ghp July 2015 pdf

ghp July 2015 | 39 status quo. In essence, it is the organisation of care around demand rather than around supply, that will drive innovative care models and new ways of working that ultimately will achieve better results for patients and enable efficiencies to be realised. While technology is an important enabler both as a channel for providing healthcare, and as a means by which the patient can understand more about how and where they can be cared for, workforce is the most important component of effecting sus- tainable change. It is in the hands of our precious health service workforce that those who are at their most vulnerable and at their time of greatest need will be cared for. Generally, people enter patient-facing roles because they want to care for people. If things are going wrong, it is often due to blockages in the system that prevent them from providing this care, such as being overloaded with work or not being able to ac- cess the right resources. Technology can help solve these problems but it’s not the place to start. Rath- er, start with the workforce, empowering doctors, nurses and healthcare leaders to define what they need to best address the care needs of a patient. For example, there has been success in piloting on- line portals and regular phone contact between high need patients and NHS staff as means by which a relatively small number of clinicians can care for a large number of patients. What really makes these initiatives work is not the technology, but the fact that the people assigned to each patient are able to coordinate with different providers, whether that is a community nurse, a GP familiar with the patient’s history or a secondary care provider. Initiatives such as these put the patient at the heart of everything they do, improving quality of care and creating efficiencies in the system. Let’s revisit our frail elderly person who is cared for at home in order to ensure that the right medicines are taken, that they remain nourished and that they can be relatively active. This home care goes a long way to avoiding unnecessary hospital admission where that individual will become far more susceptible to infection, is likely to face mental health challenges, and will experienced a delayed discharge due to the increased complexity of being cared for at home. By organising care around the demands of the individu- al, that individual can be cared for in a more efficient and high quality manner. Let’s move on from examples of patient care, and explore the macro-system context. Rather than the top down approach to driving change that has been deployed for many years, there is now an emerging freedom and flexibility in the system which was, in part, triggered by the Health & Social Care Act 2012. While its critics may point to the resultant unman- ageable fragmentation that makes change more chal- lenging, this assumes that the only way things can change is via mandate from the top. The fact that different commissioners, providers and other groups can now collaborate in fluid combinations means that they are better able work in more targeted ways to tackle the many health challenges that do not acknowledge organisational boundaries. There is still some way to go for these new-ish system arrange- ments to mature and to become fully effective – however, there is the potential for real transformation driven by those who are closest to the patients and can commission services in the most effective way. There have also been other nudges to encourage a flexible approach. The Dalton Review 2014 ques- tioned whether foundation trusts continue to be the solution for delivering high-quality acute care and, unusually for the NHS, makes no recommendations for what should be done. Rather, it encourages health leaders to think innovatively about what would work best in their organisation to meet their patients’ needs. By the same token, the Five Year Forward View also encourages different approaches to be explored and leaves it to the leaders of health- care providers to propose what would work best for their local communities. While this represents a huge cultural change for the NHS, the conditions for social entrepreneurialism are being encouraged and nurtured. This year NHS England invited applications for a £200m investment programme which seeks to embrace and encourage innovation. Leaders from healthcare organisations were invited to apply to become ‘vanguard’ sites, and 29 across the country were selected to develop new models of integrated services. Critics may point out that investment is being directed towards those organisations that are already performing well, rather than those needing increased support to help them succeed. However, working on the hypothesis that things must change and that those closest to the provision of care know best, this is a great way to discover new ways of working that will be shared with other areas with similar ambitions. It also indicates that the NHS is becoming more accepting of risk. There are of course many different types of risk and no one is suggesting taking risks with patient care. But, by encouraging small pilots that can explore new ways of working the health system is making it clear that it is willing to try new things. Of course not every pilot will be a success and this is part of finding new ways of working. However, for a fraction of the total NHS budget, this must be a sensible way forward. After all, if the system does not invest in change, it will have to invest significantly more to plug performance gaps and to prop up failing health economies. We will watch with interest to see whether the lessons that will be learned from the vanguard experiment can inform a new direction for how care is provided. As the NHS continues to grapple with huge chal- lenges in the 21st century and works hard to do more with less, there are encouraging signs that the system is moving in the right direction. In much the same way as banking has transformed over the past two decades, the NHS is now asking itself how it can adapt to better meet diverse patient needs and expectations. While technology is an important part of this transformation, the key is to create the condi- tions for the workforce and the healthcare leaders to put the patient at the heart of everything the system is looking to achieve. industry insight