Healthcare beyond the hospital
Improving the quality of life for patients isn’t just about maximising their outcomes when they become ill. It’s important to also look at how healthcare can reach beyond the hospital, into local communities, and work with other organisations invested in people’s wellbeing. Below, we summarize a few of the talks from the International Forum 2019 in Glasgow which touched upon this theme.
As part of his talk, Bob Klaber highlighted the health inequities that exist even in relatively small areas, such as that served by his employer, the Imperial College Healthcare NHS Trust in central London. This inequality came into sharp focus following the fire at the Grenfell Tower block, in one of the poorest areas in the capital, which is just one mile away from Notting Hill, one of its richest.
Stark differences in health outcomes for people who are practically neighbours is not unique to London of course, and Bob made reference to the Montefiore Healthcare System in New York as an example of how such gaps can be bridged.
A central idea that the NHS hopes to borrow from the Montefiore approach is thinking of the hospital as an ‘anchor institution’, which reaches out beyond the walls of the building to improve the health of the neighbourhood it is part of.
As an example, Dominique Allwood, also from Imperial, highlighted work happening in a hospital in Leeds, in the north of England. The hospital provides support for people looking for jobs, opens up its green spaces to the public, and encourages staff to volunteer in the local community – even running a food bank.
Rural and remote communities
Healthcare in remote and rural communities provides its own unique challenges. Though they may live off the beaten track, people rightly expect that they should not be worse off compared to their urban peers when it comes to health. So how can health services be organised to meet their needs?
Two examples came from staff from the Scottish Health Board NHS Highland. The Scottish Highlands represent 94% of the nation’s land mass, yet contains only 20% of the population, who mostly live in small towns and villages, and on remote islands. For Highlanders, their community is everything.
Gill McVicar shared the story of developing health services on the ‘Small Isles’, an archipelago off the west coast of Scotland with a total population of less than 200. By borrowing ideas from the ‘Nuka System of Care’ model in Alaska, she showed how islanders were able co-create a resilient health service which worked in harmony with their way of life.
Key components that they borrow from the 'Nuka' model and applied to the Small Isles include engagement with the local population, building relationships, and resilience. #Quality2019 #qfa3 pic.twitter.com/Q5WDWX5E26— Richard Berks (@DrRichardBerks) March 28, 2019
Clare Morrison, also from NHS Highlands, talked about a new service called ‘NHS Near Me’. It was set up to address the needs of thousands of people who would normally have to travel for hours from the outer reaches of the Scottish Highlands to a central hospital. Instead, NHS Near Me provides video consultations, either from home or at a more local NHS clinic. Crucial to the success of NHS Near Me was involving local people to co-design the service, which went through over 100 test cycles.
Working with the service users on both sides to co-design the service was absolutely fundamental – Clare says that they made over a 100 changes as a result of input from patients and clinicians#Quality2019 #qfa3 pic.twitter.com/Kg8jdn2PMf— Richard Berks (@DrRichardBerks) March 28, 2019
We also heard from Joel Mubiligi from Partners In Health, Rwanda, who talked about the challenges of establishing comprehensive primary care in rural Rwanda. Hear more about his views below:
Collaborations between health and social care
Improving people’s health will require all kinds of collaborations between healthcare services and other stakeholders, including social care.
Two talks in particular highlighted how this kind of approach can work in practise. Lee Middleton, from the Glasgow Alcohol and Drug Recovery Service, talked about work that her team were doing for people with drug addiction. Hepatitis C is particularly common in this group, but engagement with traditional hospital-based services is chronically low.
To tackle this, her team set up a ‘one-stop-shop’, a clinic which combined opiate substitute therapy with treatment for Hepatitis C. The result was reduced all-cause mortality, as well as reduced drug use amongst service users.
Kathryn Paterson talked about an innovative service she is involved in, called ‘Health and Work Support’, which is being piloted in an area in the east of Scotland. The service is tailored for anyone with a health issue or disability who needs help staying in or getting back into employment. It provides advice and practical support, both to the people referred to the service, as well as businesses who may employ them.
One part of the Quality Improvement aspect of the programme, which Kathryn leads, are workshops where the ‘stakeholders’ in the programme come together in workshops to identify barriers to entry for people, and how they might be overcome. One of these stakeholders is the local Job Centre service, and David Hutchison-McDade gave an overview of the Plan-Do-Study-Act cycles they employed to increase the number of people they were referring to the service.
One key take-home message from both of these projects is that you have to go to where your users are, rather than trying to get them to come to you.
Listen to this interview with Lee, Kathryn, and David to find out more about their work:
It’s easy to think of hospitals as the place where healthcare should happen. However, when healthcare services work with local people and organisations, to meet their needs wherever they are based, there are great opportunities for improving everyone’s wellbeing.