If you do what you’ve always done, you’ll get what you’ve always got.
A well-worn saying but not true when considering the trajectory of increasing ill health and therefore future demands on services. The situation won’t be ‘what we’ve always got’. It will be much more challenging.
The Health Foundation predicts that “the large baby-boomer cohorts reaching retirement, combined with the projected expansion of ill health, means that 2.5 million more people aged 20 years and older are projected to be living with major illness between 2019 and 2040”[1].
Well aware of this, the health and care sector in Leeds – the UK’s third largest city – has been crafting and implementing a blueprint for change. After much hard work to review, rethink and redesign how health and care services work better together for local people, the green shoots of transformation are emerging.
Where to start? What’s the plan?
In any large city there will be many significant challenges for supporting a population’s health and care. So how do leaders agree what the priorities are?
“A partnership approach is key,” says Jo Howard, Senior Strategic Lead at the Leeds Office of the West Yorkshire Integrated Care Board (ICB), the statutory body responsible for facilitating joined up (or ‘integrated’) health and care services.
“We’ve created the Healthy Leeds Plan, with and for all health and care partners in Leeds. It contributes to the city’s Health and Wellbeing Strategy and seeks to address the challenges we face by focusing on just two overarching goals. That’s a bold but important step and provides the guiding light for everything we now do in partnership.”
The Healthy Leeds Plan’s two goals are to:
- reduce preventable unplanned care utilisation across health settings
- increase early identification [of ill health] and intervention.
Whilst the Plan aims to improve outcomes for everyone, the goals are focussed on the 26 per cent of Leeds’ population who live in the most deprived parts of the city, recognising that it’s here where the biggest impacts can be made.
This provides a clear lens for what happens next.
Prioritising and partnering for population groups
For the last few years, partners in Leeds have been changing the focus from the traditional approach of treating ill health to understanding better how to prevent it. From considering a person by their ‘health condition’ to helping them enjoy healthy, independent living. And from an organisational or service-focused approach to one that thinks and works system-wide.
It has meant considering people’s quality of life by grouping them into population ‘segments’ or groups according to their greatest needs, mindful that many people will belong to multiple groups. In Leeds, these groups are:
“It’s a huge and complex task. We’re completely flipping round the way we think about care. Instead of thinking in silos of primary care, such as GPs, or secondary care, such as hospital-based treatment, we’re looking at what those groups of people most need overall and working together to provide a better experience and outcome for them,” explains Jo.
“We’re doing this by bringing together health services with Leeds City Council, public health, the community and voluntary sector and citizens, to form population boards. Together, we are gaining new insights which help us be really clear on how to redesign care for each population group and make best use of our resources.”
Start small, learn fast, share and scale.
Various activities underway in Leeds bring into sharp focus the enormous potential of these approaches.
For example, in seeking to understand why people went to hospital in an unplanned way, health and care partners have been looking in detail at the needs of the end-of-life population group.
Their data-led analysis showed breathing (respiratory) issues as the main reason people nearing the end of life were admitted to hospital in an unplanned way. A third of those unplanned admissions were people from the poorest parts of the city.
As this cohort of people aligned with the Healthy Leeds Plan priorities, the team built on their data analysis to include grass roots research. They explored the reasons for the admissions, what could be done differently to avoid these and how many ‘bed days’ would be saved as a result?
“Measuring bed days is significant because they indicate where our health and care system may have missed opportunities to support people sooner, closer to home and before their needs escalate. They’re a good measure of what we, as a partnership, are trying to avoid,” explains Catherine Sunter, Programme Director, Leeds Office of the West Yorkshire ICB.
“Led by what the data was showing us in these specific, poorest areas of the city, we asked citizens and health and care staff for their perspectives, so we could understand what needed to change.
“Although this cohort is small, just 252 people, it accounted for 3,750 unplanned bed days in a year. If we do nothing new and current trends continue, our analysis indicates that population increase and our ageing population will produce a cumulative increase for people at the end of life of almost 17,000 in unplanned respiratory bed days between 2023 and 2030.
“Our work has shown that many of these people are very frail and are waiting in A&E for long periods of time. Some do need to be there, but for others this could be avoided by supporting them differently closer to home, which would be better for them.” says Catherine.
The study’s next steps will be to test its evidence-based solutions in the communities it’s focusing on and then, to understand whether these can be transferred to other areas of the city.
“This new ethos requires a very clear system goal. It must be led by data and by local people’s perspectives and experiences. It means researching and trialling change in very small neighbourhoods and specific hot spots with our most deprived populations. And crucially, working with partners using existing resources, which is the difficult part.”
From blueprint to business as usual
Grouping health and care needs isn’t new. But it’s traditionally been through the lens of service provision, such as primary and secondary care.
By changing that lens to focus much more on people’s lives and what they need, it’s hoped resources can be better directed and people better supported to stay well.
Dr Gill Pottinger is a GP, a member Leeds Palliative Care Network and chair of the End-of-Life population board in Leeds. So she sees these challenges first-hand and is working closely with the research team and all those involved in exploring these new approaches to end-of-life care.
“Our new insights are enabling us to forecast and model what new approaches could look like. We’re considering health system economics, population growth, the impact of poverty and much more,” says Gill.
“We know the number of people aged 80 or over could nearly double in Leeds in the next five years and we need to focus our resources on helping them live as well as they can and to achieve their end of life wishes.
“With this approach, working together across all healthcare providers, we are looking to achieve the best outcomes for our patients approaching end of life and where to invest resources to support this.”
Discover more about Health Innovation Leeds:
Health Innovation Leeds represents the city’s internationally-renowned health and care research and innovation. It is supported by Leeds Academic Health Partnership, one of the biggest partnerships of its kind in the UK. Its members work together to solve the city’s hardest health challenges.
