NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic.
In this blog, part of a series of comment pieces from NHS Confederation members and partners, Andrew Burnell, group chief executive of City Health Care Partnership CIC, reflects on how, despite feelings of being overlooked at times by the centre, community interest companies (CICs) have played a significant part in the pandemic response. He explains how, by bringing CICs to the table in system-wide conversations, they can play a valuable part in resetting health and care and building a more inclusive future with fewer boundaries to service delivery.
CICs are a different type of provider, occupying a unique position within the NHS and the world of community services. Many of us are born out of the NHS while still firmly embedded as a proactive and adaptable partner with the NHS. However, our company structures and governance arrangements mean we can maximise our efficiency and productivity for wider community benefit.
It is our difference that is our biggest strength. As an employee-owned business, we are naturally collaborative and system-minded. As organisations, we represent the NHS tradition of people-focused organisations driving people-focused services for the benefit of local populations and the wider economy.
Nimble and responsive
Like many across the system, and in the community health services sector in particular, CICs such as City Health Care Partnership (CHCP) have found many innovations we will want to hold on to in the aftermath of the COVID-19 pandemic. These have included texting patients about their symptoms, multiple layers of triage, and empowering and supporting patients in self-care.
CICs are naturally nimble and responsive. This is evidenced in work we do each winter, providing extra capacity in the system and voluntarily sending our staff into local hospitals to relieve pressure and speed up discharge. This adaptability has served us well during the pandemic.
As part of our work to provide integrated out-of-hospital care, CHCP owns and operates two care home facilities in Hull totalling 82 beds, while directly leasing a further 30. This enables us to deliver capacity, add extra sustainability and integration to the system, and to offer high-quality care and rehabilitation.
Historically, it has enabled us to ‘swing’ beds to offer more ICT or community stroke provision, which helps meet changing demand. However, through this and our wider network and connections, we are able to offer more step down and hospital avoidance schemes. This proved a great help during the COVID-19 response when we secured and mobilised a vacant ward within the local hospice within a matter of days.
Our facilities offer a multi-professional approach to care, with CHCP employing carers, senior carers, registered nurses, therapists and GPs with extended roles in the care of frail and older people and stroke care. The development of the Integrated Care Centre (Jean Bishop) allows us to work very closely with our local acute trust geriatricians, social workers and the above teams, to provide a cohesive service that has and is having a major impact on supporting and caring for those frail elderly within their ‘home’ in our local place.
Health and care delivery is ‘more than one bit’
Perhaps one of the more worrying and tragic elements of the pandemic has been the effect on care homes. At times one has felt the national approach and advice to be reactive and as though politicians and the arm’s-length bodies have focused on acute care (quite rightly given the emerging evidence at the time) but did not necessarily consider that health and care delivery is about more than just one bit.
An example of this has been the approach to PPE distribution. Initially, CICs and social enterprises were not allowed to be part of the national supply strategy. Even though CHCP is bigger than some local health trusts, we were expected to rely upon deliveries from the Post Office, or to sort ourselves out. Unfortunately, this demonstrates a real lack of understanding of the provider landscape in the NHS. This also feeds my concerns that community health services will need proper support and understanding in the months to come as we treat more and more people, including those who face a long rehabilitation from COVID-19.
Across the country, CICs are ready and able to play our part in system transformation. I have personally played a proactive role in the STP as its interim lead and as it became the Humber, Coast and Vale ICS. I believed then, as I do now, that the many challenges we have to face are about system leaders working not to compete or dominate, but to have a collective accountability and responsibility outside one’s own organisation, for the wider population’s health and wellbeing.
The future must include all providers
There is a plea here: do not unwittingly cut us out of key system-wide conversations. Include us from the outset and the resulting conversations will be richer for our unique position and perspective, enhanced by having diverse provider voices from the many different types we work with and within.
The future must include all providers to achieve the best outcomes for the people we serve and the workforce and communities we support. It is important that we don’t return to a contract-driven KPI system or one that just thinks big is beautiful, but that we focus on system-wide solutions and innovations for improved health and wellbeing.
Surely, this time is about collective actions together as systems, and not to default to the view that our problems will be solved by further reorganisations or mergers.
Andrew Burnell is group chief executive of City Health Care Partnership CIC. Follow him and the organisation on Twitter @AndrewBurnell2 @CHCPHull
Get involved in the NHS Reset campaign