What if the NHS moved most care out of hospital?BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j602 (Published 08 February 2017) Cite this as: BMJ 2017;356:j602
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Brown’s future view of the NHS (What if the NHS moved most care out of hospital?, 11 February) is an inspiration for me and my colleagues working in the first health and social care integrated care organisation (ICO) in NHS England; Torbay and South Devon NHS Foundation Trust. This article mirrors our vision and direction of travel. In these times where deeply held principles are straining to hold, we believe that health and social care are basic human rights and we marvel at Brown’s audacity to suggest that the principle of ‘free at the point of delivery’ could expand to include social care. Brown dares to dream.
Since becoming an ICO in October 2015, we have invested in intermediate care expanding by 60 WTE nurses, therapists and social workers across our locality. These teams are supported by GPs and a network of clinical pharmacists who work six days a week, going to a seven day service imminently. We have invested in Health and Wellbeing with health coaches and a growing network of voluntary organisations- Brown describes each of these parts in her Utopia. She describes our vision of what care closer to home could look like by 2020 with ‘the best bed is your own bed’ principle. Having made over £6,000,000 of investments, our model also requires us to remove beds from our system as, coupled with this investment, we will save a total of £12,000,000. These are uncomfortable times for us and our communities as current dogmas play out.
So as we strive to take care into the 21st century to meet the changing expectations of people (patients and staff), it helps to know that we are proceeding down a path which could end so beautifully. Yes, the dual burdens of finance and political-will do weigh heavily but we have been given the mandate (to try) to do the right thing. Together with Brown’s article, I am in inspired by the people around me who built our vision and who work daily to make it real. Hope may not be a plan but, in our work to make Brown’s vision real, hope is vital as in a sea of despair we could all too easily lose our buoyancy.
Competing interests: No competing interests