COMMENT 9
There needs to be more of a focus on people and outcomes, rather than processes and outputs
Shifting the focus to community health Despite this long held ambition, the report highlights a mismatch in action, with the proportion of Department of Health and Social Care spending on primary care falling in recent years from 8.9% in 2015-16 to 8.1% in 2021-22. Similarly, while the NHS has received additional funding in recent years, acute hospital trusts have seen 27% funding growth since 2016-17, compared to community trusts who have experienced just half that level of growth, at 14%. The King’s Fund report goes on to suggest reasons for the lack of change, before setting out a solution for refocusing of the health and care system, which is detailed and far reaching, covering policy, leadership, funding, and workforce. A critical element to this is cultural change: “The increasing complexity of people’s health and care needs requires an integrated, holistic response, rather than a ‘body part’ or single condition response. There needs to be more of a focus on people and outcomes, rather than processes and outputs.” In terms of our approach to healthcare facility design, this is an important shift in thinking, and one that we have seen embraced in pioneering community health schemes in recent years.
Person-focused care
One example where this approach has proven to be successful is The Jean Bishop Integrated Care Centre (JBICC) in Hull. Prior to the project commencing, Hull and North Yorkshire Integrated Care Board faced numerous challenges. Hull had around 25,000 residents living with frailty, and 3,200 with severe frailty. As a result, the health system was overwhelmed with non-elective hospital admissions, struggling to fi nd beds for elderly patients amidst peak admissions and growing demands from the ageing population. A 2012 study found that a third of older patients admitted to hospital in emergency had no clinical need to be in a hospital bed, and that admission quickly reduced the ability for vital rehabilitation and ‘reablement.’ In response, and informed by engagement with residents, Humber and North Yorkshire ICS developed an ‘anticipatory care’ model that completely redesigned the approach – creating an out-of- hospital service to help people to stay at home and out of hospital. We were commissioned to work with stakeholders to develop the fi rst facility which could deliver the care model effectively. Adopting an entirely new way of delivering health services, the centre brings together a range of specialist services to provide a more holistic approach to health, care, and social support. Unlike regular community health facilities, where patients receive assessment and treatment for a single health complaint or condition, at the JBICC patients receive a full physical and mental health check, as well as help with other social challenges. They may spend an entire day there, but they leave treated and with a care plan. The type of facilities offered refl ect this extended visit and include a cafe run by Inspire Hull, a charity which aims to improve physical and mental wellbeing, through the development of friendships and feelings of purpose. Activities are curated which bring people together to tackle feelings of social isolation.
ADF MAY 2024
The therapeutic and non-institutional character of the design with views to gardens and landscape from many areas of the building, create a comfortable environment to support patients during these extended visits.
Relieving the strain on overstretched acute hospitals A recent study, led by researchers from the Wolfson Palliative Care Research Centre at the University of Hull, assessed the wellbeing of patients who received this more holistic person-focused assessment at the centre compared to those who did not. It showed, for those living in their own home, a 15-20% reduction in emergency department (ED) visits and a 10-25% reduction in emergency admissions for the 12 months after their assessment compared to the 12 months prior. Also, for residents in care homes, there has been a 20-25% reduction in ED visits, and for the frail cohort who had more than fi ve ED visits in the 12 months preceding their assessment, there is consistently over 50% reduction in ED visits and admissions in the following 12 months. Clearly, then, long-term investment in the right kind of community-focused facilities can reduce demand for acute services and bring about savings to the wider healthcare system, as well as improving the wellbeing of individuals.
Sustainable evolution of the healthcare estate The King’s Fund points to a need to invest in primary and community healthcare estates to promote joined-up, integrated working locally between public partners across health, social care, and community services. However, despite recent initiatives to bring forward innovation in the delivery of community health, investment remains weighted towards capital investment to acute services; the New Hospital Programme being a prominent example.
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Passivhaus: Cavell Community Health and Wellbeing Hub © Pillar Visuals
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