The Public Accounts Committee report warns that services for patients are likely to suffer following the collapse of an £800 million contract to provide older people's and adult community services.
Trustworthy Collaboration, written for NHS Employers by Prof Veronica Hope-Hailey of the University of Bath, explores the challenges of building trust across health systems, in the context of the 50 vanguard sites tasked with delivering transformational change through new care models.
Specific achievements have been recorded in:
1. Reducing delays in discharge from hospital including the establishment of a new ‘transfer to assess’ model between the social care reablement service (City Council), hospital discharge team (CityCare) and Nottingham University Hospital’s supported transfer of care team.
2. Increasing availability of rehabilitation – the OPM survey compared Nottingham’s levels of older people who were offered rehabilitation following discharge from hospital and found our figure of 5.8% was higher than any other of the nation’s ‘core cities’.
3. Increasing independence for citizens through integrated assistive technologies – uptake of assistive technology is now among the highest in the country with more than 7,000 people in the city being supported.
4. Improving patient/citizen experience – almost three-quarters of practitioners in a 2015 survey agreed or strongly agreed that ‘we take a holistic view of each patient/service user’s needs’ – a year-on-year increase.
5. Enhancing partnership working – the city has been granted NHS England integrated care Pioneers status, is home to two NHS England vanguards, gained Better Care Fund authorisation at the first attempt, and has seen independent evaluation (OPM) complementing the high levels of partnership working.
The service ‘Advice and Guidance’ offers the opportunity for GPs across Morecambe Bay to hold a secure electronic ‘conversation’ with a hospital specialist to obtain real time advice about a patient’s condition. This can often enable a patient to be managed under the care of their local GP.
The system offers the opportunity for GPs to seek advice via an electronic “conversation” with a hospital consultant on a patient where they have a query.
Figures released covering the last financial year between April 2015 and March 2016 show that of the 1,919 “conversations” begun by GPs to specialists (that would have previously been a direct referral to hospital for an outpatient appointment.)
655 (34%) patients were managed under the care of the GP with advice from a specialist.
A new partnership of healthcare providers, including AWP, has been selected as the preferred bidder to deliver community health services for children and young people. The services will run in Bristol, South Gloucestershire and North Somerset and are due to begin in April 2017.
The services will include health visiting, school nursing, child and adolescent mental health (CAMHS), speech and language therapy, occupational therapy and physiotherapy, community paediatricians, community nursing and a range of dedicated services for vulnerable children including children in care, children with learning disabilities, children with life limiting conditions and children with drug and alcohol problems.
The demand for Continuing Healthcare (CHC), packages of care which are arranged and funded solely by the NHS for individuals outside of hospital, is increasing, as is the cost. Staffordshire has been particularly heavily affected, with an average growth rate of 13% over the last three years.
The development of the Accountable Care Organisations contract has identified some necessary changes to regulation. This is largely to ensure that current rules continue to apply to the new contract, and the organisations using it. It also increases flexibility in some cases, for example for GPs who wish to enter into ACO arrangements without terminating their existing contracts.
This Commons Library briefing paper looks at the introduction of Accountable Care Organisations (ACOs) in the NHS in England, the development of the ACO policy, and comment on its potential impact.
Advice and Guidance (A&G) is a scheme that connects GPs with hospital specialists via a secure electronic conversation, for advice on patients, without the need to refer a person for an appointment to outpatients.
The scheme was introduced as a pilot between the Trust and the Landscape GP surgery in Garstang in 2014 and is now available across Morecambe Bay. It has expanded since its launch to cover 19 health specialties.
A recent Lancet paper gives an interesting perspective. Researchers looked at elements of dependency including continence, cognition and self-reported activities of daily living in two cohorts of people aged over 65 – one cohort recruited in 1991 and the other in 2011.
The bottom line finding from this research is that the men and women studied in 2011 were living, on average, an additional 2.4 and 3 years respectively with substantial care needs. Even with a radical shift towards healthy active ageing, it’s unlikely that a hypothetical 2031 cohort would show anything but an increase in the total number of older people living with dependency.
The team – based centrally in one location at Leechmere, Grangetown – aims to support adults who live in Sunderland, who are registered with a Sunderland GP and need short term health and or social care support, that can help to keep them living at home, with care wrapped around them while they’re at their most vulnerable.
Support is tailored to a person’s needs and can be any combination of a short term care package, from nursing to therapy to get them back on their feet without having to be hospitalised or needing long term care. GP support is also available within the service.
Through Recovery at Home, those who need greater support while they’re getting back to normal after a short term condition can also be provided with bed-based care, meaning more intensive support can be offered in their own home, including residential or nursing care homes. And those who need to be in a fully supported environment will be given all of the support and advice they need to get them ready to return home and live independently.
This centralised team gives carers, GPs, health and social care staff, as well as other agencies, like the police, an invaluable single point of contact for some of the most vulnerable people in our communities who are at greatest risk of hospitalisation.
In July we published the multispecialty community provider (MCP) emerging care model and contract framework.
This framework signalled that we would make available a draft contract for MCPs and aspirant providers.
We are pleased to share a draft version of the contract, which you can view on the NHS England website. This draft Contract has been published for a period of informal feedback and we are inviting you to let us have your views on it.
Last week we hosted a conference jointly with the Organisation for Economic Co-operation and Development (OECD) to launch their new report on wasteful spending on health. The OECD’s report suggests that around one fifth of spending on health makes no or minimal contribution to improved health outcomes. At a time when NHS funding is back in the headlines, the report’s findings repay careful study.
The vision that drove the transformation of the Canterbury health system and that has continued to be its focus is one orientated around care that is people centred, that is connected and that aims not to waste patients’ time: in other words, care that is provided at the right time, by the right person, in the right place.