'A whole new world' - Why do NHS leaders need to think outside the box to create truly integrated care systems?

31 October 2018

Sophie Johnson, NHS Graduate Scheme

Sophie joined PPL for eight weeks on placement as part of her NHS graduate scheme training. Here she shares how her perspective has broadened through her time with us.

If you’ve switched on your television or opened a newspaper in the past few months, I’m sure that you’re aware of the increasing demands on the health and care system. Last winter, almost 150,000 people spent more than half an hour waiting outside A&E in an ambulance due to the extreme pressures inside hospitals.1  

Working as an operational manager in a large acute hospital, I felt the impact of this first hand; people reaching crisis point spending prolonged periods in A&E, being admitted to hospital, losing their independence and becoming more reliant upon the system as a result. It all felt very reactive – and definitely not sustainable. 

Admittedly, it was easy to focus on the firefighting and miss the bigger picture. Since joining PPL, however, I’ve had the opportunity to take a step back and look from a system wide perspective. Prior to this, I hadn’t appreciated the breadth of the work undertaken by other public services or the opportunities that they have to shape a community. Councils commission hundreds of services within their community, all of which provide an opportunity to get to people before they reach crisis point. Connections should also be made with networks of cares, family and friends, who do so much to support the health and wellbeing of people at home. 

Reassuringly, the landscape of the NHS is changing. The creation of Sustainability and Transformation Plans and evolution into Partnerships creating Integrated Care Systems (ICSs), are an opportunity to reimagine how health, care and wellbeing is managed. At the core of the changes is the need to collaborate and work as a system rather than within organisational silos. That being said, the Vanguard sites seem to be very much NHS-driven.

To develop truly integrated future working, I would encourage NHS managers and leaders across the system to take a step back and realise the exciting opportunities for engaging outside of the health and care system, and indeed, outside of the public sector. In Wigan, for example, front-line environmental staff working within their local community to do various roles such as maintaining green spaces, collecting bins and picking up litter have been trained to spot safeguarding concerns whilst carrying out their jobs.2 The ‘Eyes and Ears’ training recognises that these people are in the heart of the community and can play a huge role in prevention. Thisnot only improves wellbeing but relieves pressures on the system as a result. Further afield in Indiana, the ‘Black Barbershop Health Initiative’3 has increased awareness of prostate cancer by training local barbers to talk to their clients about the importance of prostate education and conduct basic screening where necessary. The initiative is a creative way of utilising the community to improve health outcomes for those who are harder to reach.

I think it’s fair to say that we could learn a lot from both initiatives discussed. They are both inexpensive and effective, and reinforce the value of communities, which can sometimes feel like a thing of the past as people are more reliant than ever on technology and social media rather than basic human contact. Imagine the potential for impact if the new ICSs could nurture initiatives like these – they could tap into a whole new world.

Andy Burnham hit the nail on the head in his recent speech on place-based integration:

“When I was elected, I thought the challenge was all about integrating the NHS with social care. And, yes, it is partly about that […] But as Mayor of the only city-region with health devolution, it has become increasingly clear to me that the unique opportunity Greater Manchester has is to integrate health with everything - early years, education, community safety, housing and employment.”


  1. https://www.theguardian.com/society/2018/feb/15/nhs-winter-data-wait-ambulances-a-and-e - “NHS winter data shows 150,000 waited half an hour outside A&E”, The Guardian, February 2018

  2. www.nlgn.org.uk/public/2018/why-staff-are-eyes-and-ears-of-our-communities/ “Why staff are eyes and ears of our communities”, New Local Government Network, April 2018.

  3. https://www.urologyhealth.org/patient-magazine/magazine-archives/2013/summer-2013/barber-shop-talk - “Barber Shop Talk About Prostate Cancer”, Urology Care Foundation, 2013