NHS reform: How many patients will benefit?
- Published
The aim is to reduce admissions to hospital
Billed as the biggest national move to integrate care of any Western country, radical changes are afoot in parts of the NHS in England.
From this month, groups of local NHS and social care leaders are working together formally to devise appropriate care for individual patients, which will increasingly be provided away from hospitals.
But few are aware of these schemes and that's probably because, so far, they only affect a small minority of the population.
The so-called integrated care systems, external are up and running in 10 areas of England.
NHS leaders say more will come on stream soon with about 20% of the population covered by the end of the current financial year.
Integrated care systems have evolved from the sometimes controversial Sustainability and Transformation Plans (STPs) developed in 44 areas covering the whole of England.
These were launched in the autumn of 2016, with local campaigners in some areas alleging they were a smokescreen for NHS cuts.
Some of the plans are no more than wordy documents gathering dust on shelves.
Others have evolved into the 10 integrated care systems which are making the words reality.
Surging demand
Advocates for the schemes believe that doing nothing will eventually sink the NHS and social care as separate organisations.
They argue that the structure of the NHS has not significantly changed since its foundation, but medical research and increasing life expectancy have dramatically changed demands: 70% of hospital beds are occupied by patients over 80 and 30% of patients have dementia.
But every 10 days spent in hospital ages a patient 10 years. Muscle wastage during a stay in hospital can leave elderly patients weaker when they leave than when they arrived.
The statistics paint a clear picture. As one health service leader has put it, there is a "screaming opportunity" for the NHS and social care to work together.
It's in everyone's interest for older patients to be looked after at home and away from hospitals.
That means close co-operation between GPs, social care staff and hospital managers.
Stopping people going to hospital in the first place is the aim and if they have to be admitted, the priority is getting them home as fast as possible.
If all this sounds blindingly obvious that's because it is.
But with the NHS and social care run as different systems in England with separate funding streams, often collaboration has not been easy.
The integrated care systems, remarkably, have brought officials in some areas round a table for the first time to plan for their communities.
Complete care package
Frimley in Surrey is making a success of the new regime.
GPs in the area can dial one number to organise a complete care package for a patient who needs it.
Historically GPs could spend four hours phoning round to organise appropriate social care.
Senior clinicians are at the front door of the main hospital ensuring that people who don't need to be in A&E are sent elsewhere.
Bucking the national trend of rising emergency admissions to hospitals, Frimley has seen a static admission rate over the recent winter.
Extended days in hospital are bad for elderly patients
Meanwhile, a scheme in Dorset has widened seven-day GP access to cover 70% of the area and Lancashire and South Cumbria is working with local football clubs to promote health and wellbeing.
South Yorkshire and Bassetlaw has come up with plans to stop local hospitals competing for staff and to share experienced clinicians in areas where it is hard to compete.
But there are other parts of England where co-operation is patchy or non-existent.
Leicestershire County Council says there is so little detail in the local plan that it wants the council logo taken off the document.
In some areas there is cynicism that after years of talk of integrated care there has been negligible progress. And herein lies the challenge.
A fifth of the country will be covered by the new systems this year but that leaves a lot that won't be.
NHS England hopes that areas which have been slow to adopt the new ways of working will be encouraged to do so by successes elsewhere.
The Treasury has already released funding for some of the integrated care systems.
Legal challenge
The government's promised long-term funding plan may target resources at areas where there is joined-up NHS and social care.
NHS officials concede that legislation may eventually be needed to establish structures which will stand the test of the time.
So far the integrated systems have worked on goodwill and local understanding rather than statutory powers.
But the opportunity for new laws is low with the current government having no majority to push them through.
A legal challenge to these health reforms is looming.
Campaigners under the banner JR4NHS , externalhave argued that a contract being considered in two of the areas, creating what is known as an accountable care organisation, could usher in private health providers.
Even if NHS groups win the contracts at the outset, it's argued that future tenders could result in success for private bidders.
To many patients all this will sound technical and not relevant to their needs.
But demographic and funding pressures will affect future care across a big chunk of the population.
The new care systems represent an attempt to face up to the pressures.
But the jury is still out on whether they will deliver.