It's time to change the way we provide health and social care
Opinion: In his own words, Mike More, chair of the partnership that manages health and social care services across Cambridgeshire and Peterborough, calls for a completely new approach to the challenge of keeping up with the area's rapid growth.
We have a million reasons to change the way we provide health and care services in Cambridgeshire and Peterborough.
Before too long that is how many people will live in this booming part of the country – an area which has huge economic potential but faces historic and serious challenges keeping up with its own growth.
We need look no further than health and social care to see the impact of those challenges laid bare. Put simply, the wealth-generating capability of our two cities and enterprising rural areas continues to create jobs and opportunities. However, the system that provides everything from the vital services that support people to manage stress or reduce isolation to the highly sophisticated and expensive procedures that might save your life in our hospitals, are not adapting and changing fast enough to keep up.
I say adapting and changing, because there is an urgent need to do things differently now, rather than just building more of the same, which we can’t afford to do anyway and won’t solve our problems in the longer term. The NHS turned 70 this year and the truth is much of the structure and processes we follow today would still be recognisable to those working in the service when it first came into being. In the commercial sector this is not the same and the demands of the market and competition have required companies to completely transform their operations and innovate not just their products, but the way those products are produced.
In the health sector we are now facing a fundamentally different type of demand and a mismatch between the services needed and those we are providing. We can’t expect to solve this challenge with an NHS designed to meet the needs of the middle of last century. If we don’t adapt we are in danger of risking our most cherished principle of providing care free at the point of delivery, based on clinical care and not the ability to pay. The challenge of finding the highly trained and skilled staff we need to work in our services is perhaps one of the biggest threats we face and a perfect example of the need to think differently.
If we look at general practice, for instance, the outlook is worrying. The numbers of GPs retiring in the next 10 years will leave a gap that we can only partly fill. We know this because the numbers coming out of training and into their first jobs is easy to forecast. There are simply not enough new GPs coming through if we stick with the same model of care we’ve always had. We’re worried about future GP shortages because these are the people we all rely on to keep us healthy and out of hospital. By doing this they reduce the cost of our most expensive services and the stress of hospital admission on patients and their families.
With fewer GPs of long experience available and people in our families living longer, perhaps with one or more long-term conditions, the scene is set for a worsening in the health of our population and a deterioration in the quality of our services unless we think differently. We need a health and care system that is fit for the next 20 years.
The good news is that we are starting to see the green shoots of new ideas coming through in our health and social care system and this is being encouraged and driven by the sustainability and transformation partnership (STP) for Cambridgeshire and Peterborough. All of the major providers of health and social care are represented in the partnership and have committed to work together to improve the health of the population we serve.
One new idea that the STP supports is neighbourhood models where GPs and other health and care professionals, together with the voluntary sector, will come together to manage all the services their communities need over a manageable population size. This will bring together a group of professionals to plan and deliver health, mental health, social care, voluntary and community services for neighbourhoods they know and care about. Neighbourhood models build on the assets that are already available in communities and the strength and resilience of families in helping themselves. Similar models have been introduced in other parts of the country including in west Suffolk, our neighbour, and are starting to prove highly successful in reducing the need for hospital care.
Using their understanding of a neighbourhood and the people in it, GPs can work more effectively to manage risk and use a range of different staff to deliver services that meet the needs of the community they serve. This is where we can find a potential solution to the challenge of falling numbers of GPs and their increasing workload. A whole range of different staff whose skills are more readily available in the workforce can provide some of the services we currently rely on our GP for. Highly experienced GPs can be reserved for interventions where that skill set will make the biggest difference.
This model is one of a number of major changes we are discussing across the STP in how we organise and manage services. We are also working intensively to improve our hospital services, particularly for the frail elderly and those needing urgent care. We see huge potential for these ideas but we need clinicians in our system to lead the change and take more control of the future of their services. One thing we are fortunate to have in Cambridgeshire and Peterborough is some of the country’s most ambitious and innovative clinical teams. Great strides forward have been taken here in using technology to support the redesign of services and there is huge scope to use shared patient records, artificial intelligence and automation to radically transform how the health and social care sectors manage their relationships with patients and clients.
In order to ensure that the health and care services in this area keep up with the change that is coming, there are two big challenges that health system leaders must urgently address. Firstly we must promote a culture of improvement and innovation and make sure our clinicians are in the driving seat when it comes to change. Secondly, and most importantly, we must start listening carefully to the stories being told about our services by the people who are using them. All of the best solutions are contained in these experiences and yet they are so often overlooked. Organisations like Healthwatch are willing and able to help us tune in to what people are saying and in particular seek out the stories of those who are no frequently heard; those who are disadvantaged by circumstance and might not use services until it is too late. With a bit more attention paid to the million people depending on us, and by working as partners for a common cause, we should be able to make sure our public services support your health and social needs long into the future.
On Thursday we are holding our first board meeting in public and I hope this is a step towards a two-way dialogue and greater transparency with the public as we work for the benefit of this wonderful county that we live in.
The board of the Cambridgeshire and Peterborough Sustainability and Transformation Partnership meets for the first time in public today (November 22).
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