A few weeks ago, I found myself rushing to an A&E to find my 84 year-old mother and my 88 year-old father. My mum had a form of sepsis after an injection for her rheumatoid arthritis. She needed to be admitted urgently for emergency surgery. But the doctor was arguing that she should take my dad home before driving to a different hospital. I got there just in time to prevent this happening.
All of this took place a long way from south east London. But people in our communities will have had similar experiences. In my mum’s case, the battle to access services contrasted with the compassionate and technically excellent care she received when she was in hospital, and then the lack of support when she left. The doctors in my mum’s hospital have access to some of the most advanced medical equipment in the world. But no resources at all to get an elderly man home safely when his wife is admitted, if family or friends are not there to help.
As I write, we are preparing to make some changes in how we oversee and manage our local services. Subject to legislation going through Parliament, we will be closing our Clinical Commissioning Group (CCG), the organisation currently responsible for ‘commissioning’, or contracting and paying for, local services. In its place, we will establish a new ‘Integrated Care Board’, which will be responsible for allocating resources and planning services. We are also developing partnerships across our system, between our hospitals, our mental health services and community-based services in our six boroughs.
You may be wondering what these changes might mean for you. Will they make it easier for staff to do their jobs? Will they lead to meaningful improvements for people accessing services? The truth is that you are unlikely to see any dramatic changes when the new system goes live on 1 July. There have been lots of reorganisations of health and care institutions over the last few decades. Some made things easier, some made things worse, none waved a magic wand to improve care.
Nevertheless, I believe this is a step in the right direction. For many decades, health and social care staff have been encouraged to work in silos. One group of staff was supposed to focus on purchasing services while other groups of staff focused on delivering them. Our hospitals were encouraged to compete rather than collaborate. Everyone was encouraged to focus on the performance of their own organisation rather than working together to improve people’s overall care. Those arrangements help to explain some of the problems people in England face when using services: insufficient coordination between primary care, community and hospital services, insufficient join up between health and social care, and the complexity that comes with lots of small, separate services.
The changes we are making are all about partnership working. They are about leaders and staff across our system combining their knowledge and expertise, pooling resources and working together to improve care. Our new Health Board will bring together senior leaders from across our system to decide collectively how to allocate money and plan services. Our hospitals will work together to make better use of shared resources such as diagnostic services or operating theatres. In our six boroughs, health services, social services and the voluntary sector will work together to deliver joined up care for people who need a combination of support for their health and daily living.
Over time, we believe that a system based on partnership working should be able to deliver better care. If our GPs work in closer teams with community nurses, pharmacists, physiotherapists, mental health staff and others, they should be able to more joined-up care. If our hospital doctors work more closely with our GPs, they should be able to support people with complex conditions closer to home. Some people in crowded A&Es and hospital wards might not need to go to hospital at all.
My parents have reached the age where they rely heavily on health and care services. If you glance at their calendar, there are GP appointments, blood tests, physiotherapy sessions and outpatient appointments every other day. Every week they bounce from one service to the next. Few of the doctors or nurses who care for my parents have ever talked to each other. Even within an individual service, my parents rarely see the same doctor or nurse twice. Wouldn’t things be better if my parents received care from a single core team: a small group of doctors, nurses and social workers who know each other, know their patients and deliver the majority of their care? And wouldn’t things be better for staff if they could call on people in the team with different skills when they need them? The changes to our institutional arrangements are just the start, an enabler for better partnership working across organisational boundaries. For me, this is what we are trying to achieve.