NHS England healthcare delivery model

Current practiceIssues identified and proposed changes

Challenges faced by the country Policy recommendations

What is the NHS?

• A free service which is currently universally accessible

• Publicly funded by taxation and custom revenues

• Recognised for having efficient access to healthcare, hailed for its low cost and high quality

• Described by WHO as a system of ‘fairness, simplicity and predictability’

Health overview• Global health is facing massive challenges• Superbugs are resistant to antibiotics• Elderly care is creating greater demands on the system• There is a need for modern drug therapy to address long

term health problems• Long term management needs are not being met• Financial investment needs are huge• UK spending has been 83.9% GDP in last year and needs £65

billion by 2030

Current state of the NHS healthcare delivery model

There are several areas that make up a health model:• Urgent and acute care, major trauma and stroke• Maternity and new born• Children and young people• Planned care• Long term conditions e.g.. Diabetes• End of life care

Selected areas of improvement• Prevention is better than cure• Services need to be focused on individual needs• Localised or centralised services are important to

improve quality• Clinical care should be joined up with social care• Inequalities in health and healthcare needs to be

zero tolerance

Care setting improvements

The settings of healthcare need to reflect the type of care implemented:• Home and self care • Polyclinics- for multi purpose health needs• Local hospitals- for easy access• Major acute hospitals-for urgent care and trauma• Specialist hospitals- for long term or rare specific conditions

and illnesses• Elective centres-to offer patients more choice• Academic health science centres- to improve standards and

develop research for the advancement in medicine

• Strategies need care to be more affordable, high quality and effective.

• New technologies enable a more low cost approach, for example patient bedside screens that link to consultations by doctors online.

• The overall demands have been increasing year on year. Patients have high expectations of the NHS and demand a certain level of service.

I followed a broadcast on Panorama for the BBC commissioned in February 2015 which focused on one of the identified areas of service currently struggling under the NHS. The aim was to chart the rising pressures in the North Tees and Stockton NHS hospital:

Emergency in A & E • Heavy rise in patient attending A&E, which began in the previous winter. Summertime's

in hospitals are normally quieter but last summer had a high intake. Of this a record number of elderly and frail people were admitted.

• 3% increase or 450,00 people in a year, of admissions per year in one department of a major acute hospital. It would need 7 medium sized departments to cover this intake, which currently is not in place.

• Repeat visits especially from elderly patients coming from care homes, and where complex needs require long term planning, however this has not been set up and patient often do not want to be in hospital and die within hours of being there.

• Elderly people whose carers do not feel able to look after their parents, for example, will be admitted by A&E despite not needing urgent medical care. This is because social services are not available to contact. Extra bed capacity is then used for non urgent care, to support these frail, unwanted patients. The 56 extra bed space in this particular hospital were already used.

• Costs of medical care in the nursing home meant one patient had been hospitalised for 7 months

• A similar challenge is the 3.5 billion cases of alcohol related issues from patient attending A&E. Legality means that the hospital has a duty to keep in a patient until they have a capacity to make their own decision.

• Alongside this are the mental health patients, some of whom feel lonely and have nowhere to go, so the make use of the 24 hour A&E department.

Emergency in A&E continued• 40% of all admissions could be undertaken elsewhere, but people want instant fixes

and A&E is being used as the most available place, rather than as the most appropriate place. With the introduction of the number 111 to replace 999, it was thought that this was an effective way of alleviating the mis-use of the emergency services. However, the consensus seems to be that more patients are being admitted through the 111 number, because no other centres are open.

• Over a quarter of all people remain in hospital after they had been fit to return home because there are no adequate ‘after care’ arrangements. This disconnect between social care and the NHS is hurting staff, who are already pressurised staff, as one clinician said, ‘we are broken’.

• The ever growing targets mean that employees are expected to see 95% of patients within a 4 hour waiting time at any given time, but staff are growing tired and feeling demoralised

• Worse is the fear that staff may not be able to do their job properly as a result of the burden, moreover, this could cause serious harm to the patients.

• Reform is still needed as the current model of healthcare delivery does not meet a high standard of duty of care.

• Many issues raised in the programme have already been highlighted in previous reforms but have not been implemented

Health and Social care Act 2012

• A review of the Health and Social Care Act (HCA) 2012 was undertaken by the Centre of Labour Social Studies, housed by trade union CLASS. Their aim was to identify problem areas at a corporate and government legislative level. Their biggest concern was the ‘Marketization’ of the HCA which impacted in the following ways:

• Less funding• Erosion of entitlement to care• Service fragmentation• Lowering of clinical standards• Decline of staff morale• Health inequalities between the rich and the rest• Renege on ‘no top down re-organisation• In their words, the government of 2012 failed the people by

failing to honour the social contract!

Union versus the Government• Protection of NHS from privatisation• Increase funding• Integrate health with community services• Protect staff to maintain high standards• Tackle the problem of PFI’s• End target driven approach • End closures and mergers

Government Pledges 2015 The most recently elected Conservative party have offered a series of pledges that could help truly transform the current crisis of NHS England to make it more user friendly for all:• £8 billion by 2020• Better support for post natal care• Psychological practitioners in every part of the country• Increased funding on mental health• To train 5,000 GP’s by 2020• Integrate services by having links between hospitals, clinics and homes• Pool funding from the Better Care Fund, for regional areas such as greater

Manchester• Review support on how best to tackle obesity, drug and alcohol related

conditions, to help people maintain or return to work• Make medical records public

Conclusion• The real question is why these implementations have not been set up

already? Why in 2015 are hospitals and the general public still waiting for government promises to take effect?

• The idea that a healthcare model is either successful or not, seems to be entrenched in the politics of the country. Without a fair and equal commitment from the leady party on power, delivery of service will suffer.

• The problems seems to be more fragmented and broken than originally thought. Not only is finance a major issue, but building and infrastructure to house more hospitals and clinics. But also too is education of the general public to renegotiate their expectations of what a service can and should offer. These are already in place by way of campaigns for A&E services

• The areas for change are already ready and many commissioning experts have highlighted ways for NHS to change. We now depend on the fairness and the support of a socially conscious government to work alongside health professionals to help make those changes

References

• WHO website: http://www.who.int/hac/techguidance/tools/disrupted_sectors/module_07/en/index3.html Analysing Patterns of Health Care Provision

• Guardian Newspaper, Denis Campbell, health correspondent, Friday 23 January 2015 00.05

• http://www.londonhp.nhs.uk/wp-content/uploads/2011/03/Urgent-care-centres-delivery-model.pdf

• CLASS Union booklet, 2015 from the Centre of Labour and Social Studies• BBC Panorama documentary: “Emergency in A&E”. Aired in February 2015• Brighton and Sussex University Hospital Trust: http://nww.bsuh.nhs.uk/• IBM Healthcare 2015 and care delivery: • http://

www.03.ibm.com/industries/ca/fr/healthcare/files/Healthcare_2015_and_Care_Delivery_final.pdf

• Our NHS website article: Bart’s: a flagship hits the rocks of PFI. JOHN LISTER 18 March 2015 https://www.opendemocracy.net/ournhs/john-lister/bart%E2%80%99s-flagship-hits-rocks-of-pfi