NHS Reset: Exploding the myths of health and care | Kate Shields

Kate Shields

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation leaders, members and partners, Kate Shields highlights the way in which the crisis has managed to explode some of the myths and transform out-of-hospital care for the population of Cornwall.

Exploding myths and removing barriers

Much of the transformation achieved in our response to the COVID-19 crisis in Cornwall has been outside of hospital, and instead in and around where people live. Care homes are now part of daily discussions at system level. Although we had always aspired to an inclusive approach, the crisis made clear that our previous efforts to connect together with social care colleagues were simply not enough. ‘Made up rules’ seemingly made it impossible. For now, those rules have gone and we are seeing amazing transformation as a result.

The whole COVID-19 period has exploded so many myths that any thought of a return to our previous imperfect incarnation is unpalatable and there is commitment from leaders across the system to protect some of the gains that have been achieved. The crisis has helped us to understand some of the factors that previously held us back and get to the heart of some of the caution that had stifled change under ‘normal’ circumstances. We are seeing fantastic results and the models that we are developing are much more clearly linked to the needs of the population that we serve, rather than the demands of individual organisational or professional siloes.

Transforming care for our population

Excitement is high because we have encouraged people to do what they think is right. We’ve seen successful innovation and changes in practice in a range of areas: virtual outpatients, co-location with level 3 critical care, community-based services, locality frailty management, and a much greater level of openness about the opportunities to unlock and harness the potential of different professional groups.

The system has been working with Professor Ian Philp CBE (previously national clinical director for older people in the Department of Health) to develop community assessment and treatment units (CATUs) across Cornwall. The geriatricians have left the acute trust and are now working with GPs and broad primary care based multi-disciplinary teams that span health and social care to manage integrated frailty nowhere near acute care. We plan to put more diagnostics behind these units and in doing so remove a reliance on the acute hospital that actually has stopped it doing its own job.

Beware the bureaucracy

I am excited by a liberal approach to rapid service transformation, but I do fear that the hardwired bureaucratic processes of ’the Centre’ will prevent this - even if intentions are good. I’m reminded of a poster given to me by a colleague which says:

“I’ve just started with a great new company. They are so supportive of innovation and permissive working that they have created a really bureaucratic way of logging it”.

I really hope that isn’t where we are going. We need to guard against any approaches – however well intentioned – that begin to stifle this innovation or create an industry out of logging and capturing the progress that has been made.

Personally, I favour a more informal approach, such as encouraging ‘shout out and show off’ sessions that enable people to celebrate change, flexibility and the many personal contributions to the change that has happened. You never know, we might make agile, cross-sector thinking and working fashionable and real!

Kate Shields is chief executive of Royal Cornwall Hospitals NHS Trust. Follow them on Twitter @RCHTCE and @RCHTWeCare

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