The national view:
A relatively recent mandate given by the government to NHS England included a requirement to increase integration with social care so that care is more joined up to meet physical health, mental health and social care needs. More recently, the House of Commons Health and Social Care Committee expressed its support for improving integration of care, highlighting its potential to improve patient experience.
This backs up some of NHS England’s policy goals in relation to this area, which have been clear for some time. NHS England’s ambition to transform the delivery of care in this way was first described in 2014’s Five Year Forward View:
“The traditional divide between primary care, community services, and hospitals – largely unaltered since the birth of the NHS – is increasingly a barrier to the personalised and coordinated health services patients need. And just as GPs and hospitals tend to be rigidly demarcated, so too are social care and mental health services even though people increasingly need all three”
More recently, the NHS published its Long Term Plan. The plan describes how integration, joined up care and collaborative working are key to enabling health and care providers to deliver the care that our population demands and deserves.
For more information and an independent assessment of the plan, read about what The Kings Fund says about why organisations should work together.
What does this mean for Hampshire and the Isle of Wight?
There have been some big improvements in health and social care over the last 15 years. For example, people with cancer and heart conditions are experiencing better care and living longer. However, people’s needs have changed and they are generally living longer. They want their health and care services in a place and at a time that is right for them. For many, this means care that is provided at home, or in local healthcare centres - not in a hospital.
At the same time, people in Hampshire and the Isle of Wight are waiting longer for treatment and spending lengthy periods of time in hospital when they could be at home, or seen by their GP or at a local healthcare centre.
Things can also seem unnecessarily complicated sometimes. For example, people having to repeat themselves to doctors, nurses and care workers and sometimes having to go to lots of different appointments in different places. This could work better and services could be more joined up and easier to understand and use.
There are some big staff challenges that we need to deal with. Even though in recent years the number of qualified clinical staff in the NHS rose by 3.9 per cent, there are not enough nationally for some services.
We’ve got some tough financial pressures too which is mostly down to increased demand on services and people living longer. It’s a good thing that so many people are living longer but it means the way we work needs to change to meet the needs of an ageing population, so they can live well.
Health and care partners in Hampshire and the Isle of Wight have a long history of working together. Over the last three years NHS and local government organisations have continued to join forces to tackle the historical challenges that had been difficult to solve by working separately. Leaders are trying new and different approaches to tackling these issues and we are beginning to see real improvements in the services we offer our population as well as our financial performance. We are focusing on projects where we can take advantage of economies of scale, share expertise or make better use of our finite resources.
The publication of the NHS Long Term Plan, has reinforced our confidence that we are heading in the right direction and are on track to make real improvements for both our local population and our dedicated workforce.
What are our local challenges?
Why do we need to change what we do?
At the moment we work primarily as organisations, leading and managing to deliver on our own priorities, as opposed to focusing on wider changes. This means that we have issues such as fragmented services and limited integration with non-health providers, some care pathways which are duplicated and a lot of situations where we react to patients' needs rather than proactively planning our services.
While we have collaborated as a system for several years, we need to ambitiously transform the way we deliver care to be sustainable and overcome the barriers we face.
So far, we haven't fully committed to centralising some of the things that could or should be delivered at an ICP level, such as digital access, our analytical work and how we support and manage our workforce.
Over the last few years, we have experienced significant operational pressures, which you may well have experienced.
Some of our key challenges are that we can't meet the 4hr A&E performance target, that our elective waiting lists are growing and patients are waiting longer, and a lack of capacity in out of hospital services.
Our local system has faced financial challenges and, in 2018/19, had a deficit of £59m. Over the coming years, we expect both our overall population size and the cost of care to grow, so we will not have enough funding to maintain our quality and access levels. We therefore need to look at how we work, what we do and how we fund our services to try and minimise the impact of the shortfall in funding.