents’ social, emotional or practical needs where medication isn’t the best solution: Problems with relationships, unemployment, and loneliness can be eased in this way
- Hospital doctors, nurses and allied health professionals have agreed a single way of working across some specialties: Teams share staff and work to the same high standards
- The Sheffield, Rotherham and Doncaster Perinatal Mental Health Service delivers specialist care: System-wide support is available to women with mental health problems who are planning a pregnancy, are pregnant or recently gave birth
ICSs, however, are broader than just being members of the healthcare club. A parish council in Wokingham was one of the partners in the Buckinghamshire, Oxfordshire and Berkshire West ICS which recently helped deliver 10,000 leaflets in an area where mental health issues are on the rise.
Colleagues from the Berkshire town’s local authority and health system came together to promote ‘One Front Door’, a Citizens Advice’ service which encourages residents in need to call a community hotline for support.
Meanwhile, a new way of delivering holistic support to help children with mental health issues and common health conditions has been launched by the Children and Young People’s Health Partnership, hosted by Evelina London Children’s Hospital.
Claire Lemer, consultant in general paediatrics at Evelina London and CYPHP’s operational lead, said the partnership, which brings together professionals including paediatricians, psychiatrists and researchers, was simply making the system more efficient by spending more time on prevention or early intervention rather than “resuscitation”.
These remarkable partnerships and many more demonstrate that provider collaborations are already improving standards in some communities. But significant challenges remain if the transition from a competitive to a collaborative approach is to prove successful and sustainable.
Declan Hadley, recently Digital Lead at Lancashire and South Cumbria ICS, warned that access to the right technology remained key.
“As integrated care systems continue to develop across England, it’s vital that we ensure that the underpinning digital technology is fit: we want to be match ready for the new health and care landscape.
“Key to that is being able to deliver the right information, in a secure orchestrated way, and ensuring that when we have the information, we can use it as the basis for action.”
Digital Exemplar Surrey Heartlands ICS has done just that by bringing two separate foundation trusts – Ashford and St Peters, and Royal Surrey – together to implement a pioneering EPR (electronic patient records) solution.
The Surrey Safe Care programme has digitised patient administration, allowing key services including A&E, elective surgery, and outpatients to mould digital processes together to deliver safer and more efficient care to some 800,000 people across six sites.
The NHS must mirror such innovation and work smarter, not harder, if integrated care is to become the new normal. To avoid compromising the high standards health and care staff routinely deliver across the country, the service must use its valuable and often ground-breaking resources more efficiently.
Healthcare tech – from Life Stories to telemedicine – has shown its worth. Now it must be rolled out system-wide if a truly integrated health system is to be delivered.
Guest blogger Dan Webber examines the impact partnership-working and integrated care systems are already having on the health service
Read True integrated care already is changing lives during the Covid crisis…