Phil Gusack Talk 2017 at AGM

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Reshaping NHS Infrastructure: Will integrated care centres do the trick?

Dr Patricia Oakley is a woman on a mission. Having qualified originally as a pharmacist and becoming London Chief Pharmacist in the early 1980s she didn’t stop there. She has a masters and a doctorate; teaches and undertakes research at Kings College, London and is a Director at Practice Makes Perfect. She splits her time between London and the West Country.

On talking about building the case for change Pat told us that she talks from experience having been involved in policy making for integrated care centres. More usually she works every summer building forecasting models of the clinical workforce and particularly doctors, dentists and pharmacists in order to inform the Joint Investment group of the student numbers they need to admit to support the future workforce. These models look forward 20 years which is the time it takes for a student to become fully effective in the workforce.

At this point Pat became deliciously political, telling us how the UK only spends 6.5% of GDP on healthcare compared to France and Germany at 8-9% and the Swiss at 10%. Tony Blair moved spending on health from 5% to 10% which should be viewed as one of his most significant achievements. However it hasn’t been sustained at that level. The state also knows it requires a capital programme of £120b for healthcare.

Pat continued that the current NHS was designed for a life expectancy that was surpassed years ago. It has almost been too successful. Life expectancy and health into later life means we need a new asset class. This does not mean a return to the community hospital model (many of which were closed down but not knocked down). What is required is a care centre model creating places for care and for work.

80% of the budget within the next 30 years will be spent on care of the elderly who are physically well, socially engaged and psychologically content. These are the baby boomers who are healthier, wealthier and stealthier! It is the paradigm of chronic disease.

So, we need to think about the Mind the Gap programme that seeks to integrate mental health to close the 20 year life expectancy gap. We need to think about new science – therapeutics, genetics and molecular imaging.

Barnett et al writing in the Lancet in 2012 cited that ‘exercise is the miracle cure’. This means we must think about urban design and social space (and ban sofas!)

All this thinking is leading us to new design principles and new services such as ‘doc in a box’ and single people campuses / co-operatives. The GP practice is a ‘busted flush’ based on a 1911 model which no longer works.

So, what is the ‘place in the middle’?

This model is about placing social care; hospice and hospital at home; pharmacy and medicine; GP and community nursing and therapy on the high street. Hyper centres (the word hospital should be banned) then become about trauma; cancer; cardiac and stroke care; urgent care; maternity and neonates and mental health.

Some of this is happening already. The Nelson Centre in Wimbledon provides local care including a therapy theme park; genomics; outpatients; pharmacy; diagnostics; social space and GP adjacent to a retirement village. The model exists more widely in Denmark and the Netherlands.

Northumbria also has a pilot site.

This is about a crucible of change, happening at the centre of the community; a shared place for many professionals and new ways of working. It should become a focal point for new investment.

Pat finished by telling us we need fewer beds and fewer doctors but to deliver what is actually needed needs the construction of a persuasive, informed narrative which currently doesn’t exist.

Chris Shaw thanked Pat and said members were thoroughly engaged in this provocative and no holds barred talk. It was agreed that her passion for her subject and her knowledge of future policy requirements coupled with a style that takes no prisoners was entirely fitting for the Phil Gusack Talk 2017.


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