I was recently part of a meeting to brief local authority colleagues about the work of South West London Collaborative Commissioning. One local councillor made the very good point that the NHS has been talking about why things need to change for several years, yet many of the changes that are clearly needed have not happened. What local people will want to know, she told us, is what has really changed? What’s different now to when changes were put forward under previous programmes like Better Services Better Value, Healthcare for South West London or Better Healthcare Closer to Home?
The reality is, of course, that the clinical and financial case for change has not changed. The challenges set out in our Issues Paper are matters we have been raising for several years. The case for change is much the same as that outlined in the past but the problems it causes are getting worse.
What has changed, though, is that the national NHS Five Year Forward View sets out new ways of delivering healthcare. It advocates changing the way in which services are delivered and funded, so that more care can be delivered in the community, by GPs, nurses, pharmacists, midwives, therapists and other health professionals. New ways of organising services around the patient are suggested, making the long term NHS goal of most care being delivered in community settings far more attainable. This dovetails perfectly with what we would like to achieve in south west London.
The NHS Five Year Forward View means that the way in which patients use the NHS is likely to change. Many more services and clinicians will operate outside hospital, in the community and in a different way. GP practices are set to work more closely together and services previously provided only by hospitals could move into the community. Hospitals and GP networks will be expected to offer services over 7 days a week. Nurses and pharmacists are also playing a much bigger role in delivering care to patients and keeping people healthy.
New roles such as care navigators and case managers are being developed to help people with physical and mental health problems to stay healthy and avoid a crisis, helping patients to get the right service at the right time to avoid an unnecessary hospital admission. New ways of working can now cut across old NHS and social care boundaries to avoid duplication and fragmentation of care.
The other key piece of work that has changed the landscape is the London Health Commission. In December 2013, the Mayor of London launched an independent London Health Commission to look at how healthcare could be improved for Londoners. The Commission reported in November 2014 and made a series of recommendations, including measures to tackle childhood obesity, get people living healthier lives, better support for people with mental illness, improving GP access and more support in the community for people with long term conditions. All of the recommendations and aspirations in the London Health Commission report are in line with those set out in our strategy and in the NHS Five Year Forward View.
If we do nothing then within five years patients in south west London will no longer have the services we currently provide. Patients will be left with sub-optimal care as we will not be able to meet the required quality and safety standards – ultimately putting lives at risk. We think that patients deserve better, with access to safe, high quality and sustainable services for years to come.
We expect big changes in the way patients receive the care they need. We want to see a greater emphasis on helping people to stay well and helping those with long term conditions to manage their own health, understand their conditions better and access support when they need it. This would mean much more joined up working between the different parts of the NHS (GPs, hospitals, primary care teams, community services, mental health services, the London Ambulance Service), the social care services run by local councils (and by Your Healthcare in Kingston), and services run by the voluntary sector.
We want future services to be built around the needs of our population, rather than the needs of different public bodies. Patients and carers would get better services. They would also need to take more responsibility for their own health where possible, ensuring that they use health services wisely and appropriately. We have strong communities and networks to draw on; we want everyone to play a part in delivering a better, sustainable health service.
All our services will need to change. We expect all of our hospitals to be there for when people need specialist care. It is possible that different hospitals may do different things in future, rather than trying to do everything everywhere. But we will not make major changes to any hospital without first putting an alternative in place – and consulting the public on the options. At present, we are still discussing with local hospitals what part each of them will play.
We recognise that ideas for change can be unsettling as well as exciting. While clinicians may be excited about the potential for changing the way things work for the better, we also know that many people find change difficult and will want reassurance that what we are proposing will make things better and that they will not lose out.
That is why we published our Issues Paper: we want to put our cards on the table and let you know our current thinking. Most doctors and nurses, as well as managers, agree that we cannot go on as we are. We want our patients and local people to be part of our decision-making process and part of building a better local NHS.