Bringing healthcare to the community – Feature: Health on the High Street

Bringing healthcare to the community

We talk to Leader of the NHS Community Diagnostic Centre rollout Alexandra Pinches and the team at Warrington Living Well Hub to hear how to deliver health and wellbeing services to the community and in doing so help tackle health inequalities and reduce the backlog

Health on the High Street (HOTHS) is a key area of interest for Fortis and our readers. In the last issue, we looked at making HOTHS happen. This time, we look at moves by those delivering and making healthcare accessible to all in the community, incorporating many of the HOTHS themes. Leader of the CDC rollout Alexandra Pinches gives an update on where we are with CDCs and tells us what to expect for the rest of 2024. And we also hear from the grassroots in our conversation with the team at the Warrington Living Well Hub. They tell us about how they worked to bring stakeholders from across the community together to serve the needs of those who often fall off the radar when it comes to health provision.

It’s common knowledge that people living in more deprived areas have a lower life expectancy, a poorer quality of life and suffer a higher prevalence of long-term conditions – but by moving diagnostics closer to home with the introduction of Community Diagnostic Centres (CDCs), the government hopes to tackle health inequalities.¹ It’s also hoped that CDCs – and the concept of HOTHS in general – will help to expand crucial diagnostic services and reduce the backlog, as well as breathe life back into our communities.

CDCs have been opening at pace since 2021 and the government recently announced that 155 sites are in operation and have already delivered over 7.4 million additional checks² for a range of conditions from cancer to heart or lung disease.

One successful launch is the Rossendale CDC, a spoke building and one of only four CDC hubs already up and running in Lancashire and South Cumbria. It was established in August 2021 and together with the Burnley General Hospital CDC has delivered more than 24,284 additional tests to patients in the area between August 2021 and March 2023.³ The target from April 2023 to March 2024 will include an additional 49,000 appointments. The plan is to keep improving the hub build diagnostic capacity within the area.

Rossendale was chosen as a state-of-the-art health centre rooted in the local community, offering value for money within fit-for-purpose, modern facilities. It includes lead-lined rooms necessary for diagnostic x-ray and CT scans. It already had endoscopy facilities and several consulting rooms. Other upgrades include a floor-standing to a ceiling-mounted x-ray unit, which has increased the number of x-rays that can be carried out.

Despite the drive to situate CDCs in the local communities, in some areas the best place for accessibility can still be the local community hospital. The Finchley Memorial Hospital CDC opened in north London in August 2021 and now offers patients two MRI scanners, CT and ultrasound rooms. In addition to this, the hospital is serving the local community with a direct bus route to the CDC as well as pre-bookable, free parking on site. In August 2022, just one year after its arrival, the Trust announced that they had reached 50,000 patients, making a real impact on the local community.

Alexandra Pinches: what’s next for the CDCs?

Alexandra says in 2024 – as well as building at pace to continue to deliver the crucial capacity CDCs can offer – the focus is on how this programme can innovate on delivery.

“The funding is there to support CDC activity as well as pathway development, IT and digital interconnectivity. We are also funding Experience Based Design (EBD) across all sites to help each site best cater for patient needs and deliver an excellent patient and staff experience.

“EBD asks questions based around people’s feelings of their experience and helps paint a picture as to how patients and staff relate to the services offered and feedback on both the positive and negative elements of that interaction.”

Delivery and innovation

“We will also be supporting CDCs to evolve and improve the ways we deliver diagnostic testing, using CDCs as hubs for innovative approaches.

“We are looking at the value of working off an acute hospital site over the longer term, mindful that healthcare needs to demonstrate value for money. We monitor delivery of not just numbers of tests, but costs associated with these and how performance is evolving for each CDC archetype. This in turn will mean we can share the next steps with a clear understanding of the benefits each type of CDC delivers and the cost involved.” [See page XX for an example from Cannock Chase].

Managing workforce

“As in the NHS as a whole, workforce in diagnostics is challenged. We have invested in growing the workforce for CDCs as well as investing in training, looking at new roles and challenging perceived limitations to roles to better deliver safe, effective services moving forward in partnership with regulators and professional bodies. This is a work in progress but reporting back on these investments is a core component of our delivery.”

Prioritising how capacity is used

“We continue to support, monitor, advise and challenge CDC builds’ activity and performance, ensuring capacity is best used ahead of and during winter, and contributing to the reduction of waiting lists and the NHS’s Elective Recovery Plan. CDCs provide the opportunity to free up our hospitals for our most sick and frail patients, offering a more cohesive, ‘one-stop’ service within CDCs to larger groups of patients.

“Our aim has always been to work with healthcare systems and embrace the best local care delivery models while standardising the experience patients can expect to deliver the best possible care. Opportunities include linking CDCs with elective surgical hubs to utilise capacity and looking at effective pathway rollout to ensure NHS resources in the best way.”

Progress with diagnostics

“Despite challenges including industrial action, systems are making excellent progress with diagnostic activity. The service is prioritising diagnostic capacity for patients being investigated for urgent suspected cancer [see The Fortis Report on page XX for more on cancer performance]. The goal is to improve turnaround times, specifically around histopathology by optimising histopathology services, enhancing the workforce skill mix, consolidating services, improving equipment, and accelerating digitisation, estate, and equipment replacement.”

Combating health inequalities

“Public health data, deprivation scores and information on site accessibility including transport links were core scoring criteria in the selection of CDC locations. CDCs address the disparity in access by locating these sites in deprived community locations where access to essential diagnostic tests is challenged. Locating CDCs closer to home reduces travel times and, alongside the consolidation of services, reduces the number of visits thus making diagnostic care more accessible. CDCs are anchor institutions that in collaboration with council and local authorities enable the co-location of CDCs with health and wellbeing centres, GP practices and local regeneration schemes that improve both the economy of the local towns and access to wider health and social care services.”

Case study: Warrington and Halton Teaching Hospitals NHS Foundation Trust

We spoke to the dedicated individuals – Lucy Gardner, Director of Strategy and Partnerships; Stephen Bennett, Head of Strategy and Partnerships; and Caroline Lane, Strategic Project Manager – who brought the Warrington Living Well Hub to life. This community-centric triumph is a celebration of strategic collaboration and shows how putting people first can make an impact.

In an innovative move to enhance the health and wellbeing of its community, Warrington introduced the Living Well Hub, a pioneering facility emerging from the central government’s Town Deal initiative dating back to 2019.

“The programme was a national initiative aimed at levelling up local communities,” explains Lucy. “It prioritised local economic development, education, and employment – health was not part of the plan in the early stages,” she explains. But now the hub stands as a cornerstone of the wider Living Well programme, striving to empower residents to maintain their health and independence.

The Living Well Hub places significant emphasis on early intervention and prevention of both physical and mental ill health. It serves as a sanctuary where locals can seek advice and support for a variety of health-related challenges.

Among its comprehensive services, the hub offers support for families and children to ensure local children have the best start in life; it provides guidance for older adults showing early signs of frailty who wish to remain living independently, including playing a critical role in dementia assessments and extending support to caregivers; and it provides targeted support around women’s health and help to residents of all ages live healthier lifestyles.

Tackling inequalities

Right from the beginning, a focal point for the team was to tackle health disparities in the area. “There’s a 10-year gap in life expectancy between Warrington’s centre and its outlying areas,” Lucy points out. “Conversations with the local council about the importance of health in regeneration efforts led to the integration of a health and wellbeing provision in the town centre’s revitalisation plans. Spearheaded by Warrington Borough Council, the hub was established to take on the health inequalities in the community, with a particular focus on supporting children, families, and the elderly,” she adds.

Collaboration: the heart of the hub

“Fundamental to our work was that the hub be a collaborative space, integral to a broader system approach rather than just a hospital-led initiative,” explains Stephen. “It’s distinctive for its collective approach, bringing together secondary care, community care, mental health, social care, and local voluntary and charity groups to holistically address the wider determinants of health.

“It’s an ambitious project, promoting a person-centred model of care that puts people’s needs first and then aligns services around them,” he adds.

Putting people first

“We established a stakeholder group with wide-ranging representation, which has proven invaluable,” adds Lucy. “For instance, through our discussions, we realised the necessity of including provisions for care leavers, a previously unidentified gap.”

“If you are serious about collaboration and co-creation, you’ve got to take your time. You’ve got to speak to, and listen to, people,” says Stephen. “We must have spoken to a thousand people who work for the hospital Trust and other partner organisations right across Warrington over the last couple of years. We always came back to what do people want and need and how can we do something different to provide a different level of service.”

There’s a sense of ownership from the stakeholders. “We went back and tested ideas out. People from across our local health and care system can see their suggestions have come to life in the building itself.”

Challenge: accommodating a diverse set of needs

Accommodating diverse needs such as those of children, families and individuals with dementia under one roof needed detailed thinking and planning. The hub has been designed to be accessible to everyone and this presented challenges and needed strategic thinking from the off.

“Choosing the right location for the building included a full options analysis: setting success criteria, spending time with stakeholders and giving people ownership of the project,” explains Caroline, emphasising how important collaboration was to ensure the success of this project.

“The hub’s design had to balance clinical compliance with creating a welcoming environment. There’s no existing template for such a space – it’s a unique concept combining clinical services with ‘softer spaces’ to cater to various community needs. The hub includes a digital inclusivity area with resources for public internet access and learning, and areas for mums and babies, and older people.

“We adhered to dementia-friendly guidelines and employed design elements, like colour contrast, to aid navigation and use of the space,” she explains.

Making it happen

“To accommodate all these needs, we had to change the thought processes of our internal estates and design teams who are geared up to deliver hospital acute services. And this took time, and involved hundreds of conversations, and thinking outside the box,” Caroline adds. “We spent time researching other spaces. We visited a library in Hartlepool that had been converted to incorporate a range of community services. And were inspired by the work at Life Rooms in Walton, where we found something very close to our vision for the ground floor.”

Hypertension pilot

One of the hub’s unique clinical success stories involves a pilot project for managing hypertension, which has shown promising results in terms of health outcomes and cost savings. The hub will play a crucial role in this ongoing project by providing initial screenings and support for healthy living, providing a kiosk where passers-by can get their blood pressure checked. If they have high blood pressure, they can sign up for a remote testing kit and download a simple app to record readings. “For every 10 people with hypertension only four have it treated and controlled properly,” explains Stephen. “The pilot of 1,000 patients is estimated to have prevented six heart attacks, and nine strokes – and saved a minimum of £140K for the local health economy.”

Growing the service

When it comes to measuring its ongoing success, the hub is designed to evolve based on public feedback and demand, explains Stephen. “A key part of our model is capturing outcomes to inform future service development,” he adds. “We’re also exploring a ‘virtual hub’ concept to extend the reach of our services online. The virtual hub will help scale up the services that are offered at the physical space and reach more people.”

“We’re awaiting funding for this,” adds Lucy, “but it has been prioritised by policy partners.”

Replicating the model

“The hub model, while potentially replicable, should be tailored to the specific needs of each community,” says Lucy. “It’s vital that any such initiative maintains a focus on the community it serves and ensures that services are co-ordinated to meet individuals’ needs effectively.”

“And it’s not just about putting a whole set of services in one space,” says Caroline. “The unique selling point of this hub is that its services are relevant to people at particular times and the services are targeted for them on particular days. For example, those dealing with dementia and those with babies will be served on different days.”

Another important USP is a legally binding collaboration and contribution agreement between the four core statutory partners. “It includes financial contributions between the council and Mental Health Trust, the Community Trust, and our organisation. This type of agreement didn’t exist anywhere, and it was a challenge to get in place, but it’s something that can now be replicated by others,” says Lucy.

Once again, collaboration and ownership were central to the success of the hub. “When we presented a business case for capital funding to the government, that business case was approved by all four boards,” says Lucy. “That’s when the ownership formally started.”

And collaboration and ownership weren’t just from the top down – the team engaged with everyone involved. “We engaged with clinical teams, those delivering the services, and communities. We ensured everyone bought into the model and people have noted we’ve been responsive to everyone’s needs,” says Caroline.

Building on the success

Lucy says there is great potential to build on the flagship hub and create pop-up Living Well Hubs to service the needs of different parts of the Warrington community (for example, in the affluent south of the river area alcohol consumption is more of an issue, and in other parts of Warrington there’s a larger population of elderly residents).

“The hub model doesn’t need to provide a single solution for every town. Multiple hubs, pop-ups and the virtual hubs working in synergy provides an exciting vision for the future of healthcare,” she adds.

The model at Warrington has the potential to turn healthcare on its head, tackling wellbeing, and prevention first, and on an estates level it works too. “Nationally, from an estates’ perspective, there’s not enough funding to build the hospitals we need, so if we can move as much as we can out of hospitals it also addresses the national estates challenge we have around funding,” concludes Lucy.

If you would like to visit the Living Well hub, contact the team at whh.livingwell.hub@nhs.net

FOOTNOTES

¹ https://www.kingsfund.org.uk/insight-and-analysis/blogs/community-diagnostic-centres-moving-care-closer-home#:~:text=The%20centres%20are%20also%20conceptualised,prevalence%20of%20long%2Dterm%20conditions.

² https://www.gov.uk/government/news/community-diagnostic-centres-deliver-more-than-7-million-checks

³ https://communityhealthpartnerships.co.uk/news/case-study-rossendale-primary-healthcare-centre-cdc/#:~:text=Together%2C%20the%20Rossendale%20and%20Burnley,include%20an%20additional%2035%2C000%20appointments

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This article was taken from the May 2024 edition of FORTIS magazine.

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This article was written for the November 2024 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.