The NHS thrives on co-operation. The pandemic brought healthcare partners together as never before, and in its wake the health service has configured itself into integrated care systems. These take a co-ordinated approach to population needs, so we arrange services around our patients, not organisational boundaries.
Across the country NHS providers are exploring ways of working together in groups of hospitals in order to overcome mutual challenges and deliver better care. There is no blueprint to follow, so we can identify the model that best meets our aim to offer faster access to services, higher quality treatment and improved experience of care.
In north east London, Barts Health began collaborating with Barking, Havering and Redbridge University Hospitals Trust (BHRUT) and both are now working closely with Homerton Healthcare as well.
This builds on the mutual aid that each hospital already offers the others across the patch to help reduce waiting times for routine operations in key surgical specialities, and balance day to day emergency pressures.
The three trusts are seeking to improve quality and access for our patients through collaboration in planned care; urgent and emergency care; critical care; cancer; maternity services; and babies, children and young people.
Each strand of work is led by a hospital chief executive and aims to identify and deliver improvements that will enhance equity, quality and outcomes for our rapidly growing populations.
One early success is extending the 999/111 pre-hospital triage scheme of REACH (the Remote Emergency Access Coordination Hub) from Barts Health to BHRUT.
Through this, hospital consultants give specialist advice to paramedics so people get the most suitable treatment options as quickly as possible. For many this avoids a trip to hospital and a stay in a busy A&E department.
As a result of this scheme, about two-thirds of patients are being redirected away from long waits at A&E to more appropriate and convenient treatment, and we estimate a further 25 people a day won’t need to attend a busy A&E at BHRUT.
Barts Health and BHRUT are also looking for ways for our hospitals to provide the best care and to deliver value for money by avoiding duplication. Getting and keeping the best staff is crucial, so we’re working to reduce reliance on temporary staff and strengthen medical education.
As a new group of seven hospitals we will also align our approaches to leadership development, corporate services, and digital capacity.
Our short-term aim is to help BHRUT to exit financial special measures, while sustaining improvement in both organisations and reducing inequalities for our populations in the long-term.
Our emerging operating model builds on the Barts Health experience of leveraging the benefits of scale while managing effective and efficient services at local level.
The two trusts will remain separate statutory bodies, working together under a chair in common, a group CEO and a deputy. We will take the best of each to improve the other.
We will align our culture and values while retaining the local identity of each hospital. For example, there will be stronger site-based leadership at both Queen’s and King George hospitals.
All seven hospitals will play a significant role within the place-based partnerships of the integrated care system. We will work with borough councils, and local community and voluntary organisations to keep people healthy; to help prevent people from coming into hospital in the first place; and get them home again as soon as possible.
As some of the largest employers in the area, we’ll also work together to provide opportunities for local people to train and work in the NHS.
Across the two trusts we intend to align our approach to quality improvement, too, and agree standard systems, protocols and practices where appropriate.
The two trust boards and two executive teams have agreed to co-design the details of how the new group model will work in practice and might evolve over time.