Readers' letters - 6 December 2012

Heading down revolutionary road

The ability to capture and, crucially, share information across all facets of the patient pathway is a fundamental requirement that underpins any aspiration to forge a sustainable model of integrated care. Jeremy Hunt’s statement that “we need the kind of common sense that begins to knit local IT systems together” is testament to the fact that in reality, positive cultural changes within the NHS are as much of an enabler of change as a “technology revolution”.

There are positive signs that these changes are starting to take place.

‘Undoubtedly, technology must play a key role in the delivery of care where quality is higher, mistakes fewer and costs lower’

Only 12 months ago, it was practically impossible to track patients as they moved from one part of the NHS organisation to another. In recent months, we have seen examples of greater connectivity that are starting to transform this dated model.

The Royal Marsden’s Coordinate My Care service, which has now been commissioned by NHS London to extend across all 31 primary care trusts in the capital, is one such example where an electronic end of life care register has been fully integrated with primary, community and social care providers.

Other examples of integrated care are also live at Barnsley council, where patients’ social care records are linked in real time to NHS records. In both cases, technology and communication are driving a more efficient and effective delivery of care for patients that sits at the heart of the revolution of the NHS.

Mr Hunt’s call for a technology revolution, supported by a common sense approach to care provision, is a welcome one. Undoubtedly, technology must play a key role in the delivery of care where quality is higher, mistakes are fewer and costs are lower. The most effective solutions will be those designed to suit innovative pathways of care as they emerge.

In a clinically led, patient-centric health service, technology can help drive improvements in quality, increase patient safety and enhance patient outcomes. In the spirit of meeting QIPP targets, it can help the NHS become more efficient in the process.

Professor Michael Thick, vice president, clinical strategy and governance at McKesson UK

NHS better placed for continuity of care

I read the HSJ mental health supplement, ‘Collect my thoughts’, with a mixture of interest and incredulity.

While agreeing with parts of Philip Sugarman and Joy Chamberlain’s views that integrated secure services that move people down the levels of security are both safer and more efficient, I cannot agree that the independent sector that provides just one small part of the total service is best placed to provide this integrated care, or to become prime contractors.

Both St Andrew’s Healthcare and Partnerships In Care have massively grown over the last 20 years by generating a market for medium and low secure beds. While not questioning the quality of their services, I would question the supposition that this has been a cost saving for the NHS. There is little doubt that the expansion has been because of a closure of mental health beds and the failure by NHS commissioners to recognise the need for secure beds and discourage local NHS development.

‘Many independent providers of secure mental health services offer services they are not staffed to provide’

However, there is no evidence to support Professor Sugarman’s assertion that the lengths of stay are shorter in the independent sector. What evidence there is − and there is quite a lot − would suggest the opposite: that independent sector providers actually prolong lengths of stay at inappropriate levels of security. It is of course in their interest to do so and is hard for commissioners to ensure people move on to lower levels of security at the right point when the clinicians in the services can use the mantras of “need for security” and “minimising risk” to ensure people don’t move on.

The reality is that many independent providers of secure mental health services offer services that they are not staffed to provide, causing delays in people’s treatment. They also do not provide the community services necessary for ensuring people’s recovery journey is moved back to their home areas and to a normalised way of life.

Almost all NHS providers of secure care are part of much larger integrated health and social care organisations. My own trust, Nottinghamshire Healthcare, is the only UK organisation providing every level of care for people requiring secure care.

The trust provides services from high security (Rampton Hospital) through medium and low security, to locked and open rehabilitation, step down, hostel provision (with third sector partners) and, most importantly, community services supporting people in their journey back to their home environment. The trust also provides integrated health services to 11 prisons across the East Midlands and Yorkshire. We are therefore in a unique position to cater for men and women from prison back to the high street.

We integrate closely with our local services colleagues reintegrating people as soon as possible back into community mental health services. There are also no negative incentives to keep people in a higher level of security a moment longer than needed. The trust is a major player in training and research, being an equal partner with Nottingham University in the Institute of Mental Health and the Personality Disorder Institute, which are national leaders in the fields of mental health and forensic mental health.

While my trust is the largest and most comprehensive NHS provider, the vast majority of NHS providers are, because of the integration of secure services into a wider mental health and learning disability service, in a much better place than our very specialised independent sector competitors to provide the continuity of care to speed people along on their recovery journey.

Dr Mike Harris, consultant forensic psychiatrist and executive director of forensic services at Nottinghamshire Healthcare Trust. Former medical director and deputy chief executive at St Andrew’s Healthcare