COMMISSIONING AND PATHWAYS
He told NHE: “It’s had 100% satisfaction ratings. I’m not exaggerating, it got staggeringly good patient and carer feedback.”
Explaining the genesis of the idea, he said: “The pressure was that the hospital was struggling with the number of elderly people with complex problems who tended to stay there. Many had dementia or needed end-of-life care. Hospital wasn’t a great place for those people: they’re people who are not going to get better. You’re just trying to improve their quality of life – you’re not going to cure them, and they’re stuck in an acute hospital bed. With the best will in the world, an acute hospital is not set up to look after them.”
Breaking down barriers
The idea was developed by Partners4Health, especially its medical director Dr John Hodgson and head of clinical services Linda Gorst. Dr Charles-Jones used to be part of the company but left because of the confl ict of interest when he became chair of the CCG.
He said a community-based ‘hospital’ was a “great idea”, adding: “It made everyone come together. It broke down barriers, as to set this up we needed to get the acute hospital consultants on board, the GPs, community staff, nurses, community matrons, social care and we had some mental health input too.
“We all had to come together to decide how this would work and agree admission criteria, agree clinical pathways. It was incredibly diffi cult – a lot of egos had to be massaged, and it was hard to get hospital consultants to accept that GPs could actually manage patients in a reasonable way! Once we got it off the ground – there was some scepticism among GPs as well: ‘why are you doing what we do?’ But this is a step up – IV fl uids, IV drugs, 24-hour care – GPs can’t provide that.”
Since it went live at the beginning of this year, not only has patient feedback been unprecedented, but the GPs are really behind
the idea too, although Dr Charles-Jones admitted there remain some “rumblings” among hospital consultants.
He said: “Our relationship with A&E is very good, which is important, and excitingly now we’ve got the ambulance service using it as a divert. If they get called to a nursing home, instead of taking that person to A&E, they’ll call Hospital at Home, which guarantees a two-hour medical assessment that allows the ambulance service to be reassured that they’re leaving the patient safely.”
Collaboration and commissioning
Dr Charles-Jones was enthusiastic about the amount of collaboration now happening under the Altogether Better model. He said health had some concerns early on that it would be the ‘junior partner’, but said the amount of progress from a position 18 months ago where there was “pretty much nothing at all” has been “dramatic”.
He told NHE: “That’s not to underestimate the problems or how hard it is to bring these cultures together, but a large amount of joint working is taking place.”
He went on: “There is no way in this current climate of a fl at-line NHS and a falling budget for social care that we’re going to survive, unless we start working together and change the way we do things.
“It’s slowly dawning on people that we just can’t go on with this hospital-centric approach. It just isn’t affordable, and the only way to make things work is to have alternative provision, which has to be community-focused, and has to be done jointly with the local authority, and other public services – fi re, police, we all bring different things.”
i More stories like this at:
www.nationalhealthexecutive.com/ Commissioning
He gave the example of work by the fi re service that can have an under-appreciated outcome on health and social care: for example, on home visits to elderly people to fi t smoke alarms, noticing frayed carpets that could present a trip hazard and mean an emergency admission and everything that goes along with it.
He continued: “A big cause of A&E winter attendances is elderly people putting their bins out. Not gritting streets – just pushing bins out, and breaking their wrist or hip. The answer’s not a medical answer, it’s a social answer: how do you help elderly people put their bins out. But the health economy gains are huge, as are the gains for the individuals.”
West Cheshire CCG is in the fi rst wave of clinical commissioning groups in the authorisation process, and has been operating in shadow form for quite some time. We asked Dr Charles- Jones what the mood among his colleagues was like on the progress so far, and whether clinical commissioning was turning out to be how he imagined it would be.
He said: “We’ve got some very talented managers and we are optimistic – but we’re not naïve, and don’t think it’s going to be easy. This is a very diffi cult time that we’re going into, but we do feel that getting clinicians involved in commissioning decisions has been really effective. You can see that in our contract discussions with our providers: it’s dramatically better when you have clinicians talking.
“Joint commissioning with local authorities is really positive – there are still some concerns about how we relate to Health & Wellbeing Boards and so forth, but
generally speaking, we feel quite positive about what we’ve done so far and where we’re going. But we don’t think it will be easy.”
Dr Huw Charles-Jones
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
national health executive Jul/Aug 12 | 21
Image of Chester by ‘Crashlanded’, used under a Creative Commons Attribution-Share Alike 3.0 Unported Licence.
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