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Health village on the horizon: a step forward for integration?

Steps are being taken to develop a dedicated health village in Burton. Billed as a ‘landmark development’ is this innovative approach to health, social care and community on one site a step forward for integration?

STRIDE, the strategic estates partnership between Morgan Sindall Investments’ health brand Community Solutions, Arcadis and Burton Hospitals NHS Foundation Trust, has announced that plans for a £55m health village development in Burton have been approved by the Board.

The Burton Hospitals NHS Foundation Trust has signed an option with STRIDE to progress the landmark development on surplus land, called Outwoods, adjacent to its Queen’s Hospital site in Burton.

Although the exact timescales are not set in stone, STRIDE will progress the scheme towards outline planning before the end of 2017.

However, if outline planning is successfully granted in the first quarter of 2018, the team hopes to start construction in the second quarter of 2019. In the meantime, they will be undertaking a programme of public consultations.

Health village plans

The development, which is scheduled to provide GP and community services for about 30,000 patients, also currently includes plans for an extra care development and a step-down facility to mitigate delayed discharges, as well as accommodation for vulnerable adults and a 100+ place nursery to support the growth of intergenerational care in the area.
The health village will also benefit from the inclusion of a community hub, which STRIDE hopes will support greater integration between the different groups supported on the site and the local community.

Peter Cox, Director of STRIDE said, ‘We have outlined what is expected in the main on this site. We have yet to confirm what health services will wrap around the GP practices as this is part of the next phase of our development process. The Queen’s Hospital site provides a full acute hospital service and the Outwoods development will complement this.

‘We are currently looking at innovative ways of funding this development and this will be based on the individual types of development planned as part of the overall scheme. Community Solutions will be responsible for the overall development, which will include putting together the funding packages.’

Drivers for the development

Given that policy is encouraging integration and there is a distinct need for services to reduce delayed transfers of care, Peter explained what they are hoping to achieve with the health village, ‘There are two major drivers that this development meets. By having complementary frontline services, particularly the primary and community care provision, it supports keeping people out of hospital and, in particular, delivering primary care at scale can ensure patients don’t use A&E.

‘In addition, by providing supported living, either through the extra care or the accommodation for adults with learning disabilities, these modern, supportive environments will have an additional impact on this.

‘Developing step-down facilities also ensures that patients can be released in to a more appropriate environment freeing up beds in the hospital.’

Policy direction

The development comes from a number of policy drivers locally and nationally. Burton Hospitals NHS Foundation Trust’s Strategic Plan for 2014 to 2019 says that the Trust intends to ‘evolve with the changing landscape of healthcare and take a lead on delivering innovative approaches to delivering care.’

Added to this, NHS Property and Estates: Why the estate matters for patients, an independent report by Sir Robert Naylor for the Secretary of State for Health, published in March 2017, set out to develop a new NHS estate strategy, one that is fit-for-purpose and presents the opportunity to rebuild NHS infrastructure to meet modern standards of service delivery for the future.

The review also says that, ‘The NHS estate is one of the key enablers to change in the health system and directly contributes to the delivery of high quality healthcare to patients. It is also a significant source of untapped value.’ It could be used to release capital to fund NHS transformation, the Five Year Forward View and Sustainability and Transformation Partnership plans.

Chief Executive of Burton Hospitals NHS Foundation Trust, Helen Scott-South explained more, ‘We have long-recognised the need to ensure services in the community, including GP services, are better integrated into the services we provide at Queen’s.

‘The development proposed, in lieu of a standard housing development, enables a greater focus for the community in providing more seamless care.

‘We are also conscious, as outlined in the Naylor report published earlier in the year, that the NHS has to make better use of its surplus land and we are delighted that our partners in STRIDE have put forward this exciting development.’

STRIDE is supporting the Trust in its strategic plan for the future and is striving to deliver real efficiencies and innovation across all aspects of the Trust’s operations, as part of its journey to deliver an outstanding patient experience, every step of the way. The health village is part of the joint venture’s plans to deliver efficiency savings and infrastructure projects over 10 years.

Peter Cox finished, ‘We are very excited to be working with the Trust to realise the enhanced health outcomes which will be delivered through this development, by drawing on our wider property development skillset as well as our experience in the health sector developing health facilities.’

Over to the experts…

What are your thoughts on this proposed health village to integrate health, social care and community in Burton? Is this an ideal solution to bring together services and the wider community? Is it a solution for surplus NHS land that could be replicated elsewhere? Is there a risk that it’ll lead to segregation of people living on the site? What does the panel think? 

Should champion person-centred care

‘The traditional divide between primary care, community services and hospitals…is increasingly a barrier to the personalised and co-ordinated health services patients need.’

The NHS Five Year Forward View is predicated on moving away from acute hospital services and towards community-based approaches. The NHS has also acknowledged the need to work with social care, the voluntary and community sectors and local communities on an equal basis.

We have evidence of the benefits that can be achieved through better links between health and social care. Amongst the Enhanced Care in Care Homes Vanguards, the project in Nottinghamshire found a 29% reduction in A&E attendances amongst care home residents.
Anything that gives practical expression to the coming together of support around the person, more join-up between health and social care, and greater emphasis on wellbeing, is to be applauded.

But we know that people’s wellbeing isn’t just about the NHS. It’s about meaningful activity, social connection and good housing. Social care can provide all of these. My reservation about the health village is, therefore, if it comes to be seen as centred on the NHS, with a primary purpose of saving the NHS money. For example, Peter Cox notes that, ‘we have yet to confirm what health services will wrap around the GP practices’; and the major drivers include ‘keeping people out of hospital and…ensuring patients don’t use A&E’.

A better way of describing might be to start with the person, and what the development and services wrapped around them can do. The Five Year Forward View champions person-centred care. It would be great if the health village could do the same.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre 

Watch to see how this scheme develops

We need a genuine collaborative approach to new ways to provide care for our vulnerable people. This plan should be welcomed and has the potential to offer a new model that is credible and creative.

There may be some hurdles to overcome prior to a viable plan progressing and providing the choice we might desire for those needing this type of provision. Although, industrial-scale silos of older people may not feel very integrated to some. I’m a strong protagonist of a diverse care market and particularly smaller ‘homely homes for life’ – an option for people to choose to live as an integral part of an ordinary community. My care homes with fewer than 20 residents are exactly this.

Although not made explicit, my impression is that the Burton plan is somewhat reminiscent of the retirement village model that tends not to take account of the reality of decline in health of those with advance, late stage and end stage frailty and/or dementia. Such people, once they need more care, will not be easily supported in these facilities. Idealising provision for those living with multiple complex needs retaining independence, whilst laudable, can be unrealistic for many. Right care, right place, right time and readiness must be considered in a positive and proactive way.

Health villages will be attractive to those able to find, and afford, one. Many will be well-suited to this type of living for a considerable time, but perhaps not lifelong living. The mention of local consultation, I hope, will take account of the need for life-long planning for those who will ultimately need 24/7 care. I will watch to see how this scheme develops.

George Coxon Independent Health and Social Care Consultant 

Has potential to be an innovative approach

Community development has to be a vital aspect of the future of the NHS. It was a policy driver behind the introduction of Sustainability and Transformation Partnerships and it is widely acknowledged that acute services need to be properly integrated with primary care at a local level.

It’s good for people (patients), communities and the NHS. However, for such health services to be truly successful (in other words, efficient, effective and economic), they also need to be aligned to adult social care services, both within local authorities and the independent sector.

There can be little doubt that this proposal has the potential to be an innovative approach to the delivery of local healthcare services. Surplus NHS land is undoubtedly a source of ‘untapped value’ that could help to unlock systems to create change that results in new services and new ways of working. Arguably, it could bring necessary leadership at a local level.

Nevertheless, integration is as much about relationships as structures and systems. It requires many different partnerships in order to work best. Co-operation between hospitals and GPs is a start. Adding specialist supported housing could facilitate models of intermediate care and support.

It would be even better to see the partnership extended to other parts of the health infrastructure such as pharmacists, physiotherapists and occupational therapists, and to the range of adult social care provision. Better still for the partnership to include engagement with local authorities and community groups, including people receiving care and support and their carers. That really would be a ‘game changer’ for me.

Des Kelly OBE Chair, Centre for Policy on Ageing 

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