Do you care about where you live or do you just have a house and an address?
Do you know what is happening to your community or what its needs are?
Does the health services you have reflect where you live?
This is more a rhetorical question because reality is it wont. It wont go anywhere near what your community needs. We currently have a system that is very much based on silo approaches, that actually as a community access is the most important factor to the care you have. Whether you live in the most affluent area or the most deprived area, your access to care is relatively the same. It does not change. It is based on generic care provision that considers mainly your GP and the large NHS Trusts.
Key Factors of Health Determinants:
Based on the World Health Organisation there are 4 key determinants, and 7 determinants.
These include the following:
· the social and economic environment,
· the physical environment, and
· the person’s individual characteristics and behaviours.
The further 7 determinants are:
· Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
· Education – low education levels are linked with poor health, more stress and lower self-confidence.
· Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
· Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
· Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
· Health services - access and use of services that prevent and treat disease influences health
· Gender - Men and women suffer from different types of diseases at different ages.
So what is it about these factors and what does this really mean?
Healthcare currently is looked at upon larger areas, when actually a place based care system would have greater advantages to the individuals and we start to view patients as citizens and take a wider more holistic approach to how the care is delivered.
· This means localising services.
· This means citizens becoming accountable, but also holding services to account.
· This means that health outcomes become a focus of a community along with the factors that directly impact the health outcomes.
Is this realistic?
We know that economically for the wider region, and in particular Yorkshire that addressing the health economy and looking at place based care would change how the system is structured and would become a fairer provision across the whole region. This would need parity across our services. It would mean that changes would need to happen to look at a system joining up across health, education, social care and charity and voluntary sector. It would also need primary care to be redefined - a move where GPs and Medical Centres are not the gate keeper but are key advisors into place based care through Primary Care Networks. Primary Care needs to front load prevention than this continued pressure to be reactive. The services we have need to meet clinical need, not patient need. This is the beginning, however there needs to be a greater consideration of the impact of the other detriments and how we address these to improve health outcomes.
What would the ideal model be?
This is a significant question and although LivingCare are only a single provide in a significantly massive health system, our view is that the ideal model needs to bring together all elements of the state system; health, education, social care, public health, housing and the local economic partnerships to look at how between all partners we begin to look and identify with the citizens of the cities, towns and communities that we all serve. That we begin to develop systems based on place need, place issues and importantly how we look at place investment. The development of community based assets and social structures that empower our citizens to develop resilience and local led solutions.
Our model would look at a tier that puts the power to the citizen, the immediate work is underpinned within the community the "look after the community", this is supported through the charity and voluntary sectors to support the development of local led initiatives including ways of preventing attendance at hospital. Above this we have the GP and traditional Primary Care sector. They provide the immediate support to look at solutions in the community including how community providers support the delivery of care. The GPs have localised diagnostic and outpatient hubs very much like LivingCare provide. The community provision is then layered and supported with integration with community based services such as Health Visiting and School Nursing along with the community based pathways such as pain management, diabetes etc. Above this sits the acute hospitals and inpatient provision that enables trusts to position their resources to provide the care that is complex, critical, inpatient based.
How does LivingCare fit in this?
Our roots come very much from community based care. Our founder Dr Stephen Feldman established the business to support his patients in receiving care that is closer to their home. That was to enable patients quicker access, improve their health outcomes quicker. This founding philosophy is what we believe in to this day. We want patients to be diagnoses and treated quickly. We want to see their health improve from quicker interaction. We provide care across our four hubs in West Yorkshire. We serve over 3000 patients per month. We are proud of where we have established our business from, and this continues to be the essence to how we will serve the Yorkshire communities in the future.