Working in partnerships with the voluntary sector can prove beneficial to patients as well as relieving pressure on overstretched NHS hospitals and trusts, writes Paul Woodward
We have all seen and heard in recent months further evidence that some parts of the NHS are overstretched, struggling to cope with financial pressures and sometimes failing to meet required quality standards.
In the wake of the second Mid Staffordshire inquiry report and the initial Mid Staffordshire inquiry published in 2009, there is still much to do to across the health sector to ensure that such shocking examples of poor care are not repeated.
Recent calls from senior doctors and NHS leaders argue for much of hospital care to be replaced with new services in or nearer to patients’ homes, in order to avoid increasing failures of overwhelmed hospitals.
‘Many voluntary organisations have detailed understanding of specific local needs, high levels of trust and engagement with local communities’
Recent examples of proposed service closures at both Lewisham and Whittington hospitals in London illustrate the growing financial pressures within the NHS and the fear among patients and the general public that access to certain health services may become “too few and far between.”
There should also be greater discussion around the potential for voluntary organisations to provide specialist solutions to specific local health issues.
Many voluntary organisations have detailed understanding of specific local needs, high levels of trust and engagement with local communities and the ability to work across multiple services to provide “holistic” care for individuals.
Working in partnership with the voluntary sector can be effective for the NHS if trusts are open to working with other organisations to build specific services around the needs of their patients.
Such ways of working could enable NHS hospitals and trusts to focus on the delivery of wider general services and avoid being overstretched due to providing resource intense specialist care for specific conditions.
As a leading charitable health and social care provider, Sue Ryder runs five neurological centres and seven hospices located across the UK, each providing specialist care for people with long-term conditions and life-changing illnesses.
We believe that more organisations should be open to partnership working with voluntary organisations that can provide specialist care for patients with specific conditions and can help to “free up” much-needed hospital beds as well as reduce unnecessary hospital admissions.
NHS Bedfordshire − Partnership for Excellence in Palliative Support
We have seen first-hand how vital partnership working is for delivering effective palliative care through our Partnerships for Excellence in Palliative Support (PEPS) service, which was nominated in the patient-centred care category at the 2012 HSJ Awards.
Most people would like to remain at home in familiar surroundings to receive their care at the end of life. PEPS aimed to ensure that care provided was in line with patients’ preferences and choices through the availability of high-quality care within the community.
The service, led by Sue Ryder and NHS Bedfordshire (wich was replaced by Bedfordshire CCG on 1 April), has brought together 15 organisations in the local area to improve the continuity of care and experiences of patients in the last 12 months of their lives. The service has coordinated the care of more than 400 patients in the first five months since it was launched and helped to reduce NHS costs by reducing avoidable emergency hospital admissions.
Across Bedfordshire, a single telephone number and central hub was established to coordinate all palliative care 24 hours a day, 365 days a year using a shared electronic record system.
Berkshire West PCT
In April 2011, Berkshire West Primary Care Trust (since succeeded by local clinical commissioning groups) transferred all specialist palliative services to Sue Ryder as part of the Department of Health’s Transforming Community Services agenda. This was believed to be the first time an NHS-run hospice was transferred to a voluntary organisation.
‘To increase effective partnerships with the voluntary sector, there needs to be greater understanding of what voluntary organisations can offer’
As well as the transfer of community services to Sue Ryder, Berkshire West PCT introduced a range of initiatives including a shared electronic patient record system to improve continuity of care.
Prior to the transfer and changes to services, Berkshire West had an average of 369 annual emergency hospital admissions costing £900,000 per year and 2,400 excess bed days costing £250,000 per year. There was also clear evidence of a gap in services and a real need to establish 24-hour access to specialist palliative care advice and support for patients at the end of life and their families within the Berkshire West area.
The partnership aimed to make it possible for more people to be cared for at home and also to help reduce avoidable hospital admissions, which were not only costly for the trust but also very distressing for the individuals at the end of life and their families.
Nursing support was increased by recruiting additional clinical nurse specialists to enable the service to be expanded to offer care seven days a week instead of the previous five days a week. This helped to fill the identified service gap, reduce hospital admissions and enabled more people to be cared for within their own homes as they wished.
Across Berkshire West, a single point of referral was established, which has meant that any health or social care professional needing to refer a patient to any of Sue Ryder’s palliative care services within the area can do so by calling one single telephone number 24 hours a day, seven days a week.
After almost two years since the transfer of services to Sue Ryder, access to end of life care has greatly improved with the number of patients seen by the CNS team and the number of patient contacts increasing by over 25 per cent.
The combination of the transfer of services and other initiatives has achieved a 50 per cent reduction in annual emergency hospital admissions; a 50 per cent reduction in excess bed days and the prevention of seven emergency admissions per month.
Increasing effective partnerships
The benefits of integrated ways of working can clearly be seen in the approaches that were adopted by NHS Bedfordshire and Berkshire West PCT.
In order to increase effective partnerships with the voluntary sector in future, there needs to be greater understanding and awareness of the specialist services voluntary organisations can offer, so that the NHS can engage with a wider range of organisations and then develop the most appropriate solutions.
Commissioners also need to be open to changes in procurement and contracting that will enable voluntary organisations to deliver specialist health and social care services that meet local needs and help them to retain their flexibility to deliver a more holistic approach.
More successful partnerships can be made possible if trusts are willing to work with other organisations to improve services and meet local needs, whether that means transferring specialist services to improve quality and efficiency or increasing education available to staff.
Paul Woodward is chief executive of Sue Ryder