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Young doctors and community services are hospitals' only hope Older people need healthcare closer to home – not in hospitals
(about 2 hours later)
It is now a year since I finished a seven-year stint as an acute trust chief executive. The end of my time was dominated by the challenge of maintaining high quality care for our patients in the face of continually overcrowded hospitals. This overcrowding was largely because of gross shortfalls in the provision of alternative forms of care, whether home-based or residential, which meant patients were unnecessarily admitted to hospital or subject to delays in leaving once their acute illness was over.It is now a year since I finished a seven-year stint as an acute trust chief executive. The end of my time was dominated by the challenge of maintaining high quality care for our patients in the face of continually overcrowded hospitals. This overcrowding was largely because of gross shortfalls in the provision of alternative forms of care, whether home-based or residential, which meant patients were unnecessarily admitted to hospital or subject to delays in leaving once their acute illness was over.
This insufficient provision of support in community settings is not in the best interests of patients. Acute hospitals are set up to treat the acute phase of illness, and older people in particular are at risk of losing independence and suffering complications such as chest infections if they stay in hospital for longer than necessary.This insufficient provision of support in community settings is not in the best interests of patients. Acute hospitals are set up to treat the acute phase of illness, and older people in particular are at risk of losing independence and suffering complications such as chest infections if they stay in hospital for longer than necessary.
This service imbalance was a major challenge for me and it is why I took up my current role as chair of the NHS Confederation’s commission on improving urgent care for older people. This work is focused on finding practical solutions that are locally based and tailored to people’s needs. We will report early in 2016.This service imbalance was a major challenge for me and it is why I took up my current role as chair of the NHS Confederation’s commission on improving urgent care for older people. This work is focused on finding practical solutions that are locally based and tailored to people’s needs. We will report early in 2016.
The commission has been looking at innovative practice around the country. Excellent frontline clinical leadership is behind initiatives in hospitals such as Sheffield and the Royal Berks, while the Age UK Pathfinder Project is demonstrating the impact care co-ordinators can have in patient care and bringing services together. In the south-west, the role of the ambulance service has been broadened, to great effect, and Oxford Terrace and Rawling Road surgery in Gateshead have mobilised the local community to provide a range of options for people who are better served by support that isn’t necessarily medical.The commission has been looking at innovative practice around the country. Excellent frontline clinical leadership is behind initiatives in hospitals such as Sheffield and the Royal Berks, while the Age UK Pathfinder Project is demonstrating the impact care co-ordinators can have in patient care and bringing services together. In the south-west, the role of the ambulance service has been broadened, to great effect, and Oxford Terrace and Rawling Road surgery in Gateshead have mobilised the local community to provide a range of options for people who are better served by support that isn’t necessarily medical.
We have visited numerous local health systems and found common themes and opportunities emerging. There is evidence that nominating leadership roles within local clusters can drive innovation, compensating for the inertia of so many organisations trying to work together. A common feature of successful change is one individual who fights tirelessly to overcome the blocks to progress. Unsurprisingly, progress is greater when these individuals are helped by system leaders to overcome these barriers. Supporting the frontline, and those driving constructive change, must become the norm for senior leaders.We have visited numerous local health systems and found common themes and opportunities emerging. There is evidence that nominating leadership roles within local clusters can drive innovation, compensating for the inertia of so many organisations trying to work together. A common feature of successful change is one individual who fights tirelessly to overcome the blocks to progress. Unsurprisingly, progress is greater when these individuals are helped by system leaders to overcome these barriers. Supporting the frontline, and those driving constructive change, must become the norm for senior leaders.
NHS England’s vision for transforming the way care is delivered is a journey we can all support, yet a myriad of obstacles mean that few are persuaded that it is achievable, or affordable. It is clear that relentless pressure on frontline services is not reducing. This winter is viewed with dread, and longer-term solutions, which would reduce pressure by shifting the balance away from hospitals and towards community or home-based care, seem as far away as ever.NHS England’s vision for transforming the way care is delivered is a journey we can all support, yet a myriad of obstacles mean that few are persuaded that it is achievable, or affordable. It is clear that relentless pressure on frontline services is not reducing. This winter is viewed with dread, and longer-term solutions, which would reduce pressure by shifting the balance away from hospitals and towards community or home-based care, seem as far away as ever.
For many hospitals there is a daily struggle to maintain safety standards and meet performance targets amid shortages of key staff members and worsening financial positions. This is mixed with a lack of sufficient capacity in the wider system that would allow older people quick access to the right care in the best environment. Many organisations are also preoccupied with having to respond to escalating regulatory requirements, which compel the implementation of short term quick-fix solutions that are not sustainable and crowd out longer term planning. Furthermore, there is an urgent need for clarity about levels of future funding.For many hospitals there is a daily struggle to maintain safety standards and meet performance targets amid shortages of key staff members and worsening financial positions. This is mixed with a lack of sufficient capacity in the wider system that would allow older people quick access to the right care in the best environment. Many organisations are also preoccupied with having to respond to escalating regulatory requirements, which compel the implementation of short term quick-fix solutions that are not sustainable and crowd out longer term planning. Furthermore, there is an urgent need for clarity about levels of future funding.
Payment mechanisms and the multiplicity of organisations are also cited as blockages to greater collaboration in local health systems, as well as current regulatory methods that force leaders to prioritise their own institutional performance over a more collaborative approach across a local health community. Government, national bodies and the health service could change these and incentivise leaders to adopt a broader approach. Perhaps the vanguard initiatives across the NHS represent the start of such a change?Payment mechanisms and the multiplicity of organisations are also cited as blockages to greater collaboration in local health systems, as well as current regulatory methods that force leaders to prioritise their own institutional performance over a more collaborative approach across a local health community. Government, national bodies and the health service could change these and incentivise leaders to adopt a broader approach. Perhaps the vanguard initiatives across the NHS represent the start of such a change?
Despite all these obstacles, many local systems are moving towards the new shape of care and many more will follow. We have spent time in discussion with patients, carers and advocates trying to unpick what it means, in practical terms, to make care more patient-centred. We have heard evidence that we are very far from being truly centred on individuals in our service delivery. Aiming to change this would be a radical step, and I hope it will form the basis of some game changing recommendations from our commission.Despite all these obstacles, many local systems are moving towards the new shape of care and many more will follow. We have spent time in discussion with patients, carers and advocates trying to unpick what it means, in practical terms, to make care more patient-centred. We have heard evidence that we are very far from being truly centred on individuals in our service delivery. Aiming to change this would be a radical step, and I hope it will form the basis of some game changing recommendations from our commission.
Young doctors and managers are interested in the challenges of healthcare planning and delivery too. If they are developed and then enabled, they will devise and deliver the solutions we are currently seeking.Young doctors and managers are interested in the challenges of healthcare planning and delivery too. If they are developed and then enabled, they will devise and deliver the solutions we are currently seeking.
The challenges are great but many green shoots exist. The main role for our senior leaders now is surely to nurture them.The challenges are great but many green shoots exist. The main role for our senior leaders now is surely to nurture them.
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