How we’re evolving our services to deliver better results for patients
Technological advances and research breakthroughs are transforming the way we practise medicine. We’re developing a clinical strategy that reflects the changing needs of our patients as well as the quickly evolving healthcare landscape. Here Dr William Oldfield, deputy medical director and respiratory consultant at Imperial College Healthcare NHS Trust, explains how we want to continue to evolve our services to ensure the latest advances deliver better results for patients.
Our clinical strategy recognises that ’one size fits all’ does not apply in healthcare – that’s why we’re shaping our services to meet the needs of our patients. In some areas, consolidation of expertise is appropriate. In others, developing more services in the community is better. But, in every case, we must step back and understand what our patients need, want and expect from ‘home to home’ – from supporting them to stay healthy, to stepping in and providing treatment when they become unwell, to helping them get back to their normal lives or as close to it as possible.
When consolidation works
Consolidating services – creating fewer, larger, busier services from several smaller services – has proven effective for some aspects of specialist care. Medicine is not like riding a bike – specialists in trauma and acute stroke care must continue to perform their procedures on a regular basis in order to maintain high quality standards. They must also work together in large teams to ensure they can provide their services 24 hours a day, seven days a week – this is much more effective than having services that can only sustain a nine to five, Monday through Friday operation. Finally, there are, and always will be, a finite number of specialists in any given service, so it is important to give them the opportunity to work together in specialist centres where they can audit one another’s work and ensure they all stay at the forefront of their field.
The heart attack centre at Hammersmith Hospital is a fantastic example of the benefits of consolidation where appropriate. In the fourth episode of the second series of Hospital on BBC Two, we see the cardiac team at Hammersmith save a man’s life thanks to their concentration of specialist skills, equipment and resources.
This approach is also effective in major trauma services, such as those provided by St Mary’s Hospital – one of four major trauma centres in London. As Mr Shehan Hettiaratchy explains, treating a high volume of trauma cases in Afghanistan enabled his team to gain the skills to save lives and limbs here at home. By concentrating the skills of trauma teams like his in a few large centres, we ensure that those teams constantly develop and improve. The evidence bears out – research into the impact of the major trauma network found that the odds of a major trauma patient surviving in England were over 60 per cent better in 2014/15 than they were in 2008/09. Likewise, the hyper acute stroke unit at Charing Cross Hospital – one of eight in the capital – concentrates all the skills and equipment required to stop a stroke in its tracks in one location. Since 2010, the introduction of hyper acute stroke units has saved 96 London lives each year.
The quicker you get the right care, the better your chances of a good recovery. So when it comes to life-threatening trauma, stroke or heart attack, it is vital to get to a specialist team. The success of these specialist centres is thanks in part to developing good relationships and standards of practice in collaboration with our partners. In consolidating our specialist cardiology services at Hammersmith Hospital, we worked closely with London Ambulance Service to ensure that their paramedics have the skills and resources to assess people with chest pain. Paramedics can perform ECGs on the spot, interpret them and, if there’s evidence of a heart attack, will take the patient straight to our heart attack centre at Hammersmith Hospital – even if they drive past another hospital on the way.
Planning patient pathways
For care that is more predictable – but no less important – we can and should also carefully plan every step of a patient’s journey. This means considering what happens at the moment a person first notices pain in their hip, for example. What’s the next step they will take? When will they go to their GP for advice? How will the GP decide where to refer them?
We continue this process for every possible step in that journey or pathway, which enables us to plan much more efficiently. Thus, we’re able to ensure patients, GPs, staff and community health professionals all have clear targets and expectations. This helps us to anticipate potential challenges, prevent delays to diagnostics or operations, reduce variations in care and ensure every patient gets what they need when they need it.
In some cases, redesigning the patient pathway can mean redesigning physical spaces. We recently refurbished the Riverside theatres at Charing Cross Hospital thanks to a £1.8m grant from Imperial Health Charity. We’ve introduced a standardised care pathway for all patients who have planned operations at Charing Cross and redesigned the space to accommodate the pathway. You move through the pathway in a certain way in controlled steps so everybody knows each step in the pathway and the patient knows what's coming next.
Developing an integrated care approach
Of course, even the best-laid plans won’t work if there is a break in the chain. We’re working to develop seamless relationships with GPs, community practitioners and social care organisations in our community to develop an integrated approach to care. This means organising care around our individual patients and their needs. Rather than treating aspects of their condition separately, or treating their multiple conditions in isolation, we want to work together to make sure that everyone involved in the care of each individual patient understands what that patient needs at any given time.
We have a number of well-established community pathways in place right now. Connecting Care for Children is one. We have an excellent cardio-respiratory pathway and a great diabetic pathway. The chronic kidney disease shared care pathway is another great example where this joined-up approach is improving outcomes for patients. Accountable care partnerships and systems are starting to develop across the country – where you essentially have one budget that joins up social, primary, community and secondary. They're still in their infancy but there's a lot of promise for providing that seamless care to a local population. Sharing that budget can allow services to operate more efficiently – for example, if the GP does a thorough assessment of his or her patient, the secondary care team in hospital won’t need to perform another assessment, they can move to the next stage in the patient’s care. That’s a great example of how joined-up care can save everyone time and money.
Personalised care
Establishing these more person-centric approaches to care is paving the way for the next revolution in medicine – personalised care. Our Trust is the lead organisation for the West London Genomic Medicine Centre, a recruitment centre for the Government’s 100,000 Genomes Project. We are already starting to personalise care for conditions like breast cancer and lung cancer where we can look at certain molecules on the surface of a cell to work out what sort of treatments you will be best placed to receive. I think we're only scratching the surface at the moment, but we have made a start. Over the next decade or so, it will become the norm.
In the meantime, it is absolutely vital that we all take control of our health. Roughly one in three of us will have cancer in our lifetime. Though we cannot control or change our genes, we can make positive choices – around diet, exercise, limiting alcohol, not smoking – to ensure that if or when we do get cancer, we are in good shape to fight the disease. Even as personalised treatments develop in the next 10 to 20 years, we need to do our best to stay well to ensure the treatments can have the maximum impact.
As medicine continues to evolve it will become more important than ever to have fully joined-up, tailored approaches to care. Now that we’re living longer, often with a whole range of conditions, it is vital that each aspect of our care system – from emergency services to care homes – offers efficient, clear pathways and information to all patients. By taking this approach, I believe we can help you live well and be well.
