The NHS recently celebrated its 70th birthday, but if it is to last for another seventy years and beyond, the system needs genuine expansion, investment and rejuvenation. A further key element of the urgent updating the NHS needs is for it to adopt more modern, integrated ways of working that take advantage of the cost and efficiency benefits that co-locating services can bring as well as the ability of innovative medtech firms to deliver services more efficiently and effectively to help usher in a new, more integrated health and care environment.
The words ‘care’ and ‘crisis’ have become synonymous with the NHS in recent years. An ageing, growing and increasingly sickly population is being served by an NHS without the capacity to treat it. Budgets are starved, and resources are dwindling; care is fractured, solitary and uncoordinated.
A new study from the King’s Fund, collected by the Organisation for Economic Cooperation and Development, placed the UK 18th out of 21 countries in terms of healthcare resources.
Compounded by cuts to council and social care budgets, the UK’s health system at both a national and local level is faltering and unable to deal with the range of complex health issues patients are currently facing, as well as significant variations in response times, treatment quality and communication levels between institutions. The NHS is constrained by a vast funding gap equivalent to 35,000 hospital beds or 10,000 doctors. It needs lower-intensity, non-acute care facilities to reduce pressure on beds and provide integrated, community-centred care.
In response, a greater emphasis is being placed in wraparound, integrated care in the NHS to improve care-giving delivery and quality. Integrated care brings together different disciplines and specialisms to a central location, moves services into the community but also frees up acute space to service acute needs.
Through the creation of ‘hubs’, or formalised support networks, medical practices operate not as independent businesses but as communities in which decisions and administrative duties are shared. Such hubs mean that care becomes a collaborative process, with physical, mental and community health services synchronised, not separated.
This new approach focuses on providing better community support for people with long-term conditions, alongside prevention and early intervention. The goal is ultimately to treat people outside of hospitals and closer to home as much as possible, so that bed-based care is used only when it’s appropriate and necessary.
Integrated care is not a recent innovation – UK cancer services have long followed this model. But it is only now that these networks are being expanded more broadly. Wraparound care has already been implemented in Dorset as part of the wider NHS Sustainability and Transformation Plans (STPs) currently being rolled out across the UK, and has been hailed as a pioneering approach to care that might just be able to prevent our healthcare system from declining into freefall. There, the system saw average hospital stays drop from 10.3 days to 5.87 days, with costs falling from £4,120 to £1,772 per patient.
However, for co-location to work, different budget holders need to come together to agree, which is often not easy within the public sector. Also, new facilities come at a cost, but with no new money in the system providers must be brave enough to drive operational savings and assume system efficiency benefits. And greater collaboration will ultimately lead to improved outcomes for patients. Co-location of services in one strategic area alongside the closure of costly inefficient space and space not fit for purpose, will free up future budgets to meet the costs of newer and more efficient buildings and service delivery.
This is where the private sector can help through promoting occupation strategy shifts, to sessional space booking of rooms, longer operating hours, flexible workspace reducing area and enhancing collaboration. The private sector can also drive efficiency through co-location, blending mixed-use developments that include both residential and commercial premises that will bring income and subsidise the cost to the NHS.
Technology can also play a crucial role in integrated care, with the former care secretary Norman Lamb citing it as ‘critical and central’ to its success. Despite this, it is still used only in a fragmented and uneven way across the NHS, and legacy systems in health and social care, which reinforce silo mentalities, remain the norm. At a time of intense budgetary frustrations, streamlining operations through technology not only cuts costs and improves efficiencies, it plays a wider multifaceted role – supporting the development of better services for a local area in terms of improved engagement with the needs of local people and organisations; and on an individual level helping people manage their own health conditions and care arrangements.
Indeed, broader teams covering different specialisms, from mental health to acute care to local authority roles, are well-placed to take advantage of digital innovations like virtual GP services and streamlined, tech-based communications, making care communicative and comprehensive; and budgets can be pooled and used flexibly by teams who are able to arrange and fund services to meet the specific needs of their communities.
Designing and planning to take proximity and recovery into account means viewing hospitals not just as standalone treatment centres but as part of the wider community. New hospital developments are beginning to reflect this attitude by building alongside them supporting community infrastructure such as new homes, parks, schools, sports grounds and transport facilities. Staff members are located near the practices and population they cover to increase responsiveness in urgent situations, and local specialist teams are provided to help monitor patients with long-term conditions.
For integrated care to be truly effective, it must be delivered at scale and pace, over large populations at city, county or country level and across a range of groups – specifically, older people, those with particular diseases or conditions, and those requiring access to specialist services. This requires a recrafting of the UK’s healthcare narrative at both a national and local level, to change how decision makers believe services could, and should, be delivered under the NHS. By truly embracing and implementing wraparound, integrated care in our communities and taking advantage of medtech firms’ capabilities to transform how many aspects of healthcare services are delivered, we could deliver a revolution in how care is provided across the entire country.
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