Neighbourhood Health and Integrated Health Organisations (IHOs) represent one of the most significant shifts in the future direction of the NHS. The ambition to deliver more joined-up care, strengthen prevention and support people closer to home is one that few would disagree with.
However, listening to recent discussions between NHS leaders, it’s clear that while the ambition is widely shared, there is still a great deal we are learning about how these models should be implemented and, more importantly, how their success should be measured.
A recent episode of Health Service Unpicked, exploring Somerset NHS Foundation Trust’s journey towards becoming an Integrated Health Organisation, offered a refreshingly honest reflection on both the opportunities and the challenges.
The discussion raised important questions around evidence, measurement and sustainability. These are questions every system considering Neighbourhood Health will need to address.
Watch the discussion here: Health Service Unpicked: What Does It Actually Take to Build an IHO? Somerset FT’s Journey
Understanding what success looks like
One of the strongest reflections came from Chair of Somerset NHS Foundation Trust, Rima Makarem, who highlighted the importance of measuring meaningful outcomes rather than simply recording activity.
“We actually need to be measuring the outcome, not just the outputs.”
Across the NHS, innovative models of care are being introduced to better support patients within their communities. However, without understanding the baseline or consistently measuring patient outcomes, it becomes difficult to know which approaches are making the greatest difference.
As Rima went on to explain:
“How do we know which one is working best? How do we know whether we need to stop some models and adopt the one that’s working best?”
These questions are fundamental. If integrated care is to evolve successfully, organisations need to understand not only what they are doing differently, but whether those changes are genuinely improving patient care.
Building the evidence
The discussion also challenged another widely held assumption, that shifting care into neighbourhoods will automatically deliver financial and workforce benefits.
“We’ve got a lot of theory that it would potentially give us lots of savings whilst treating people and keeping them well, but does it actually? …that plays on my mind a lot”
It is important to remember that while the ambition behind Neighbourhood Health is persuasive, evidence must develop alongside implementation.
Understanding what works, where it works and why it works will ultimately allow systems to make more informed decisions about future investment and service redesign.
Greater understanding between Primary and Secondary communities
If some aspects of Neighbourhood Health are still evolving, where should organisations focus their efforts now?
Regardless of how services are organised in the future, patients will continue to move between primary and secondary care every day. Their experience depends not on organisational structures, but on how effectively those services work together.
- Timely discharge information.
- Accessible advice and guidance.
- Clear referral pathways.
- Shared understanding between clinicians.
- Strong professional relationships.
These are the foundations of integrated care, and they are improvements teams can begin making today.
Looking beyond hospital activity
A similar theme emerged during a recent Channel 3 discussion on Neighbourhood Health. Director of Public Health at Hampshire County Council, Simon Bryant reflected on how success is often measured across the NHS.
“We’ve very much focused on reducing acute demand on hospitals.”
Reducing pressure on acute services remains an important objective. However, it should not become the only measure of success.
The benefits of a stronger primary and secondary care interface are often seen elsewhere. Better communication, reduced duplication, more timely clinical decisions, improved professional relationships and a smoother experience for patients may not immediately translate into fewer hospital attendances, but they are essential components of a more integrated system.
Later in the discussion, David Probert, Chief Executive at University College London Hospitals NHS Foundation Trust argued that while organisations may serve different populations, many of the operational challenges are remarkably similar.
“Let’s just get on and do it.”
His message is clear. The NHS already understands many of the behaviours and ways of working that support better collaboration. The challenge is implementing them consistently.
See the full discussion here: Neighbourhood Health From ambition to action
Strengthening the interface is not something we need to wait for
Claire Fuller, underlined this point in conversation with the Norfolk and Suffolk ICB, Training Hub and Xytal:
“To do all of those things [Neighbourhood and Shifts], we’ve got to know each other. The interface between primary and secondary care – we’ve lost it. We’ve had that spread in specialisation…that increase in demand. And now we just don’t know each other any more, and actually, that’s to the detriment of delivering patient care. So that’s why… we’ve got to rebuild it.”
The national conversation around Neighbourhood Health will continue to evolve. New models will emerge, evidence will grow and systems will continue to learn.
Whatever shape Neighbourhood Health takes in the future, strengthening the primary and secondary care interface is not something we need to wait for. It’s practical, evidence informed improvement that can be expanded today, creating stronger relationships, better collaboration and, ultimately, better care for patients.
- Developing leaders who can work confidently across organisational boundaries.
- Creating opportunities for shared improvement.
- Building trusted relationships between clinicians.
- Improving communication between services.
These are practical, affordable interventions that strengthen today’s system while creating the conditions for successful Neighbourhood Health tomorrow.
The future model of integrated care will continue to evolve, but whatever that future looks like, patients will continue to move between primary and secondary care every day.
References:
Channel 3 Neighbourhood Health: From Ambition to Action
