Chief Executive’s Message – Friday 20 August
August 20, 2021
In the upcoming August edition of Heartbeat, our Trust Chair, Sir David Nicholson, sets out his views about the possible consequences for our patients, our population and our Trust, as a result of the now confirmed shift of the Ladywood & Perry Barr area (“place”) of our Integrated care System (ICS) coming under the auspices of The Birmingham & Solihull ICS and Birmingham City Council. Like all trust chief executives, I am completely aligned to my Chair’s views on all matters! In all seriousness, however, David’s views on why this should not and will not have negative consequences for us or our patients, are the ones I hold as well. I would like to set out in more detail why I share the same view.
One of the big reasons why I consider this move of the west of the city’s health services into a different system to be relatively low risk, is because I firmly believe that the bulk of the mitigations to our problems in health, public health and social care, are to be determined more locally than at system level. I genuinely feel that the Pareto Principle applies here – 20 per cent of our issues can be solved or mitigated at system level; 80 per cent of them locally at place level, through our place based partnerships.
What are place based partnerships? I hear many of you ask. Why will they do anything in this space which we haven’t already tried and sometimes failed, to resolve? What are the problems we face and how will a more integrated, multi-agency approach solve them? Below, I set out the answers to those questions, which I hope will interest or even excite you about the possibilities and you will then start to be able to think through how you or your services might change to become better integrated and more proactive in the management of and ideally avoidance of, chronic disease.
We serve some of the most deprived and diverse communities in the country. As a result, our local residents have both an increased risk of developing chronic disease, developing mental health problems or needing social care support, than most. Our hospital services, community team caseloads and primary care services are overwhelmed – look at our current bed occupancy in summer, the pressures on acute medicine and ED and the pent up, un-serviced demand in primary care raining down on NHS 111 services at present. This is not sustainable. Despite poor resourcing and inconsistent strategy nationally for some years, which actually disinvested in public health and set our statutory organisations up in silos, focusing on contractual issues rather than how we work better together, we still have a huge opportunity to reverse that tide and the new health and care act going through parliament now, will help accelerate that. By using population health data/information, we are better able to see who most at risk of developing chronic or acute health or social problems. Moreover, by harnessing that data and working more collaboratively, not separately from primary care, social care and mental health, we can better marshal our slim resources to point towards getting ahead of the game, such that we rely far less on health and care services to pick up the pieces when people slip into crisis.
The nirvana I seek is our acute hospital specialists, working with primary care and specialist community teams in localities, to plan preventative interventions for those most at risk. Ideally, we will move to a world in which practitioners in the different agencies or organisations don’t refer to each other in that classic “hands-off” approach which has become the norm over the last 30 or 40 years. Instead, they are bold with their time and case conference planning for the most vulnerable patients or citizens. The unharnessed potential of that approach, combined with what the housing sector and voluntary sector can bring, should allow us to start to harness the full potential of the Midland Met and halt the most depressing trend of all in local healthcare terms – that the healthy life expectancy of people in the Black Country and West Birmingham, is actually going backwards. For this to be the case in the 7th richest nation on earth, in the 21st century, is nothing short of scandalous.
Our Trust vision remains an ambition to be renowned as being the best integrated care organisation in the country. We will not achieve that aim by being an island, organisationally. We must see our local place based partnerships (ICPs) in Sandwell and Ladywood & Perry Barr, as virtual organisations in their own right. As Sir David says, we are leading those partnerships effectively and in Sandwell, should shortly be named as the host organisation with a dedicated leadership team for the partnership. Our next step, is to develop a programme of work which standardises clinical pathways and clinical practice between primary, community and secondary care; to develop a programme of work which establishes locality, multi-agency teams into which our hospital and local mental health specialists input; to develop a programme of work which unifies the delivery of social care and health under one roof, with an unrelenting focus on admission avoidance and discharge facilitation and speed. This is what integrated care should look like. I hope this interests you, because it is the answer to very many of the unsustainable pressures you currently face in your services.