Access to primary and community health care (Supplementary) [2]

Session date: 
June 18, 2014
Question By: 
Joanne McCartney
Labour Group
Asked Of: 
Lord Darzi (Chair, London Health Commission) & Simon Weldon (Regional Director of Operations Delivery, NHS England (London))


Joanne McCartney AM:  I was just going to pick up on something you said earlier, that when we are changing any aspect of the health system it is essential that we build the trust and confidence of the public and patients.  We have all been out supporting our local hospitals that are at risk of closure, and it is very emotive when you talk about changing healthcare provision.  I know from my experience of ChaseFarm, for example, that one of the requirements of the Independent Reconfiguration Panel was that primary care and access to primary and community care had to be dramatically improved before the A&E services went.  As far as the public in Enfield are concerned, the A&E was taken away before those promises had actually been kept.  We would say that that community healthcare is not good enough even now.


Can I just add, given that - I can see some of you nodding at that - is there a case for actually having a programme of upfront investment in primary and community care before you take away A&E and other services?  It seems to me only that way will you actually convince the public that the alternative provision is actually there in the first place.


Answer for Access to primary and community health care (Supplementary) [2]

Answer for Access to primary and community health care (Supplementary) [2]

Answered By: 
Lord Darzi (Chair, London Health Commission) & Simon Weldon (Regional Director of Operations Delivery, NHS England (London))

Professor the Lord Darzi (Chair, London Health Commission):  I may ask Simon to talk about Chase Farm because I do not really know the details.  Even forgetting about reconfiguration of services, we need a significant investment in primary care.  It is nothing to do with changes of services.  It is to do with what I said earlier.  Two-thirds of our primary care estate is not fit for purpose and we need to do something about that.  If we have an aspiration, based on the aspiration of our patients in whom we are spending £3.6 billion for near enough one million people with long-term conditions, they are asking us, “I want longer consultation.  I want it in primary care.  I want the care integrated around me.  I would like to see the same GP as much as possible”.  To do that we have to invest in primary care, both capital and recurrent.  That is the model of care that is emerging from here.  That is irrespective of the hospitals and the services provided around us.


Simon Weldon (Regional Director of Operations and Delivery, NHS England (London)):  I would just agree with what has just been said.  I will give you the example, let me just say, about north west London. 


The slide on segmentation is not something that people sat in a darkened room and invented by themselves.  It was actively by engaging with patients and saying, “What do you find good or bad about your GP services at the moment?  What do you want to see changed?”  Broadly speaking, they said three things.  One was that they wanted care that was more appropriate to their needs.  They wanted to be able to access that care when they wanted to, as opposed to having to ring up first thing in the morning and sit in a long queue.  They wanted to be able to have appointments that were longer than ten minutes, so that they could properly talk about their healthcare needs.  To do that, as Lord Darzi has said, we need to make investment and we need to demonstrate to the members of the public, to patients, right across London, that those services are making a difference and can offer them the healthcare that they need.  It is only that way that you build the confidence you are talking about.


Joanne McCartney AM:  You are right.  If you can do that, it then means that changes, for example, to hospitals become a lot easier because people can see that there is good provision.  Can I just ask you where that investment is going to come from?  Are you confident it will be there?


Simon Weldon (Regional Director of Operations and Delivery, NHS England (London)):  We have to make a case both for more investment as Lord Darzi has said, and look again at how we fund services in London. 


There is no denying that the financial settlement that we face in the health service is going to remain tight.  There is also evidence that we can make better use of the resources that we have got.  We have given an example just now about the estate, how under-utilised the estate is, and how if we made better use of that, that would enable us to provide better services to people more locally. 


As we change the burden of care, as we build services outside of hospitals, we believe that we can release some of the money that has been currently invested in acute care to support the development of better primary care services.


Joanne McCartney AM:  Can I move on as well to the Better Care Fund?  It is not new money; it is just a reworking of old money both from CCGs and local authorities.  The Better Care Fund was delayed because a Whitehall review said there was serious concern at arrangements merely to protect protracted battles between local authorities and the CCGs in order to protect their respective services.


Lord Darzi, you said earlier that in north west London it seems to be working quite well and there is lots of collaboration.  Are you seeing that across London or are there areas where there does seem to be some retrenchment and resistance to the pooling for the benefit?


Professor the Lord Darzi (Chair, London Health Commission):  No to the latter question.  In fact I would say that local partners have come together absolutely in the spirit of the endeavour.  I think we showed you a slide that said the future of planning has to be between partners.  The Better Care Fund is a key tool to enable that to happen. 


The point that you make is how do we make sure that we actually see the benefits flow into the system so we do not end up paying for the same thing twice?  The challenge that we have got to work with local partners to make sure they are in a position to deliver, is when they say they want to put in place a Better Care Fund scheme that is going to save admissions or reduce delayed transfers of care or prevent admissions to hospital, it will actually result in savings to the system.  That is the challenge that we face. 


In terms of the spirit in which local partners have entered into that endeavour, no, all I have observed is that people have been absolutely willing to rise to that challenge and see it as central to their long-term delivery.


Joanne McCartney AM:  Thank you.