Wednesday 12 June 2013

NHS Charities; sleeping giants or agents of change?

I'm giving the keynote address at the annual meeting of NHS charities today at the Royal Free hospital in London. Chris Burghes is the Royal Free charity CEO and is acting as host. He is also an active ACEVO member and asked me to make a provocative contribution! 

So here is what I'm saying.

“The NHS needs to change in order to meet the health and care needs of today’s population. How can NHS charities promote that change?

What are the key problems?
·         The majority of people in hospital beds are elderly,
·         Long term conditions take three quarters of the NHS budget
·         Resources are stretched and will not meet growing health needs

Do NHS charities have a role to play in arguing for change?  Or are they simply happy to be passive recipients of funding demands from their hospitals?

When NHS charities have an asset base of 2.2 billion this is a sleeping giant that needs to wake up. You have a duty as a charity to use your funds for impact, and to ensure that any responsible investment and engagement is, where possible, aligned to your interests. For NHS Charities,  that could be the challenging areas of Public Health – alcohol abuse, obesity and its related diseases: diabetes, heart disease.

 One example of what fund managers can achieve is illustrated by CCLA - In a recent survey of its clients, they found that 80% of its charities were concerned about alcohol, so they invited charity investors (ranging from health and police charities, to Church of England and national youth charities) to work with them to design a minimum standards framework to reduce corporate complicity in alcohol abuse, resulting in companies changing their policies and removing some products from shelf. Results will be published in 2014.

 CCLA are currently designing a further public health engagement program – addressing obesity and nutrition issues within the food and beverage sector. They will be using the new Access to Nutrition Index and full details and discussions will be had on Wed 26thJune at the Access to Nutrition Index investor seminar, run by UKSIF (UK Sustainable Investment and Finance).
Maybe NHS Charities need to ask more from their fund managers and fund managers need to change their engagement practices to suit. 

And remember that you are not simply finance institutions sitting on your endowments looking for the best place to invest. You must recapture the charity tradition of advocacy and campaigning; using your funds for better health outcomes for citizens and communities; not a cash cow for the next piece of medical kit. Not that that’s not important. It is. But do you demand enough in return for your investment? When Thomas Guy left his fortune to found a hospital he wanted to better the situation of the poor and ill of a deeply deprived London borough. He understood that hospitals were not simply about operations but needed to provide care and support to the most vulnerable. Shall we regain that charitable instinct?

How can you help move the NHS and its hospitals towards integrated, preventative services that reduce pressure on acute services?  Free them up for the crucial work hospitals do in treating serious illness and breaking the boundaries of knowable science. 

Our country's great charities and social enterprises have the skills , knowledge and innovation to drive real change in how the NHS treats and supports citizens. Without a more active engagement by hospitals with charities we can't meet the growing demand on hospital beds and services. Just look at the A&E crisis. Some quarter of all those presenting are over 65. And it is those patients who often have the poor treatment and care. So tackling this problem by using the sector makes eminent sense.
We must face up to the fact that, unless it undergoes fundamental change, the NHS will not be up to the challenge of meeting the health and care needs of the population. The recent publicity around the Macmillan Cancer report which shows soon half the UK population will face cancer in their lifetimes demonstrates that it’s time to act, not talk. 

The reality of an ageing population presents therefore presents great challenges for NHS services. Life expectancy in the UK is forecast to reach 83 years for men and 86 years for women by the year 2031. In the period to 2031, the proportion of 65-84 year olds and over-85s in the UK are set to increase by 39 and 106 per cent respectively.

An increase in life expectancy is good news, of course. But it does put more pressure on health and care services, particularly around long-term conditions. It is estimated that the number of people requiring formal long-term care services will increase by over 1 million by 2025- a 37% increase.
Conditions such as diabetes and asthma will take up an ever-increasing proportion of the NHS’ budget; Diabetes UK has estimated that, if current trends continue, annual spending on diabetes in the UK will increase from £9.8 billion to £16.9 billion over the next 25 years, meaning that the NHS would be spending 17% of its entire budget on the condition.

And unlike in times gone by, the NHS must no longer expect regular, substantial budget increases to help meet this extra demand. Central government spending will remain restricted for the foreseeable future. Consequently there is no alternative but to do things very differently if we are to meet this demand with the resources we have available.

I'm not sure the NHS has grasped this essential fact. So NHS charities have a role to play in pushing for change. 

The NHS must grow and develop services which meet the population’s health needs in a way that promotes both financial sustainability and better outcomes and experiences for service users. To do so it must move away from the traditional, reactive model of treatment, provided in predominantly clinical settings. How much of your spend from your endowments is here?  What do you spend in prevention or community care?  Time to review this. We must focus on developing preventative, integrated services that treat people in the community or at home where possible; that address the underlying causes of poor health and wellbeing, including social determinants of health, before matters reach a critical stage; that support better self-management of long-term conditions; and that give patients real choice and control over their own pathways of care.
In order to meet the health and care needs of the 21stcentury, service users need strong, integrated pathways of whole-person care that is wrapped around the more traditional interventions by medical staff

There is scope for significantly alleviating the pressure on acute services by providing more intelligent and responsive care and support at an earlier stage.
For example, a recent King’s Fund report suggests that7000 fewer emergency hospital beds would be needed by the NHS if all areas of England achieved the rate of admission and average length of stay for over 65s as those with the lowest use, saving almost £500 million a year. But this can be bettered. 

How can you help achieve that change?
How can this change be achieved? Undoubtedly, charities and social enterprises have a central role to play and NHS charities could enable us to expand our work.
For many years voluntary organisations have led the way in developing the kinds of services we need-innovative, holistic services which provide people with the support they need to stay well, healthy and out of hospital.

For example, the British Red Cross provides wonderful support to help older people re-adjust to life at home after a spell in hospital. After a hospital admission resulting from a fall, volunteers transport the patient home, settle them in, advise neighbours or relatives of their return, help prepare a meal and make a further home visit the next day to ensure they are safe and well. Simple steps such as this not only make a huge difference to the quality of the patient’s experience of care- they also have a very significant impact on rates of readmission, leading to real financial savings. They also provide professional volunteers in some casualty departments to work with staff in helping frail elderly admissions. Why is this not being used more? This is the kind of approach that NHS commissioners all over the country should be embracing. They have yet to do so.
NESTA’s recent People Powered Health project helped to demonstrate the value of interventions that empower service users to improve their health and wellbeing, such as peer support networks, expert patient programmes, social prescribing and time-banking.

Analysis of the project suggests that the NHS in England could realise savings of over £4 billion a year by improving the support and choice available to patients around the management of long term health conditions, based on an estimated 7% reduction in A&E attendance, planned and unplanned admissions, and outpatient admissions.

The NHS needs to face up to reality. When demographic change means bigger numbers of the elderly needing health and social care, why do we not commission third sector organisations that prevent unnecessary admissions to hospital ? When we know that the vast proportion of the health budget is spent on long term conditions why do we not commission the very organisations that provide the support and advice needed to manage conditions outside hospital? Why do we not spend more on preventing ill-health?  

Our society has changed enormously since 1948, but our approach to healthcare delivery has not. Before then the 1000 charity hospitals, some of  the greatest names in the NHS , provided excellent care. We have forgotten the role charities could play in hospitals. . Not just the volunteers selling the newspapers. Hospice in hospital schemes . Intermediate care facilities run by charities in the hospital. Advisory services at A&E. volunteers on the elderly wards working with the nursing staff to provide that essential key to recovery; love, care and attention. Charities working with consultants on their ward rounds of their elderly patients, linking with their home and community. Expanding schemes like that of the Red Cross so they are common in every hospital. Using the alcohol and drugs charities to identify people at risk when they present at casualty. 

So my message to NHS charities is be agents of change. The "agent provocateurs" of the NHS. When you get the next request for funding of a new facility or programme from your beloved consultants, ask them what they are doing to link with community and prevention services locally.”

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