The financial pressure on the NHS increases year on year. With net expenditure rising from £78.9 billion in 2006/07 to £120.5 bn in 2016/17, and expenditure estimated to be in the region of £124.7 bn for 2017/18, rising to £126.3 bn for 2018/19, the costs keep mounting, while the infrastructure and health systems are starting to creak under the strain.
In Summer 2018 a £20.5 billion budget settlement was announced for the NHS and the NHS Long Term Plan, which sets out how this will be spent over the next five years. The plan focuses on the population getting the best start in life, greater support for older people, improved digital health services, and improved out-of-hospital care, by supporting primary medical and community health services. With an ageing population, and an increase in long-term conditions, new models of care will need to drive the future design of health and social care facilities.
The current service delivery model
Historically, the service delivery model is disjointed, involving a large number of different touch points for service-users, including GP practices, pharmacies, health centres, acute hospitals, mental health teams, and nursing homes, but also possibly Citizens Advice, the police, schools, and colleges. This is confusing for patients, who may need to access a range of services at a number of different locations for even just one condition. Consequently, it is likely to increase the number of people not accessing their care effectively.
New service delivery models
The ever-increasing pressures on the health system, and a historically disjointed health and social care delivery system, are driving the development of system-wide reform programmes which embrace new ways or working and models of care. While there are many models developing throughout England, among the key trends are the formation of multispeciality community provider organisations, development of new models of primary care delivery, and an extended clinical workforce operating in primary and community care – including advanced nurse practitioners, physician associates, pharmacists, and paramedics – along with healthcare and social service co-ordinators. We are also seeing the development of high impact ‘extensivist’ care models, where enhanced integrated care is delivered closer to home for the elderly and those with chronic or complex needs, along with an increase in reablement and intermediate care. These new models have the goal of deflecting patients from a saturated acute healthcare system, and putting the patient at the centre of the service provision at all times, improving clinical and social outcomes, along with delivering systemwide efficiencies.
Community Health and Wellbeing Hubs
In this new world of healthcare delivery, there is also a requirement for improved community infrastructure, with the most commonly used description being that of a Health and Wellbeing Hub. But what does this exactly mean in practice? Hubs should be a connection point in the community for a range of public and possibly private sector services, acting as a base for the delivery of integrated health and social care services NOT just co-located. From experience there is no single prescriptive, formulaic solution to what should be included within a hub; rather they should provide facilities that reflect the needs of specific communities from a socio-economic, health prevalence and demographic perspective.
A hub might operate from a defined physical asset which could be new build or existing facility or virtually from a range of community buildings that link the provision of support and care services for people. Bu co-locating and critically integrating services locally, a hub will significantly reduce the number of “front doors” the individual will need to enter. With one of the key aims being that they should enhance and become intrinsically part of the communities they serve, empowering local people to take greater control of their health and wellbeing and focus on delivering better life opportunities and health outcomes.
This holistic approach to the patient, allowing them to have one point of access for all their health and social care needs, with a person centered approach should support improvements to population health and wellbeing and over time people taking more responsibility for their own wellness, reducing the frequency of visits and ultimately time and cost per patient, that surely must be the best future outcome for all.