Manchester hubs show a way forward for health on the high street
Work underway in Manchester shows how intertwined technological and economic revolutions can be harnessed to create a health revolution in which streamlined care is brought closer to the UK’s rapidly aging population.
Putting more NHS healthcare assets into the heart of local communities presents an exciting opportunity to increase efficiency, lower costs, improve staff wellbeing, while reducing clinical risk. There is now a once-in-a-generation chance to embrace economic and technological changes and put healthcare right where it is most needed.
One example of this new model is already up-and-running in Manchester. The Trafford Macular Treatment Centre opened in November 2019 in two high-street shop units. It is a joint venture between the Manchester Royal Eye Hospital (MREH), pharmaceutical company Novartis and Manchester University NHS Foundation Trust.
The centre joined two others in providing follow-up consultations and treatment services to patients living with age-related macular degeneration (ARMD), which blurs vision in older people. Around 14% of people over 80 are affected by the condition.
Patient Valarie Wrigley, who was 80 at the time of the opening, said: “I find the service much easier to access and much more convenient. I have to come in quite frequently – every six weeks – and before moving my appointments to Trafford, it would take up my entire day with travel, but here, I am in and out and the staff are lovely.”
Sajjad Mahmood, consultant ophthalmologist and clinical lead for the medical retina team comments: “I am a great believer in the model which meant we did not have to contend with the limitations of the infrastructure at the central hospital site. We managed to make the cost of the centre stack up because [in] high street locations…costs are not the highest.”
He says that the high street location is also a better working environment for staff, being just as well equipped as the hospital site but with fewer distractions than at the hospital it was easier to focus.
“The demand for age-related macular treatment is increasing and expanding our services has proved invaluable for our patients,” adds MREH chief executive John Ashcroft. “Our community eye clinics still remain amongst the first in the country to offer this level of treatment, in the heart of the community.”
All three ARMD centres are based in communities which are less-well-off, helping the “levelling-up” of healthcare, the two others being in Cheetham Hill in north Manchester and Wythenshawe in south Manchester. Evidence shows that those living in some deprived.
Each of the three Manchester community eye clinics are staffed by optometrists, ophthalmologists and specialist nurses who have provided tens of thousands of additional appointments a year in Manchester since they began in May 2018. This has also brought valuable footfall to the shopping centres with more than 90% of patients reviewed on or within a week of their required appointment.
The Covid-19 pandemic has allowed the centres to show their value in providing extra capacity. They were able to reopen relatively early and being away from hospitals meant their re-opening presented less of a risk to hospital patients and staff. This was reassuring to the centres’ Covid-wary patients too, many of whom are older and so more at risk from the disease. They have since been helping to steadily work through the backlog.
Seeing more widely
The UK’s rapidly-aging demographics had already meant a large number of people were waiting for treatment even before Covid struck in early 2020. More than 4.5 million patients were waiting for elective treatment before the pandemic began, one in twenty of them doing so for over a year. And the number had already increased by half since 2015.
The Covid pandemic only exacerbated the situation, with delays adding another 100,000 patients to ballooning waiting lists, doubling the number waiting longer than the 18 week target to some 1.5 million. Many patients are now having to endure waiting times of a year or more. The Covid crisis appears to have peaked, but the challenge of waiting lists is still mounting because the UK population is both growing and getting older.
There are ways to prepare now for future crises, as well as the demographic challenges we can readily predict. The number of people aged 85 and over is expected to nearly double to 3.2 million over the next 40 years. And as we age we tend to need more ongoing healthcare, including ARMD.
Meanwhile, in the economic sphere, our rapid shift to online shopping has led to a steep fall in high street property prices, making highly accessible retail properties more affordable than ever. And the advances in technology which underlie this shift are making it possible to bring ever more sophisticated health services to new locations.
Nearly one-in-seven retail properties lies empty, suffering the consequences of the growth of online and out-of-town shopping. Falling commercial demand means that high street healthcare would come at a relatively low cost, added to the lower capital costs of repurposing existing buildings. It also avoids the problems of using existing hospital sites.
Taking health services out of secondary care also helps hospitals do their core job, cutting unnecessary footfall and traffic. It also dramatically cuts the infection risk to hospital patients whose immune systems are often compromised. This advantage was particularly obvious during the Covid crisis.
Local healthcare spaces can form a bridge between centralised healthcare and personalised tele-health, both supporting the Government’s drive for more integrated care accessible to everyone.
Patient experience can also be transformed by providing some of the services hospitals offer in alternative spaces, nearer to patients, without hampering the services hospitals do best. Taking outpatient appointments off-site allows for more welcoming spaces. Patients will feel more connected to healthcare which is more like walking into a shop than into the intimidating, alien environment of a large hospital.
Hospitals pose a particular problem for some more than others. People with autism and learning difficulties, for instance, can often struggle to navigate large, impersonal hospitals.
Healthcare generally needs to be more accessible to people with mental impairments and older people. The high street is far more welcoming and accessible for everybody. Similarly, hospitals need to be accessible to all, especially as the UK population ages.
Uberising NHS healthcare
Shifting healthcare to the high street has the additional potential to integrate new technologies, bringing the astonishing convenience of a ride in an Uber to a doctor’s appointment. Cutting-edge technology allows for appointments to be arranged and administered across multiple sites that patients can self access using QR codes.
A healthcare unit can easily run one site in a hospital, for more intensive treatment, and another on the high street, both managed by the same system connecting patients by phone. Patients could pick the appointment that suits them best by using a mobile app in the beginning, rather than having an appointment arranged for them and being notified by letter. People who are not happy with smartphones can have their appointments made for them by other people who are, be they family members or members of an NHS support team.
The technology would also enable entirely new features for smartphone users. Our phones might detect that we are out shopping on the high street already and offer an earlier appointment if one opens. This would save the patient time and mean a clinician’s time was more fully used.
We would all be spared the costly paper chase of letters and phone calls. Analogue appointments are a mammoth task. Across England there were nigh-on 125 million outpatient appointments in 2020, up by 66% over the decade. ixJust one large hospital like Guy’s and St Thomas’ in London schedules over 2 million appointments per year. But still around 13% of outpatients do not show up.x
Each appointment will need one or two letters, each costing £2 to print and stuff in an envelope. This is not even including the typing, administration and the cost of any rescheduling. This could all be done for as little as 40p per appointment on a paperless app, slashing the carbon footprint. This offers a huge saving, flexibility and constantly up-to-date information.
Efficient healthcare depends on bringing patients together with the clinicians and specialist equipment at the right time and the right place. New technology allows our time and place to be more efficiently interlinked, in healthcare this will benefit patients, and all without a single piece of paper or envelope.
Rolling it out
Following Manchester’s lead and expanding high street healthcare more widely could help ease the growing burden on the NHS. Hospitals could focus more on what they excel at while high street healthcare tackles what it does best at outpatient clinics. Beyond ARMD this could include day case procedures, non-acute diagnostic tests, physical therapy and help tackle substance use and mental health issues.
The new hubs would also be freed from the often eye-watering inefficiency of paper-based hospital appointment systems, replacing them with a patient-centred “Uberised” self-serving system. As in Manchester these health hubs would also help restore the economic health of struggling town centres by bringing back footfall, which e-commerce has often reduced to critically low levels.
Health centres would generate a new set of customers for drinks, food, for pharmacies, health food shops, gyms and groceries. Town centre working is likely to be far preferable for healthcare professionals than in a giant hospital complex on the remote fringes of town. Improving the wellbeing and job satisfaction of those working in healthcare will help recruit and retain the best staff and enable them to deliver to the best of their ability.
Publicly-funded health services can reasonably be expected to play an active role in the “levelling-up” agenda. The NHS is under pressure to identify problems earlier if not prevent them and to treat health problems, like mental health, that have been neglected in the past. It needs to treat 380,000 more patients in 2021 just to stop the current waiting list from growing even longer.
The local economies of the places in which the centres are created also benefit. These circumstances may be little more than a fortunate coincidence, but it is nevertheless a golden opportunity to pioneer a model of healthcare that would make the NHS a world leader.