Improving health and social care

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This page will highlight a combination of case studies and issues that face the sector but also provide ideas on how we can develop both the infrastructure and staffing required in sufficient quantities to deliver good health and social care.

This section also mentions early intervention and preventative healthcare measures which we need to work on to help reduce the strain our precious NHS is under.

This is an area of urgent need. our health and social care systems are under immense pressures as we see the population increase, longer life expectancy, advances in treatments that allow people to enjoy a much longer life and more patients with complex health needs.

The question is what comes first do we increase capacity into the NHS or into social care?

The truth is we need to look radically at this including revisiting the subject of council run residential and nursing care homes something we used to have in the past. This needs to be done alongside of:

• Improved access to home care service.
• Reopening of cottage and community hospitals
• Better health and wellbeing preventative measures 
• Easier access to early intervention care
• More GP practices and development of multi-disciplinary hubs
• More Urgent treatment centres and minor injuries units
• Expanding of acute care hospitals
• Development of day surgery hubs away from conflict ED demands.

If we are to help with the flow of patients including the discharge from acute care and cottage/community hospitals into the social care network we need to look at innovative ways of working.

I believe that we need to look at a national social care service with integrated bed management systems which flag up capacity at the earliest opportunity to more suitable patients from the NHS to social care provision in nursing or residential care homes, sheltered accommodation or home with a care plan in place and appropriate adjustments made.

We have to acknowledge that without a functioning social care system we have patients unable to leave hospital when it is clinically safe for them to leave with the appropriate care package put in place. As a result we need to be managing the ability to properly address those leaving hospitals whilst also looking to reduce the pressures on the NHS at the other end of the process. 

As patients enter the process we need to look at ways to improve the process from the first point of contact to discharge.

There are a handful of pathways that are open to us:

• Pharmacy
• General Practitioner
• Phoning 111
• Visiting an Urgent Treatment Centre (UTC) or Minor Injuries Unit (MIU)
• Attending A&E
• Referrals from other healthcare professionals / services.
  

GP practices and Pharmacies

We need to improve the network of Pharmacies and GP practices avoiding bunching where possible leaving areas under represented.

I believe that the use of a GP practice with a linked Pharmacy is the best option allowing easier working between both teams but also allowing some cases to be referred to pharmacists if the GP, Practice Nurse or Paramedic Practitioner is fully booked.

It is also important that we look at the offering of out of normal working hours appointments even if this is a service offered across a group of local GP surgeries. This should cover appointments being available from 07:00 to 20:30 Monday to Friday, 10:00 to 19:00 Saturday, Sundays and public holidays at one or more of the surgeries in each local operating hub. 

We also need planning reform that includes provision to healthcare to be mandated in areas where demand outstrips capacity.

Urgent Treatment Centres (UTC) / Minor Injuries Units (MIU)

Every hospital with an Emergency Department should have either a UTC or MIU on site ideally located adjacent to the Emergency Department allowing easy redirecting of patients whose conditions are not requiring the ED. 

This has the potential to allow a more streamlined service for those in the Emergency Department whose clinical needs would need quicker care or assessment of whilst not compromising the level of care given to less time critical patients in the UTC/MIU.

With various options open to us it is also important to run campaigns to raise awareness of the different options open to patients. For too long we have not run health education awareness videos except for during Covid19. This is something we need to change.

We need to raise awareness of:

• Pathways open to patients and when to use each one wisely
• How to access early intervention services such as those offered to patients in mental health crisis but also for other conditions too.
• Public health messaging we need to ensure during an era of “fake news” that the correct messages are getting out there we have seen great results with campaigns for drink / drug driving so why not other issues which can help people both before it becomes an issue and to also address ongoing care / support.

we have a lot of great organisations, charities and community groups that provide great support to people in their time of need but we lack a good platform for finding services in a man easy to use manner.

This hospital featured in the New Hospitals programme that was proposed by the Conservatives during the Boris Johnson government following Covid. The site is home to a hospital so old it predates the NHS and is in desperate need for rebuilding.

A proposal was put forward to relocate the acute services to the Sutton Hospital site which was shrunk due to building of a school on the northern end of the site. The Sutton Hospital site is also located adjacent to the Royal Marsden Hospital which with the increased prevalence of cancer I believe we need to expand to futureproof the site to meet future demands.

Instead of using the Sutton Hospital site I would recommend the levelling of the site behind the current St Helier Hospital and the construction of a new hospital with an enlarged A&E Department and Urgent Treatment Centre on Rose Hill. With the new building opened the site could be cleared to be restored to replacement parkland or allow for an expansion of the hospital towards Wrythe Lane.

This development would also allow for the provision of rehabilitation care beds similar to the community/cottage hospitals that offered a great step down level of care whilst also ensuring patients still have regular access to healthcare professionals including physiotherapists.

Finally I do question if it is time for the Epsom and St Helier Trust to be split. I believe that it makes sense for St Helier Hospital to merge with St George’s and Epsom General Hospital to merge with Surrey & Sussex Healthcare NHS Trust allowing these new partnerships to focus on London or Surrey patients.

Again using Surrey & South London as case studies we have seen a number of hospitals look at selling land when we desperately need to see an increase in capacity in terms of bed numbers, theatres, emergency departments, outpatients, specialist units etc.

Epsom General Hospital sold land at the rear of the site that could have accommodated a lot of wards allowing for the gradual modernisation of the site and upgrading of facilities.

St Peter’s Hospital in Chertsey saw a large housing development built on the flattest part of the site when the hospital is in need for also expanding its facilities as the population increases.

Kingston Hospital has also seen land earmarked for redevelopment whilst also being a site with considerable congestion and parking challenges.

These three hospitals also have overlapping catchment areas and are not the only examples of land being sold off when we need to ensure that we prepare for the future. We know the trends in terms of demands on healthcare facilities so we need to ensure that we retain the space to accommodate future needs to avoid more costly projects in the future. 

Our ambulance service is under immense pressure with the demand often out stripping demand despite the best efforts of staff.

We have seen nationally a move towards the setting up of make ready centre (MRC) stations where vehicles are prepared by the MRC staff, who will also deliver replacement ambulances to nearby hospitals for crews to switch to with minimum delays before they return with the ambulance needing deep cleaning to the MRC.

There are a network of community response posts that crews will if workloads permit respond from in many toow s where the historic stations are located. In some areas additional response bases have been set up to also spread cover better should sufficient resources be available without a job assigned to them.

I believe that whilst we look to expand / renew our hospital estate it would make sense to ensure that MRCs are located on the doorstep of the A&E hospitals within that trust’s operating areas. We also need to acknowledge that there will be times when crew will need to return to an MRC from outside the trust area and it will be quicker for the crew to complete the journey such as with South East Coast, South Central and East of England crews who may transport a patient to a London specialist hospital including those in the trauma network.

Patient Transport Services has come under increased competition as privatisation by stealth has creeped into the NHS. We need to see patient transport services revert to being an integral part of the ambulance service and a good training ground for learning the basics of patient care as well as getting to know your area.

Some services used to team up experienced patient transport staff with a technician or paramedic to crew high dependency/ intermediate care ambulances handling the GP referrals, transfers between hospitals as well as first responding to emergency calls if the nearest resource. Staff from patient transport were an integral part of the team supporting their clinical colleagues and in some cases also trained on emergency driving to free up other resources for other emergency calls especially for blue light transfers and during the blue lighting of critically ill patients. 

Having seen the pressure that Ambulance crews were under during the Covid19 pandemic and the need for military personnel to step in as non emergency drivers this pool of PTS staff could have been called upon to team up with clinical colleagues maintaining the ability for blue light journeys whilst the clinician was in the back treating the patient.

The time to upskill from PTS to Technician was too long during the pandemic but this type of high dependency/ intermediate care ambulance could have been useful during the pandemic and will be useful in times of high demand.

Replacement PTS staff require a considerably shorter training course before being deployed on the road so this is a sustainable way of working pulling new recruits from the waiting lists from regular campaigns. 

One of the biggest challenges we face is the recruitment and retention of staff in both the NHS and social care. Over the last 20-30 years there has been an even greater push towards degree led qualifications however with the costs of university education being so high we need to be radical in the way we develop the workforce of tomorrow.

On the job training - an ambulance prospective.

This is an areas that the ambulance service excelled at. staff in my local service would join working on patient transport services learning the area, the hospitals, patient handling, some clinical skills and ambulance driving skills amongst a range of course content.

They had to work six months minimum before they were allowed to take the entrance exam for an ambulance technician course, on successfully completing that course and the emergency driving course they would spend a year on the road as a trainee with periodic assessments and feedback from their crew mates/mentors before after final assessment being signed off as a qualified ambulance technician.  

Following a year as a qualified technician with 2.5 years service they were then able to undertake the paramedic entrance exam, on completion of the course including hospital placements with different teams and mentoring they would be signed off.

As the Paramedic Sciences degree came out this Technician to Paramedic upskilling route was closed but those Technicians wishing to progress to Paramedic were given the opportunity to attend University on day release which understandably filled in the gaps in knowledge between the technician role and paramedic role. Some of the Paramedic sciences degrees was learning the work technicians already were qualified on but gave them the extra skills and knowledge to progress.

Since then we have seen further extended skills paramedic qualifications offered and this has lead to specialist paramedics being able to completed skills on scene that would have needed to be done at hospital or delayed that advance care being given during the transfer to hospital.

With the pressure on ambulance crews these days with supply of crews not always meeting demand burn out is a common concern. Some Paramedics are struggling after 8 years of service but straddled with the debts incurred training for the role.

Would the return to a pathway like this with day release for technician to paramedic be a better option?

As the technicians either via PTS or on direct entrance pathways can be operational quicker than a degree paramedic is this also a way that the service can increase the number of crews on the road in a relatively short time catering for the ever increasing demand.

Recruitment alone is not the solution and we need to better educate the public when it is appropriate to call 999, when to call 111, visit a walk in centre or urgent treatment centre or see a GP or Pharmacist.

We also need to see the review into call types and look at whether there is sufficient demand for specialist units such as mental health crisis cars, falls teams, district nurse or GP on call cars, joint response units with police to ensure that the correct specialisms can attend calls releasing double crewed vehicles for those calls with a higher likelihood of requiring transport to hospital. This also needs to be supported by specialists with potentially upskilled paramedics depending on the type of specialist response they are providing.

Other skills areas

Whilst the above is an example for the ambulance service  I do wonder if similar lessons or pathways could be explored to allow prospective future clinical staff to gain an insight into the work in the NHS and potentially also social care.

I do believe that where we have University graduate entrants that we should also look at the issue of student debts and whether there is a way we can link the length of service to the NHS to writing off of reasonable student debts and my recommendation should work on the principle of for every 4 years (full time equivalent) worked in the NHS post qualification we could write of 1 year of debt. This means for nurses and a number of other roles completing a 3 year degree they would have an incentive to work 12 years in the NHS increasing the size of the clinical team.

This retention boost would also help with increasing staffing levels allowing more reasonable workloads compared to the pressures staff are currently under.

Degree locations.

We also need to acknowledge that the high costs of degrees does put people off from going to University especially when combining the costs of tuition, accommodation/living costs and any materials/books required.

Is there potential to increase the number of places around the country that can offer these courses closer to the homes of these prospective employee? would not having to pay out the accommodation costs be a great motivator to student medicine?

We have to remember during their training a lot of these students also have to undertake clinical placements so they are already working (in many cases for certain roles) for free. In a cost of living crisis are we doing enough to promote healthcare as a career?

As home ownership is also an issue it is worth also looking at whether we need to look again at the increasing of staff accommodation provision at our hospitals. However, with changes to renters rights, we need to ensure that these prime properties are retained for staff current employed by the trust.