We recognise that delivering care which supports both individuals and commissioners – in local authorities and in the NHS – is a complex challenge.
Providers need to understand and respond to rising expectations of the quality and accessibility of services. At the same time, care has to represent value for money in a pressurised economic environment. Commissioners, families and communities all have the same fundamental expectations – that care services will be safe and personalised, that the outcomes they create will continue to improve and that they will be sustainable into the future.
We can’t meet that expectation without knowing how to review, re-design and re-engineer the way we invest in care services and the way in which services are structured and operated. What follows are just a few examples of how we are supporting our commissioners to bring fresh thinking to health and social care solutions.
Sustainable residential care across Suffolk
For Suffolk County Council, the need to future-proof its financing for older people’s residential services was as important as providing excellent, modern care for its current generation of older residents. We have enabled the council to renew its residential care for older people through a unique combination of investment and planning for a financially sustainable service in the future. The council’s demographic analysis – like that of many other areas - showed that the number of people in Suffolk aged 75 and over will increase by 85 percent by 2030, with the number of people living with dementia in the county set to double.
Working closely with the council, our development programme resulted in us taking responsibility for current provision as well as bringing around £60m of investment in ten new care homes and day clubs. This will bring much-needed additional nursing and specialist dementia care to the communities across Suffolk within planned budget parameters.
Day clubs are a positive first experience of social care at a time that can be very frightening and confusing for people – for both the person living with dementia and their family carers. As a service model they maintain individuals’ independence, allowing many people to continue to live at home for longer. For commissioners they allow more cost-effective use of the social care budget. We believe they will become increasingly important in creating and supporting dementia friendly communities, as well as tackling the issue of social isolation.
In December 2012, we took over full operational responsibility for 16 care homes formerly operated by the council. These homes are being progressively replaced by new-build homes containing a total of 690 beds – increasing capacity but enabling the council, which will block-contract approximately 54 percent, to achieve greater flexibility in its future financial planning.
The strategy has been a success, creating services that will support Suffolk communities for years to come while giving current residents excellent care.
Step up and down rehabilitation
We know that well-commissioned social care services can help bring down the numbers of hospital admissions and free-up hospital beds. In Sussex, working with local Clinical Commissioning Groups, we have created ‘step up, step down’ rehabilitation that offers nursing care for those recovering from strokes, falls or surgery or who need to build up strength whilst awaiting life changing surgery.
Our projects are true collaborations reflecting the different needs of commissioners: at Darlington Court care home in Rustington, West Sussex, the NHS Sussex and Coastal West Sussex Clinical Commissioning Group has been working with the team for more than three years. Many people have used the rehabilitation service - reducing costs to the NHS and freeing hospital places. At Bowes House, Hailsham, where we provide nurses and therapists to support individuals who would otherwise remain in hospital, an initial trial has had positive results and lead to an extended service.
Balancing capacity and demand for MSK services in Lincolnshire
We provide the Lincolnshire Teaching Primary Care Trust with musculoskeletal treatment and diagnostic services through our Lincolnshire Musculoskeletal Pain Assessment and Treatment Services (LPATS). The service, which only treats NHS patients, operates out of ten locations in hospital and health centres across the county. As well as offering one-stop assessment and lifestyle advice for a wide range of orthopaedic and soft tissue conditions, LPATS also offers a flexible and modern diagnostic service. MRI scans are carried out by radiographers with a special interest in musculoskeletal conditions and are analysed by a team of experienced consultants.
When we mobilised the service it soon became apparent that whilst some clinics quickly reached and exceeded capacity, others were regularly underutilised. Our teams, which are made up of dedicated health care professionals, did not want unfilled appointments when they knew they could use that capacity at other sessions in different parts of the county where clinics were full. Working with the Trust’s AQP project manager they developed a plan to re-order the spread of clinic time and resources, cutting the frequency of some underused clinics but increasing the time resources to others which were in greater demand.
The plan, supported by comprehensive evidence detailing capacity and demand, was put in front of the contract management team and accepted. Commissioners reported back that they were very pleased with the flexibility shown by the service, which had gone out of its way to meet the needs of Lincolnshire people.
Supporting urgent care in Worcestershire
Whilst we are most often approached by commissioners as a strategic partner we can also provide tactical support. For example, when the provider of the NHS 111 service in Worcestershire withdrew from the market, we were able to deliver the service until a new supplier could be found, drawing on our market-leading experience in both the 111 service itself and in wider out of hours health care.
Our NHS out of hours services give advice and health care to more than 15,000 patients every week with more than 450,000 patients each year receiving a face-to-face consultation outside normal GP practice opening hours, either in their own home or at one of our centres. Patient confidence in our out of hours care is strong – fewer than one in 2,000 (0.04 percent) raise any concerns about any aspect of their experience.
Having the broadest range of health and social care services in the UK enables us to operate a more diverse and flexible range of partnerships with commissioners and with local communities than any other provider.
Increasingly, we’re able to change, adapt and improve services as we respond to commissioner, patient and service user needs.