We need to get under the skin of the NHS if we’re going to collaborate

By Andrew van Doorn - on 22/04/2016

Andrew van Doorn, HACT's Deputy Chief Executive, advises Housing Associations about the importance of understanding what drives the delivery of healthcare services and the changing environment in the NHS if they want to engage with health.

It’s always a privilege to walk in someone else’s shoes, even if only for a day. And walking in the shoes of an NHS Provider – an acute hospital trust, mental health trust, community trust or GP practice, is a real eye opener.

Too often we see the world through our own eyes and forget that others see and experience the world differently. We may think we understand health and how it works, after all, we all have experience of using its services. But how much do we really understand about what drives the delivery of healthcare services – and what is changing in the NHS? What keeps a CEO of a hospital awake at night and what issues fill their inbox day in, day out?

For the past couple of years HACT and Common Cause Consulting through our Housing and Health partnership have been working with housing associations and NHS Trusts to promote better engagement.  We have spent time with HAs exploring, thinking and learning about what NHS organisations do, and what drives their businesses. If a Housing Association wants to be a partner, with a coherent offer to integrate itself in local health systems and supply chains, it needs a better understanding of the healthcare market.

The NHS is at a turning point. NHS England’s Five Year Forward View (FYFV) launched in 2014 laid bare the future challenges. The need to reform, change and collaborate is clear. There may well be an increasing budget for the NHS, but the pressures to deliver increased efficiency are huge and take-up a lot of time of senior people.

The daily crises in the NHS - in recruitment, availability of inpatient beds, delayed transfers of care, A&E usage, pressures on GPs, and the delivery of community based healthcare - are real and present. Quality of care and patient safety is high, but pressures are mounting and solutions are desperately needed. Housing associations have offers to all of these issues, but we need to be smarter in how we develop and sell them to our NHS partners. The NHS is reforming itself now with new models of care and new drives for efficiency – but sadly providers are re-organising themselves without us and opportunities are passing us by.

There is so much to know and understand, and it’s about seeing the wood for the trees. Here are my highlights of the things that housing needs to notice:

Sustainability and Transformation Plans – this is the new placed based approach to planning local services.  44 ‘footprints’ have been identified and each area is tasked with defining a multi-year plan that will accelerate the implementation of the FYFV, strengthen local relationships and meet the needs of the local population.  Plans need to be in place by June so they are being built on existing systems, relationships and programmes. Transformation money is available, but this year it’s being used to meet deficits. But from 2017, it is expected that these resources will be used to transform local systems and services, not just plug holes.

New Models of Care – a.k.a. the Vanguards. There are over 50 collaborations across the country focusing on enhanced health in care homes, integrating primary and acute care systems, acute care collaboration, urgent and emergency care, and multispecialty community providers. They currently cover about 10% of the population which is expected to grow significantly in the future. They are the new game in town.

Cost Improvement Programmes – these programmes are driving the efficiency agenda within NHS Providers. All providers have them, they are well evolved and are a major contribution to the £22bn efficiency challenge needed by 2020. They’re not new but they dominate the plans of providers to transform how they deliver health care services. If you can’t respond to CIP, get out the room. (CCGs have their own programmes called QIPP, so best not confuse them).

Carter Review – the recent review by Lord Carter looked at how greater efficiency could be driven in the general acute sector. With a view to reducing variation in both quality and costs, the DH is now driving forward a number of initiatives to support the acute sector to make a further £5bn of efficiency savings. Delayed Transfers of Care which costs the general acute sector £900m a year, is a key part of this, as is the use of estates and improvement in care pathways. It’s the new kid on the block and will no doubt gather pace throughout the year.

Emergency and Urgent Care – the review by Professor Sir Bruce Keogh (Medical Director for NHS England), launched in 2013, addresses the need to improve emergency and urgent care. Now in its implementation phase, it looks at issues such as improving self-care and care at home, reducing demand on A&E, improving access to and response of NHS 111, and has seen the role out of alternatives to A&E such as Urgent Care Centres. Demand management for the NHS is a huge issue and any contribution is valued (though not always paid for).

MH Taskforce and Crisp Commission – February saw the launch of two influential reports that will shape the future of NHS mental health services. The Mental Health Taskforce Report is the FYFV for mental health and mirrors much of the need for broader change in the NHS: 7 day a week access to the NHS for those in crisis, integrated physical and mental health, promoting prevention, the need for additional £1bn, and workforce development and leadership. Together with the Royal College of Psychiatrists’ Commission led by Lord Nigel Crisp, there is much in there for housing, recognising the need for greater integration, innovation, and the creative use of the NHS Estate. Housing Associations now have a much stronger platform on which to play.

Together with the ongoing financial tightening within the NHS, these are the policies and programmes driving change. Devolution is certainly important in some parts of the country, but beyond this so much more is happening, and it is happening everywhere.

The most successful housing associations who have found a route into health, have taken the time to engage, understand how NHS providers operate, identify the drivers of change and seek out the opportunities locally.

On 19th May, HACT and the Northern Housing Consortium are hosting a conference where many of these issues will be addressed. The line up is made up of leaders from the NHS, together with their housing partners who are making a difference. It is not often we get the opportunity to hear directly from those in the NHS about what matters most to them and how they think housing associations can play a role. I hope you can join us!

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