A metaphor I often refer to in talks is the concept of lego brick resilience, particularly in the context of health systems, but what exactly do I mean by this?
Health systems are complex. They contain a myriad of actors interwoven into a multidisciplinary web of patient pathways.
In a basic sense of building blocks, we can consider these as pre-hospital, primary, secondary, tertiary, and community healthcare services.
Primary healthcare forms the cornerstone, focusing on preventive care and basic treatments managed by general practitioners, pharmacists, dentists, optometrists, and other specialist clinicians. It addresses routine check-ups, vaccinations, and chronic disease management.
Secondary healthcare provides specialised medical services requiring advanced expertise and equipment. Specialists such as cardiologists and surgeons offer diagnostic procedures, surgeries, and treatment for acute conditions, often in hospitals or specialized clinics. Seconday care provides our point-of-entry for emergency care at the hospital.
Tertiary healthcare offers highly specialised medical care for complex and rare conditions, requiring advanced technology and expertise in areas like organ transplants and intensive care. It operates in large medical centers or hospitals, involving multidisciplinary teams.
Community healthcare focuses on delivering care closer to where people live, promoting health and well-being, and managing long-term conditions effectively. This includes services such as community nursing, health visiting, physiotherapy, mental health support, and many others. Community healthcare aims to prevent illness, support early intervention, and provide ongoing care to improve quality of life. It plays a vital role in keeping people healthy, reducing hospital admissions, and ensuring that healthcare services are accessible and responsive to local needs.
Pre-hospital healthcare refers to medical care provided to patients before they reach a hospital or healthcare facility. It is typically administered by emergency medical services/ ambulance serivces, including paramedics, technicians and other emergency care clinicians.
From a patient experience perspective, it is essential that these services collaborate closely to deliver the best possible outcomes and quality of care. For example, effective communication and referral systems facilitate seamless transitions between these levels, ensuring patients receive timely and appropriate care across the healthcare continuum.
One could continue to build upon this to reflect the many other parts of the healthcare systems that are components of the above sectors. Furthermore, the fundamental delivery of healthecare is predicated upon a functioning social care system - itself incredibly complex.
So what does this mean for resilience?
Just as the delivery of seamless patient pathways relies on integrating these foundational elements, building a resilient healthcare system demands the same integrated approach.
Imagine a city with the most prepared ambulance service nationwide, yet it may struggle to handle disaster care if its acute hospitals lack the capacity to treat patients effectively. Moreover, after patients are medically fit for discharge, the readiness of community-based services becomes crucial, especially non-physical health services like mental health and psychosocial care, which are pivotal in disaster response and long-term recovery.
However, the mere existence of these components is not enough; they must seamlessly connect and interact. Think of it like assembling LEGO bricks — the connections must be strong, and the blocks must be interoperable to ensure the stability of the entire structure.
Without this stability, you have isolated components rather than a resilient system designed to withstand such challenges and provide the care that is needed to its dependent population.
In the context of the modern English NHS, ensuring interoperability among these building blocks falls under the purview of Integrated Care Boards (ICBs). These boards play a critical role in convening, facilitating, coordinating, and assuring that healthcare services work together effectively. They hold Civil Contingencies Act 2004 category 1 responder status, and are the de-facto leaders of NHS system preparedness locally. However, since their inception, challenges have arisen due to significant pressures to reduce costs (20-30% running cost reductions), excacerbated by cuts to NHS England's central support (30-40% staff reductions) and local ICB capacities, which complicates their ability to deliver integrated care efficiently.
Let us also not forget that change can be a significant distraction from focusing on delivery.
As a new government takes office in Westminster, the focus should be on how to empower and support the 42 healthcare systems across England to enhance their resilience. This entails fostering collaboration, investing in interoperable systems, and ensuring that resources are allocated wisely to strengthen the healthcare infrastructure for future challenges.
That is, assuming that the model of 42 healthcare systems is here to stay... we can only watch this space.
References
Community Health Services explained (2024) The King’s Fund. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/community-health-services-explained (Accessed: 07 July 2024).
The healthcare ecosystem (2022) NHS Digital. Available at: https://digital.nhs.uk/developer/guides-and-documentation/introduction-to-healthcare-technology/the-healthcare-ecosystem (Accessed: 07 July 2024).
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