1/14 Brilliant visit to @SurreyDownsHC, part of @SurreyHeartland ICS today. Very impressed with the excellent progress they have made in actually integrating services on the ground, delivering better care and improving outcomes. Thread below with what particularly impressed me.
2/14 Impressed with the way that the @SurreyDownsHC’s vision for integration starts with concrete action to improve services. Of course governance, finances and structures are important. But they start with a data driven understanding of the needs of their population…
3/14 …And they then put the relevant professionals together to work out how they can improve the relevant service or pathway. Strong emphasis on enabling right collaborative relationships between different people from different disciplines and organisation to drive improvement.
4/14 Key elements of pathway improvement include having the right people in room; strong emphasis on co-design including patient and carer input; data driven approach to “is it improving outcomes” and then using PDSA methodology to assess if adequate progress is being made.
5/14 Impressed with the way that @SurreyDownsHC has primary care & GPs at the heart of their leadership approach. Lots of people talk this talk but this really feels like genuine equality. Strong view that investing in primary care leadership training has been a key driver here.
6/14 Very impressive innovative approach to community service delivery @SurreyDownsHC. Joint venture with primary care, trusts and social care as joint and equal partners. Then delegate budget and responsibility to Primary Care Network Hubs who are empowered and accountable…
7/14 ….With hubs led by a quadrumvirate of a Clinical Director, GP lead, community nurse lead and operations manager. Great way to join up community services & primary care and empower hub to shape service to meet local need. But also clear where accountability lies - with hub.
8/14 Impressed with how “put right people in room to co-design an improved pathway” @SurreyDownsHC has led to new integrated post covid recovery service created at real pace. Brings together GPs, community services, consultants (eg respiratory & chronic fatigue), mental health…
9/14 …into a highly effective single service. Strong emphasis on the different elements of care required being joined up and treated holistically and the patient having their care co-ordinated for them. Very positive early outcomes but big demand - 100 to 120 referrals a week.
10/14 Great to see genuine and full partnership in @SurreyDownsHC between the NHS and @SurreyCouncil in their whole system frailty model. Not just enabling effective rapid hospital discharge and post discharge care provision from a single, joined up, co-located, hub but….
11/14 …a proactive service in which any patient with a raised frailty score can be referred in for a multi disciplinary team review of need, driven by the question “what matters most to this patient and what do they need?” Data driven whole population health in action.
12/14 Striking how busy it currently is across the ICS. A&E attendances up by 20% vs normal. GP demand up by 20% vs normal with number of face to face appointments same as pre-covid. Ambulance service under very significant pressure. Vaccination campaigns at full pelt…
13/14 …Worries about current high rate of staff leaving with strong competition from hospitality and retail. Concerning anecdote about strong social care provider ready and keen to expand pre-covid now having to hand back domiciliary care contracts due to lack of staff.
14/x Thanks to the wonderful @clairefuller17, new ICS Chair Designate Ian Smith and the whole @SurreyDownsHC team for a great visit. It’s good to talk, see and be really inspired!

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More from @ChrisCEOHopson

1 Nov
1/5 Thanks for everyone's responses to my thread / your contributions to this important debate. They show how complex this issue is and how there are strong views here, understandably. Three quick thoughts in response to some of the comments that have been made.
2/5 A. The patient perspective is, of course, vital. There will be many patients who will feel very strongly that they have a right to be treated by staff who have been vaccinated. Equally, there are some staff who feel very strongly it is their right not to be vaccinated...
3/5 ...One of the complexities here is that there is a potential conflict between people who believe, equally strongly, that their fundamental rights are at stake and should not be breached. B. Thinking further about the patient perspective and the NHS looking after patients...
Read 5 tweets
1 Nov
1/13 Possible Government will announce approach on mandatory NHS staff vaccination this week. Consultation has now closed. A complex issue. Tweet thread follows, based on conversations with, and intelligence from, trust leaders. There are differing views in trust sector…
2/13 Our intelligence suggests c2/3 of senior trust leaders - hospitals, mental health, community & ambulance - favour mandation & 1/3 don't. Everyone agrees there are two risks to manage here, not one. Not just the risk of covid/flu cross infection from unvaccinated NHS staff….
3/13 …It’s also about managing the risk of losing unvaccinated staff when the NHS is at full stretch and carrying 93,000 vacancies. The issues currently facing social care providers illustrate the very significant scale of risk to care / patient safety if we get this wrong.
Read 13 tweets
2 Sep
1/19 Media reports suggest Govt now finalising health & care part of spending review and we're heading for a potential £5 billion NHS funding gap next year. We've issued a new report today with @NHSConfed showing why frontline NHS needs £10bn extra next year. New thread follows.
2/19 Bit of background context first. The NHS budget for five years, including next year and the year after, was set in June 2018, before covid. Over the last two years the Government has suspended those plans and given the NHS the extra money it needed to deal with covid…
3/19 ...Last year NHS received £18bn extra on top of original plan. In 1st half of this year NHS received an extra £7bn with more to come for 2nd half of year. According to Monday's Times (thetimes.co.uk/article/nhs-bo…) Govt now wants to return to pre-covid budget plan next year...
Read 19 tweets
12 Aug
1/10 Important new joint report with @AACE_org on ambulance services released today.

Report: nhsproviders.org/media/691897/r…

Blog by @daren_mochrie & me here: hsj.co.uk/quality-and-pe…

News story by ever wonderful @AliJaneMoore here: hsj.co.uk/service-design…

Quick ( 🤣) thread follows.
2/10 It’s a very good time to talk about ambulance services given the unprecedented pressure they have been under for the last two months. This is a clear warning sign that we have to address the underlying demand / capacity mismatch ambulance services face. Risks increasing..
3/10 ...Growing risk of ambulance staff burnout given constant pressure. And growing risk of harm to patients because, despite best efforts of frontline staff, demand/capacity mismatch means ambulance services can't always provide quality/speed of care they want & need to.
Read 10 tweets
11 Aug
1/12 NHS monthly stats due out tomorrow. Although the number of covid hospital cases is significantly lower than many were predicting/fearing, the NHS is still under huge pressure due to a combination of six factors. Stats will show this tomorrow. Shorter thread (🤣) follows!
2/12 Particularly important to understand that every part of NHS is under pressure. Hospitals, ambulance, community & mental health services and general practice / primary care. Many CEOs saying that although the shape of the pressure is different, it feels as busy as Jan/Feb…
3/12 …Striking that some CEOs are saying that their trust is under the highest pressure they have ever known. Don’t measure overall NHS pressure by looking at covid-19 caseload. Vital to look at all demand and capacity pressures, particularly the latter at the moment.
Read 12 tweets
8 Aug
1/23 Health and care funding now centre stage as Govt sets 2nd half 2021/22 & longer term Spending Review settlements. Great article by @michaelsavage & @denis_campbell here: theguardian.com/society/2021/a…. My accompanying comment piece here: theguardian.com/society/2021/a…. Thread follows.
2/23 Health & care budget central to spending review, given the size of spend, so strong case to settle early. NHS budget for second half of 2021/22 must be set by end September. Increasingly likely this could be a single NHS money discussion, concluded relatively rapidly.
3/23 Decisions made here, over next two months, likely to set health and care funding for next three years. They will impact the health of our nation for a generation. So they’re very important to get right. They could also have a significant impact on the next General Election!
Read 23 tweets

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