After the NHS – a CHS?

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A new social care system is a prize worth fighting for
19 Jun, 2017

The election is finally behind us. The Labour Party had most of the eye-catching policies – and community businesses could provide the next big idea, writes our guest blogger Bill Graham from New Wortley.

One of the ideas was to turn the education system into an NES – or national education service.

I suppose some of the thinking behind this is to try and generate the same level of public confidence in education that we have in the NHS. Satisfaction in our health service remains high among people who use it, and it remains a national treasure in many eyes.

We should all be thinking about how the NHS can be strengthened. The work I have been doing at the Leeds Institute of Quality Healthcare, and at the Community Business Leaders programme, has given me real insight into how the third sector and community businesses can be part of the solution.

We have all read about the pressures in hospital A&E departments: people turning up who should probably go to a GP instead; patients attending who need support, but not the emergency service that our hospitals provide. Already some A&Es have a GP on site to try and ensure this pressure is reduced.

And we know how difficult it can be to get a GP appointment. It can be deeply frustrating not to get a GP appointment on demand, but the truth is that on the patch where I work, in Leeds, 30-40% of GP appointments are for non-medical issues (this was brought up recently at the Leeds Institute of Quality Healthcare). In most cases the GP is not the most effective person to see, and may indeed just refer the patient on.

So to free-up GP time, and in turn take pressure off primary care in hospitals, wouldn’t it be nice if patients could access a different service for these non-medical issues, a place where there is a friendly face, where there is some expertise, and where patients can trust the help and services on offer. A place where non-medical issues can be discussed, triaged, and solutions found or sought.

These places do exist. At the moment they are provided around England by a wide variety of charities, third sector organisations, and community businesses.

But it is patchy. Some areas have lots of these organisations and some have very few. Some organisations have very high standards, but some will struggle to provide the service to which they aspire. Some of these organisations will be well networked into the health system, and some will not.

At some of the workshops I’ve attended recently, we have been looking at the barriers and the issues that stop some of the third sector, community businesses and charities becoming a more formal part of our NHS.

Questions of trust, and the quality and consistency of services, can weigh heavily on a patient. If organisations use volunteers, then the service provided may not be at the standard a patient – or indeed a GP – may expect.

But some organisations get it right and can work well in the system. Cancer charities and hospices already provide a trusted service embedded into a network of cancer care or end-of-life care from the NHS.

So maybe in the future we will look to create a Community Health Service (CHS).

A CHS would invest in our local providers, help train staff and volunteers, and let GPs and nurses lead the way services are developed. It would report outcomes in a clinical scientific way, provide high-quality care (and outcomes) around key issues like low-level mental health, self-management and social isolation.

I believe this is a prize worth fighting for, to help save the NHS and create capacity in the system.

Just maybe, this is the future. You never know, this might even be one eye-catching policy at the next election.