Innovation moves at the speed of trust: Thoughts from a New York visitor

3 OCTOBER 2017

Ryan Ocampo is a Senior Account Manager working with NHSE’s New Care Models Programme. He is our main point of contact to make sure we are on track with our Vanguard programme. Please see below for his blog on a recent visit from Jason Helgerson, Medicaid Director from the New York State’s Department of Health.

Tower Hamlets is a vibrant and diverse community. Half the population is Bangladeshi with a wide mix of nationalities making up the rest of the community.It has some significant challenges, many associated with deprivation. Two out of every five children live in poverty, one in four 10-11 year-olds are obese. Management of long-term conditions, such as diabetes and chronic heart disease (CHD), have been historically poor – and life expectancy one of the lowest in England.

Through the new care models vanguard Tower Hamlets Together, community health services are being reshaped to improve the health and wellbeing of this community.

In September Tower Hamlets was visited by Jason Helgerson, Medicaid Director from the New York State’s Department of Health. Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, elderly adults and people with disabilities.

Jason heard about the work Tower Hamlets Together is doing and wanted to see the results first hand. He was impressed with how they have built strong local relationships that are transforming care, and was clearly interested in their ambitions to push even further and develop an accountable care system.

I was struck by one of his key points about relationships.

“Innovation moves at the speed of trust.”

Jason said challenges faced on both sides of the ‘pond’ are very similar around integration of care. Collaboration is hard, it doesn’t happen overnight – and when there are financial incentives and shared risks if things go wrong, collaboration becomes harder still. Trust is pivotal.

Collaborators need to focus on the needs of the population and make best use of all the assets in the community. Solutions need to come from the ground up with local people solving problems together. We need to help people across the system to ‘get on the same path’ to build trust, using strong business intelligence, and population health data. And we need to help frontline staff adopt evaluation and quality improvement approaches to improve patient care.

Tower Hamlets has come a long way. Health and social care providers and commissioners have a history of emerging alliances before they came together as a multi-specialty community provider vanguard in the new models of care programme over two years ago.

Tracy Cannell of Tower Hamlets GP Care Group (a federation of 36 GP practices), says the vanguard programme gave them an accelerated period of transformation.In a nutshell, community health services across the borough have been remodelled, so that three separate providers of care are now jointly contracted to deliver a set of outcomes for residents.

Working in the new care models programme has given Tower Hamlets the freedom and capacity to develop innovative practices, for example, a virtual kidney disease clinic where a hospital consultant and specialist nurse review and monitor patients’ kidney functions and advise GPs online – all without the patient needing to attend a hospital outpatients appointment.

They have a ‘hospital in a car’ which response teams use to help older people with urgent care needs in their home, keeping patients out of hospital.

Children’s centres offer a one-stop shop for children and their families. Teams across public services look at children’s physical, mental health and well-being, and centres give a space for parents and carers to take on community activities and education.

And the results so far – they have significantly slowed the rise in emergency admissions. Against a national average of 3.3% they have contained growth to 0.3%. The number of non-elective bed days has also consistently fallen and is outperforming other MCP sites! They are the best performers in London for flu immunisations and they have reduced delayed transfers of care by 5% year on year since 2015.

It’s worth adding that Tower Hamlets was once one of the worst performers for managing diabetes and CHD, and is now one of the highest.

Their sights are now set on becoming an accountable care system which will bring their partnership even closer together with the potential to add more services and partners with a stronger focus on prevention.

Richard Fradgley, East London Foundation Trust’s Director of Integration, says the “fluffy” partnership stuff is essential for the harder conversations on governance, accountabilities and risk management.

I could go on; much more was shared with Jason. He agreed with the Tower Hamlets team that there are no ‘magic bullets’ – success relies on the convergence of many solutions into a single culture that is determined to make a positive difference for local people. We were fortunate enough to be joined at the session by colleagues from Stockport an aspirant primary and acute care system (PACS) and Berkshire an emerging accountable care system (ACS). It was striking how similar the challenges and solutions to their respective health care systems were. Each system was so keen to learn about how they approached improvements in primary care, brought partners together to collaborate and how each one would commission for the longer term to make the changes sustainable.

I was left reflecting on Tower Hamlet’s mantra which is: be collaborative, compassionate, inclusive and accountable – for the people and patients of east London it’s working.

For more information contact Ryan Ocampo at r.ocampo@nhs.net