Leveraging partnerships to serve the cause of prevention

When a senior charity leader took to the stage at the 2017 HSJ Commissioning Summit, it was an opportunity to speak with pride about the partnerships between the organisation and the NHS. Delegates heard how third sector support was helping ease transitions between hospital and home, reducing readmissions, and preventing situations from escalating in seriousness.

Nipping problems in the bud

The leader explained how the charity now works with the NHS on well over 100 services and projects. It is an approach embedded in the idea of nipping problems in the bud; getting in early before an individual becomes sicker and costs escalate. In other words, exactly the sort of approach the health and care system has long been espousing.

Yet for this individual, prevention hadn’t yet “won the argument”. “I think we [as a system] have yet to make the really powerful case for prevention. I think people are still sceptical and, therefore, find it difficult to carve out the backing and support for it in a highly pressurised environment.”

It is a contention with which Mike Wallace firmly agrees. As strategic affairs director at Nutricia Advanced Medical Nutrition, Mr Wallace spends much of his time talking about the importance of prevention – including as one of the speakers at the Commissioning Summit.

In 2011, NICE concluded that the identification and treatment of malnutrition had the third highest potential to deliver cost savings in healthcare

He told delegates there was no doubt that addressing malnutrition would offer cost savings to their organisations. Back in 2011, the National Institute for Health and Care Excellence actually concluded that the identification and treatment of malnutrition had the third highest potential to deliver cost savings in healthcare.

“Where we have guidance which can unequivocally save costs, then the NHS’s ability to respond to that and enact that guidance is very important,” he argued.

“Somebody who’s malnourished is going to cost the NHS £5,000 more a year to manage than somebody who’s not. So, if you can actually grasp it properly, then you can actually save money.”

So, just how can the NHS grasp prevention properly?

Importance of integration

It will come as little surprise that many Summit speakers pointed to the importance of integration. Nor will it be surprising that when the conversation headed in this direction, it was not long before someone mentioned Manchester.

With the grand DevoManc plan starting to turn into action – earlier this year, a single commissioning body across health and social care became officially established – that was entirely to be expected.

But to expect that it’s only councils across Greater Manchester that are focused on closer working with the NHS would be a mistake, argued senior representatives from the sector.

“Most council chief executives are now spending the majority of their time working on issues to do with health and social care,” said one. “And if you wind the clock back a decade, it would be a tiny proportion.”

“Most council chief executives are now spending the majority of their time working on issues to do with health and social care”

“There isn’t a chief executive in local government in the country who isn’t struggling with wanting to get wellbeing writ large across all of our population,” added another. “They need engagement with the NHS.”

They aren’t the only ones, representatives from the third sector and from industry argued. Mr Wallace reported that Nutricia Advanced Medical Nutrition has employed a team of 130 nurses who can care for patients with nutritional needs at home.

“That allows people to be discharged from hospital who have a need for nasogastric tubes or tube feeding. That’s a partnership which we as a company forged with the NHS, to deliver that quality of care.”

But he was concerned about the number of healthcare leaders who may not be fully familiar with the issue of nutrition.

“One in four people turning up to a hospital is malnourished, and that’s a fact which isn’t often accepted or known. We’ve done some recent analysis which shows through Hospital Episode Statistics that there are 20 CCGs in the country that don’t even record malnutrition. So there’s the issue of is the health service aware of this.”

Explain the offer

For the third sector leader, it was incumbent on the healthcare sector to be curious about what potential partners could offer – but incumbent on potential partners to clearly explain that offer.

“We have to acknowledge the voluntary and community sector can look quite complicated to you. I think we have to, therefore, present ourselves to you much more cohesively around what we can offer, with clear business cases that play to the issues that are on your minds.

“If you’re being pressed on efficiency and wellbeing, then that’s the language we should be using as we present some of the things we do, to make you curious about how we can help.”

It was incumbent on the healthcare sector to be curious about what potential partners could offer – but incumbent on potential partners to clearly explain that offer

The leader concluded: “I think we’ve got to make it easier for you to interact with us, but you’ve also got to be curious about doing so, and about those things that might make great outcomes possible.”

It was a statement that was made in reference to the third sector, but one with which industry and local authority representatives seemed likely to agree.