Ministers, health staff and the public gathered in London last week for a summit to discuss the 10-year NHS plan in England. It was the final roadshow in a nationwide tour to help set out the strategy the government says will rescue the “broken” NHS, which has a waiting list of nearly 7.5 million patients and public satisfaction of just 21% – a record low.
Not for the first time, moving healthcare away from hospitals and into the community is being touted as a way of treating people better and for less. Research suggests that every £100 spent on community care would otherwise cost £131 for hospital care.
This helps explain why Health Secretary Wes Streeting has promised to turn the NHS into a neighbourhood health service.
Washwood Heath, a community health clinic that was set up in a deprived part of east Birmingham two years ago, is a living, working example of what this could look like. Here, hospital doctors, GPs, nurses, occupational therapists, council social care teams, mental health professionals and charity staff work under one roof.
The target is the most frequent users of health services – and the aim is to keep them well and out of hospital. “We want to work with the 10% of the population that is responsible for 70 to 80% of its use,” explains Richard Kirby, head of Birmingham Community Healthcare NHS Trust, one of the key partners at Washwood Heath. “The NHS cannot meet their needs on its own – it requires partnership working.”
However, not everyone is convinced. An expert has pointed out that the model is being expanded across the city, with the aim of having a network of six community hubs and 25 to 30 integrated neighbourhood teams, covering Birmingham’s population of 1.4 million people. Not every centre will be identical. For example, in the north of the city, there might be a focus on helping with frailty to support the older, more affluent population demographic.
There are of course costs – these are estimated at less than £100,000 as the six hubs as the centres will use existing buildings and redeployed staff. Richard Kirby thinks the model could easily be replicated nationwide. “We believe this is the right model,” he insists.
But there is a catch. As he puts it, “It only works when the whole system buys into it.”
Part of the problem with making the whole system buy into it is money. Ruth Rankine, an NHS Confederation primary care director, believes that during times, such as now, when money is tight, collaboration generally becomes harder.
Another concern is around finding suitable premises. In Birmingham, officials I spoke to acknowledged they were lucky to have a network of large health centres (as they were beneficiaries of a short-lived finance programme launched in the 2000s to improve community NHS buildings) but many other places around the country do not.
There are deeper rooted political pressures too that make a nationwide rollout of centres like those in Birmingham a challenge. Even though the work in east Birmingham ticks a lot of the boxes set out by independent peer and NHS surgeon Lord Darzi in his report for the government last autumn, after being commissioned by Wes Streeting, this is not the first time such calls have been made. Lord Darzi himself set out similar goals in a report for the Blair government in 2007.
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