What the NHS can learn from community centred care in the Bronx: the Montefiore health systemBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3301 (Published 30 July 2018) Cite this as: BMJ 2018;362:k3301
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The report quotes "When the case managers identify housing as a critical problem, they don’t simply ‘signpost’ patients to housing services or hand over a telephone number. They prepare the housing application, hound the housing department to do something, or sit with people in their interviews with housing associations if required."
Yes that would work. And it used to work here when we had people called Social Workers who were attached to GP surgeries. The shift in the role of social workers to signposters happened, if memory serves me right, during the Major government and it has been disastrous for the most needy, especially those with mental health problems.
Competing interests: No competing interests
Montefiore has a steadfast approach to social determinants of health and it all begins on the first day of medical school training. They emphasise continuously through their curriculum the need to understand the individual as a whole, not just treat their blood results or disease. As I embedded myself in the local population I recognised the significant cultural diversity that exists, the need to understand such culture when providing care and the associated socio economic issues that such a population hold, a far cry from the typical well to do residents of Manhattan.
Candidates chosen to study at the Albert Einstein College of Medicine are diverse in themselves, from a range of backgrounds. That in itself ensures that who is chosen are ultimately the right individuals for the long term job at hand. In the UK we still see elitism at play and often the posh and polished are not best suited to treat the patients in front of them.
There can often be a complete mismatch in truly understanding a patients’ needs. A unique feature of Einstein, is that their students are heavily engrossed in the Einstein Community Health Outreach programme (ECHO). Here they provide free healthcare to uninsured residents of the Bronx area alongside physicians completely voluntarily. Such a platform again instills from early on, Montefiore’s focus of seeking out the local population and supporting them accordingly. Global health fellowships are another feature, ensuring learners can gain even more insights into the economic and sociocultural aspects of residents within a developing nation.
Dr Neel Sharma served as a visiting scholar at the Albert Einstein College of Medicine, New York
Competing interests: I served as a visiting scholar at the Albert Einstein College of Medicine, New York