As Chris Little’s emphysema burns, he no longer needs to trek towards a local hospital in Birmingham, attracting the specialist attention he needs. The 73-year-old retired plasterer can receive treatment at a modern health center located at the heart of the community. The parking is abundant and the staff are too busy to provide welcoming and tea.
Little’s wife Sue said he was “more secure” since he began attending a hub in the Eastern Region, which was cared for by a team that made him feel “like family.”
The new arrangement may be familiar to Little, but it represents a fundamental reworking of the traditional NHS model. Since its foundation almost 77 years ago, taxpayer-funded healthcare systems have generally maintained a strict division between hospitals, GP surgery and community care.
Chris Little at the Respiratory Same Day heath Heath and Wellbeing Center emergency medical services © Andrew Fox/ft
However, in the respiratory emergency medical services Little used, consultant Alain Al Helou sits with GP Imtiaz Begum and nurse Hayley Cornelius. Al Herrow said that such “polyclinics” are not uncommon elsewhere in Europe. In the UK, they represent a prominent departure from a traditional hospital-centric model of outpatient care.
As the government prepares to launch its 10-year NHS plan next week, the East Birmingham project points to how frequently WES Streeting says it wants to create health services that focus on prevention.
Streeting told the Financial Times:
The key role is to play by an “integrated neighbourhood team” each covers a population of 30,000-50,000 and focuses on people who have the biggest demands in both the NHS and social care. INT includes GPS, mental health and community nurses, social workers and the voluntary sector “social prescribers”. We recognize that non-clinical factors such as loneliness are just as important as physical illness in promoting the demand for healthcare.
Alan Al Herrow, consultant doctor. Dr. Imtiaz Begum; Haley Cornelius, Respiratory Specialist Nurse © Andrew Fox/ft
Rifat Rashid, executive director and respiratory medicine consultant at local hospital Heartland, is one of the major moves behind the joint approach. She and her colleagues are “on the brink of achieving a complete change in mindset,” she said. “What we’ve demonstrated over the last 18 months is our willingness to put organizational boundaries behind us.”
But while it provides an encouraging template, it is clear that health leaders need deep sheet changes to replicate this approach nationwide. These include the universal sharing of records between the NHS and social care, a new funding arrangement to promote collaboration between different parts of the system, now far from standard.
The merits of cross disciplinary action are displayed on two stories above the respiratory clinic at the Care Coordination Center. There, several large screens track “high intensity users” in real time. These include 250 people who took into account most visits to the Heartland accident and emergency department.
Dr. Rifat Rashid: “What we have demonstrated over the last 18 months is our willingness to put organizational boundaries behind us.” © Andrew Fox/ft
An alert will flash to the neighboring team every time one of them arrives at the hospital. One patient has made 21 calls to ambulance services over the past 90 days and was taken to the hospital eight times.
As the initiative is known, Richard Kirby, CEO of the Birmingham Community Healthcare NHS Foundation Trust, who is responsible for community care collaboration across the board, said, “We discover that it’s often a mental health intervention that people need.
After intervention by the integrated neighborhood team, contacts with GPS were reduced by approximately 30%. The number of “occupied bed days” in Heartland fell 14% between June and November last year and December and February.
Richard Kirby: ‘We’re discovering that it’s often one of the mental health interventions people need. . . Intervention from community and voluntary sector-type organizations.
Rashid, the released beds are filled too quickly by patients from elsewhere in the hospital’s catchment until the approach can be deployed more widely.
However, spreading the model may require additional resources as well as another system of incentives.
Solihull GP Sunaina Khanna has played a leading role in implementing new approaches. “We have to have an honest conversation about resources and finances, how is that extra work being funded?
Kirby hopes Streeting’s plan for the NHS will include the freedom to experiment with the “sackoverflow model.” This freedom encourages a pot of funds to be allocated to each patient in the local population, encouraging countless organizations providing care as effectively as possible.
Dr. Sunina Kanna: “We have to have an honest conversation about resources and finances” © Andrew Fox/ft
In East Birmingham, approximately £5 million in additional funds are pooled across the region, rather than being given to individual organizations such as GPS. This is intended to highlight the benefits of collaboration.
Kirby believes that resources can be gradually rebalanced, so that “the amount spent at hospitals grows slowly than the amount spent on community and primary care.”
He argues that, although on a small scale, the Birmingham Project already provides a “proof of concept.”
Matthew Taylor, CEO of NHS Confederation, said he is the CEO representing senior health managers, but not just the surrender model, but multi-year fundraising is “absolutely important” to change the way it works fundamentally.
He suggested that a key factor in East Birmingham’s success is securing support from GPS, a often independent contractor in the English language system. “One of the questions the 10-year plan has to answer is how to ensure primary care, especially GPs, come to the table.
