NHS: Integrate Care to Help the Poor

There is a shocking gap of 11 years between the life expectancies of the rich and poor residents of a single London Borough, Tower Hamlets. Poorer adults there can expect to have the disease profile of a 75-year-old at the age of just 55 while 40% of children live in poverty.

The British Medical Association has used these alarming statistics to hail the area’s role as one of 50 vanguards to trial the NHS’s new scheme of “multi-specialty community providers” or MCPs that will offer more integrated community care services and should see its NHS services transformed in a bid to reduce decades of outrageous health inequality.

The Services they Need

“It is these sorts of statistics – and the patients and people behind them – that NHS England’s New Models of Care aims to address, giving clinicians, health managers and patients a chance to form new systems, pathways and structures to deliver the sort of health and social care services people really need and not just the services already designed,” said the BMA.

The Tower Hamlets Together scheme run by the GP Sir Sam Everington (above) aims to integrate services to give children a better start in life and provide longer term help for patients with chronic conditions.

According to the BMA, new systems for integrated local care are already reporting much slower growth in emergency admissions.

Louise Watson, director of NHS England’s new care models programme, told the recent NHS Expo that while growth in admissions across England had risen at 4.08% over 2016-17 there were lower growth rates for MCPs (3.3%) and Primary Acute Care Systems (1.3%).

Disjointed Services

One patient, Ian Clayton, told the BMA about his experience of being passed apparently randomly between services after being diagnosed in October 2014 with stage-four thyroid cancer which had spread to his neck and lungs.

After leaving hospital without any further support he began working as a volunteer with the MCPs trying to improve cancer services across the country.

“I was sent away with this book and it was only reading it that made me realise I had stage-four cancer,” he said.

“When you flick the page there’s no stage five – that’s dead. There were no returned calls, no point of contact, no idea what happens next and lots of unreturned messages. I was convinced in my own mind that this meant I had gone too far and no one wanted to be there for me. “The system wasn’t there for me – but it didn’t have to happen. It could have just been me being given a card or shown to a Macmillan nurse. I’ve been through relocation, bereavement, divorce, redundancy and the cancer itself and I can tell you quite honestly that fragmented services and the effect they have are the worst of the lot.”

Dr Donal Collins, clinical lead for the Better Local Care (Hampshire) MCP, told NHS England about the benefit to GPs of getting more control over patients’ outcomes. “The vision behind the multi-specialty community provider that really got me excited was about creating a truly integrated system and a system that acted as one for patients,” he said.

“The benefits of going down the multi-specialty community provider route for the team are that it’s going to create an environment where we can improve outcomes for patients. We’re going to stop working as individual silos – the last 20 years have proved that hasn’t worked.  We’ve got a new way of working together for our common purpose and mission.”

by Stewart Vickers

 

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