Many of you will have seen last week the headlines following comments by David Prior, the Chairman of the CQC, about the unsustainable pressure on Accident and Emergency wards in the UK. The truth is that patients are getting excellent care in A&E departments up and down the country. The NHS is coping well with the increase in demand. But there is no denying that there has been a big increase in demand on our emergency services. There is no easy fix to this situation, especially at a time when the NHS needs to make limited resources go further. But this week marks the beginning of a new approach to health care in Britain that I hope will provide a much better long-term solution to this problem.
With people living longer, we have a rapidly ageing population – many of whom are living with chronic health conditions. And while people are living longer, they are not necessarily remaining healthy in those extra years. Across the world, changing lifestyles are leading to an epidemic in diabetes, cancer, and heart disease. NHS patients nowadays are increasingly likely to have complex health needs that span a variety of disciplines and services, and the particular challenge we face is the number of people with complex conditions turning up at A and E.
At the same time, NHS services are too often fragmented. Unfortunately many patients with long term conditions have to negotiate a bewildering array of doctors, nurses and care providers and this leads to delays in accessing the treatments that are needed, and poor decision making. Patients are left feeling let down and frustrated. Often, people end up in A&E after a crisis admission – putting strain on frontline services, and adding to spiralling costs in the NHS. If we stick to the same old approach, the NHS could in future buckle under the pressure.
The Health Service must adapt in innovative ways to accommodate evolving, and increasingly complex, patient needs. Today’s announcement of 10 “integration pioneers” across the UK marks a revolutionary change in the way that health services are provided, with a new emphasis on joined-up case management, and decision-making that always looks at the whole picture in supporting a patient.
Many local service providers have already set a precedent of what can be achieved by integrating services; North Elmham Medical Practice in Dereham, in my own county of Norfolk, for example, has a team of mental health nurses, district nurses, GPs and County Council social workers who meet regularly to review patient care and treatment plans. This means people get more joined up care, and don’t fall through the cracks in the system.
The Torbay Care Trust case is another great example of local health professionals working together to create an integrated service with very encouraging results. The Trust introduced measures such as an integrated information system, making background information on a patient easily accessible to employees and saving hours of valuable time. A single point of contact for patients means they don’t have to repeat their story to dozens of separate clinicians. Today, reduced waiting times, lower numbers of occupied beds and a marked decrease in crisis admissions clearly demonstrate the benefits of the Torbay Care Trust’s approach.
With today’s announcement I am encouraging applications for the Government’s new Pioneer Sites Programme. The Programme will provide support for ten sites across the country working to explore how they can integrate their services, to make sure that organisations always work together to provide the best possible care for patients. The aim is to establish pioneers that will champion their ideas across the NHS to provide the inspiration for large-scale change. I want to move the NHS away from top-down re-organisation, and instead encourage local services to find sensible ways of working together to support their patients.
I believe that working towards a more integrated health service will stop people falling through the gaps in the system; it will help to develop a more joined up, holistic approach to patient care that protects our NHS for the future.
* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee
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7 Comments
One problem is now the difficulty of knowing who to contact at short notice.
Twenty years ago GPs were seen as more accessible. Now they are seen as a service needing long-term appointments ahead of time so more people are making their first approaches to A&E. The minor injuries units in some places help – but it can be confusing finding out what is appropriate to go to.
The integration of social care services for the elderly with NHS services seems to be an area in need of review and coordination with so many seniors occupying hospital beds , who would ostensibly be better cared for in residential care homes or in their own homes.
Is this area of provision under review?
Mr Lamb was and is a supporter of the Conservatives’ Privatisation/Commercialisation of the NHS (with the notable support of Baroness Williams). The LibDems increasingly treat the electors as complete fools, we are not; and we eagerly await the opportunity to vote in the 2015 General Election. I voted LIbDem at the last General Election.
It is no wonder that there are delays in discharging older people from hospital, in view of the swinging axe taken to council budgets by the coalition.
Further fragmentation of services can only be expected, when the coalition have opened the door wide open, to full privatisation of services.
People are indeed being treated well once they get into A&E, but there are increasing numbers of ambulances queuing at A&E departments which Norman Lamb doesn’t mention. Bristol hospitals’ A&E departments have recently had queues of between 10 and 20 ambulances and their crews. This prevents the ambulance service having sufficient capacity to meet its target call out times, and is a clear waste of resources.
The problem is that hospitals are failing to discharge patients into care homes, where care costs a lot less than a hospital bed, and is more oriented to longer term holistic care than hospitals can offer.The discharge failure is due to local social service staff being unable to respond sufficiently quickly to place patients ready for discharge from hospital into care homes. It needs to be fixed.
Norman hails the newly organised health care management system, but it is very difficult to see what Clinical Commissioning Groups are really going to do to change the age old structure whereby most of us consult our GP and then if necessary are referred to our local hospital consultant. CCGs do not commission new hospitals, or train new doctors or nurses. They place contracts with existing institutions at nationally set prices per procedure. They will cost less than the PCTs they replace by the simple means of a lower management budget having been imposed on them. Otherwise, don’t expect any great change.
Channel 4 tonight (15th May) reported that A&E is in crisis, bleeding consultants and not able to recruit even trainees to replace them. Apparently the new 111 service is exacerbating the situation by pushing more patients to use them. Not quite the rosy picture that Mr Lamb paints
My family have been coping with various agencies for the last two years to try and ensure our mother, a dementia sufferer, enjoys a reasonable quality of life in her own home. Not having had much contact with care services in the past, we were completely shocked at the lack of communication between all the responsible agencies. Most noticeable is the lack of concern for those who are caring for their family members and the extremely poor management structures. It can’t be the hardest thing in the world, surely, to expect hospitals, G.P.s , District Nurses and Care Organisations to actually talk to each other and us, the Users? Mother isn’t the cause of our stress – it is the NHS!
Phil Bowerman