Trust is needed as well as money and staff to deliver an unprecedented reform in community servicesservices, writes Matthew Winn as NHS England’s national director.
Today NHS England and NHS Improvement have announced the seven sites that will develop a national operating model for community urgent care services, and will be the first to hit the new national standards of delivering urgent care within two hours and re-ablement services within two days.
First time for everything
This is a “first” announcement on many levels: the first time we have put the investment and infrastructure in to develop and deliver a standardised model for any community health services, and the first time any community service has had a national standard attached to it.
As the chief executive of a community service provider and former chair of the Community Network, I am particularly proud to have been involved in getting us to this point, and pleased to see wide-ranging support for the approach from both within and without the NHS.
The litmus test for this new approach is simple - the next time my father needs an urgent care response, I do not need to negotiate and arbitrate between the GP, community health provider and social care colleagues about who will take the lead and provide the service.
Last time this happened it took me a day and half to get him the support he desperately needed, and that’s as someone who knows how the system works; for the vast majority of people who don’t, it must be harder and more bewildering still. As we regularly hear in the NHS, once he got the care it was great, but getting to that point was harder than it needs to be.
This new approach gets to the heart of how we make changes across all of local systems.
Trusting our trusts
The national ambition is that by March 2023 an urgent model of community healthcare is available for all residents of England and is characterised by adaptability and responsiveness, not eligibility and capacity problems.
However, it will only be possible if we make the cultural changes in how providers operate together, and if relationships between health and social care professionals and organisations are good.
It is only by getting to the stage where we can take risks together that we will be able to provide easily accessible services for our local residents. And to take those risks, trust is required – trust that a partner can and will keep their end of the bargain, and pick up someone’s care.
The new investment monies and extra workforce are important, but to provide a two-hour service it is crucial that the trust and interdependencies between providers of community health, GPs, 111 providers, ambulance trusts, accident and emergency departments, and adult social care teams are strengthened, to make care seamless and easily accessible for their local patients and their families.
And to take risks, trust is required – trust that a partner can and will keep their end of the bargain, and pick up someone’s care
The seven accelerator sites will test, define and develop a new national approach to deliver the two-hour and two-day standard, but we know the challenge will be to spread and adopt this approach.
Inevitably we will run up against the usual debates and tensions as we do this – the standardised models versus what is best for my local population, the focus on national metrics versus local information and, of course, the need to demonstrate impact from new NHS money versus budget autonomy for local commissioners and providers.
That is, of course, not to mention the ongoing uncertainty over workforce supply, and the budgetary pressures faced by our local authority partners. The new government’s commitment to growing the nursing workforce by 50,000, and finding a long-term solution to the funding of social care, will be as crucial for those of us involved in developing this new approach as they are for many other parts of the NHS system.
Treading on tough terrain
The new model of care will take three years to fully roll out and will of course stretch us in identifying and training the appropriately-skilled workforce in the numbers we need without cannibalising other services.
It will be a tough and long road – we’re under no illusions.
But I am heartened that there has been universal support for these models of care as the right thing to implement. And most importantly, the prize is a sustainable service model fully implemented next time my father, your relatives or our elderly neighbours need this support to stay well in their own homes.
My plea to fellow chief executives and local leaders is to develop the trust that we will need to deliver this new model.
Yes, trust us nationally to guide and design the rollout of this new service with you and argue for those things that will create the conditions for success.
But most importantly, trust in your local colleagues – your fellow professionals, whichever organisation they work for – to make this work for your local population and every individual within it who needs our support.