Charity service innovations can help transform the NHS | Mike Hobday

Heart symbol

Barely a day seems to pass in the run-up to the general election without a report being published on the need for better integration between health and social care, or a headline appearing on the unprecedented pressures on A&E that underlines the urgency of action to achieve the former. 

There is wide agreement on the need to transform the health and care system to cope with the many challenges and unprecedented consensus around the vision for this set out in the Forward View.

The British Heart Foundation is one of those championing change. We are calling on the next Government to introduce measures that will give people with cardiovascular disease access to the integrated health and social care they need.

We are one of the 23 organisations that have endorsed the NHS Confederation’s 2015 Challenge Manifesto, and a member of the Richmond Group of Charities, which last week published the Vital signs report, showing that although much excellent care is provided, there is still some way to go before everyone with a long-term condition receives the care and support they need.

As well as a wealth of experience in the needs of people with long-term conditions, many charities have robust evidence on the best way of meeting these needs, through independently evaluated services.

The British Heart Foundation is working alongside health and social care providers to develop and implement new models of care that improve the outcomes and experience of the seven million people living with cardiovascular disease in the UK, and save the NHS time and money.

This is exemplified by a number of our pilot projects, such as our two-year pilot across ten NHS organisations to assess safe and effective ways for specialist nursing teams to administer intravenous diuretics to people with heart failure at home. Why are we doing this?

One of the most common symptoms of heart failure is fluid retention, which leads to breathlessness. As the condition progresses, oral diuretic treatments can become less effective and many patients need to go into hospital for intravenous diuretics. These admissions last on average 13 days and account for 2 per cent of all NHS bed days.

All of the patients that received treatment at home as part of the pilot, and 93 per cent of their carers, preferred this to being admitted to hospital. Admission to hospital was avoided in 79 per cent of cases, saving 1,040 bed days and nearly £163,000.

Another example is our two-year pilot across nine NHS organisations to better integrate primary and secondary care services for people with cardiovascular disease. 

At the East Cheshire NHS Trust site, the new, integrated cardiology nursing team developed new care pathways for the main cardiac conditions patients were presenting with.
A hospital in-reach service has been established which identifies patients in the Medical Assessment Unit and A&E before they are admitted onto general wards. They are assessed by the team the next working day and treatment is started to support early discharge. Follow-up clinics have been set up in the community. A shared decision-making tool has been developed to help patients self-manage and access further support when necessary. 

Over the course of the pilot, the average length of hospital stay for the most common cardiac conditions has reduced, saving 2,391 bed days and nearly £1.2 million.  

Our new, two-year pilot across three sites will extend this integration beyond health services to access and build on local social and psychological support services, including third sector providers. Based on the House of Care model, the pilot will identify the needs of people with cardiovascular disease using care and support planning to encourage self-management, with the aim of re-designing and commissioning services built around these needs. 

New service models like these, and those developed by other healthcare charities, have the potential to make a substantive contribution to the transformation of the health and care system. They are starting to be adopted by commissioners. But we need to see a step change in the scale and pace at which this happens to ensure that patients reap the benefits of these innovations.

Mike Hobday is director of policy at the British Heart Foundation, one of 23 organisations that make up the 2015 Challenge coalition. Follow the organisation on Twitter @TheBHF and @BHFpolicy

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