West Country Chronicle: An ICB finds inspiration in Brazil

Could a healthcare model developed in a remote corner of Brazil be the answer to some of the NHS’s problems?

The idea may be unexpected, but in Cornwall it’s a live conversation. 

Recently, Cornwall Integrated Care Board chair John Govett and CEO Kate Shields met with public health clinician and lecturer Matthew Harris, of Imperial College London, where they heard more about the “Brazilian model” of primary care, which has been rolled out to more than 70 per cent of the South American country.

The model – developed in response to a cholera outbreak in the 1990s – essentially sees residents from a given area recruited and trained on a broad range of low-level health and social care issues. They then visit all the households they are responsible for (usually around 200) at least once a month.

Within their patch, the recruits assess people’s needs, develop relationships, and work with local primary care teams to try deal with health or social care needs arising. They also carry out prevention and public health duties, such as encouraging vaccination and screening.

The model (read more about it in this blog by Dr Harris) appears to have delivered health benefits, with lower mortality rates for stroke and heart disease. And, importantly, it is also cheap.

Clearly, it can’t be just lifted straightforwardly across the Atlantic. Dr Harris told the Chronicle it had taken the best part of 17 years to drum up enough interest for local implementations in the NHS. 

But similar projects have now been launched — on a small scale — in pockets of England, such as Westminster and Sutton in London; Selby in North Yorkshire and in Cornwall itself. 

In fact, Dr Harris said Cornwall was already one of the leading areas for the model, with 32 community health workers recruited. 

He said Cornwall had rolled out “probably the biggest implementation in terms of size”, although the model is not as developed as at the sites which have rolled it out earlier.

Asked what outcomes had been reported from pioneer sites, such as Westminster, Dr Harris cited increased uptake in vaccination and screening in households with dedicated workers and a 7 per cent reduction in unscheduled GP appointments. He said work was ongoing to assess benefits across more indicators.

It’s early days for the model in the NHS, but — given the deep and widespread problems with primary care in the UK — Cornwall and other areas should be applauded for looking further afield.

It’s a long road to NOF 3

Across the Tamar from Cornwall they could certainly do with some inspiration, where latest board papers from Devon ICB reveal a gloomy assessment of progress towards exiting the bottom rung of NHS England’s oversight framework (National Oversight Framework 4).

There are nine exit criteria for the ICS, which comprise operational performance improvements and financial progress over two quarters. But Devon’s latest assessment against these criteria conclude the ICS is on target to hit just one of these nine targets.

Quite the challenge, then, for new ICB CEO Steve Moore who returned to his home county this month after a stint at Welsh health board Hywel Dda.

A couple of the criteria are of a financial nature, with Devon required to develop a financial plan that shows non-recurrent balance in 2024-25 and recurrent balance in 2025-26, which is signed off by all Devon’s organisations and receives regional and national NHSE approval. 

Achieving this will be some feat given Devon’s previous struggles to stay out of the red, and the board papers stated its 2024-25 financial plan includes a forecast deficit of £84m. 

A letter sent to trusts from ICB CFO Bill Shields last autumn — obtained by the Chronicle via Freedom of Information — illustrates the ICB’s doggedness in finding savings across the ICS. 

The letter sets more than 20 “urgent spend controls”, which include only booking standard class train and air tickets, ceasing to provide catering for events, sending post second class, and printing in black and white.

Another departure

The previous Chronicle noted the somewhat sudden high turnover of CEOs in Devon, and since then another experienced leader has announced she is off.

Melanie Walker, who has been CEO of Devon Partnership Trust for 10 years, has resigned from the role during her ongoing recovery from a heart problem, which occurred last autumn.

Ms Walker is a long-serving mental health CEO who was awarded an MBE in 2019 for services to healthcare.

Her trust has been relatively well performing — no mean feat in a financially challenged ICS where others have been at the wrong end of the performance tables.

Ms Walker was keen to stress that her departure was not due to her heart condition, which she is recovering well from, but she told the Chronicle she was ready for a career break.

New chair

There’s also been a leadership change in the top echelons of Gloucestershire health economy, where a new chair has been appointed by the county’s community and mental health provider.

Graham Russell will chair Gloucestershire Health and Care Foundation Trust after current incumbent Ingrid Barker finishes her term of office at the end of April.

Mr Russell knows GH&C well as he is the trust’s vice chair and a non-executive director there since 2019. His CV includes advising the Organisation for Economic Co-operation and Development for 10 years and being executive director at the Commission for Rural Communities.

Bristol eyes reconfiguration

It’s a brave new world in Bristol as the city’s two acute trusts work towards their shared leadership and group model.

This month saw an important development in that endeavour with the publication of a joint clinical strategy.

Comprising just 17 pages, it’s mercifully at the lighter end of NHS strategies, and — while it admits it “doesn’t have all the answers” — there are a few clues on the new group’s direction of travel.

There is a commitment to make all duplicated services “work together as single managed services,” and two specialties — cardiology and perinatal medicine — have been chosen as “pathfinder clinical services”.

These two specialties will “design their services together for the whole population and our trusts together”.

In parallel, every clinical service — including specialised and single site services — will consider the way it delivers care to patients “reflecting the combined assets of both NBT and UHBW”.

Once these two projects have been completed, the trusts will move to its third phase, which will see all services “consider how we organise (or cluster or reconfigure) clinical specialties on each of our sites to bring the maximum benefit to the acute care we provide”.

This will all take some time, so don’t expect any major changes soon, but for a city that has held out longer than most with two acute providers, it is a significant shifting of the sands.