Guardian Public Service Awards 2016 health and wellbeing winner: Deventio Housing Trust

“Quite often people are in hospital and they’ve got nothing: no food, no clothes, no toiletries,” says Kate Gillespie, Derventio Housing Trust’s strategic lead for its Healthy Futures initiative. “We get all that sorted out, so people at least have a bit of dignity when they are discharged.”

That’s just the start of the scheme’s work with homeless people due to leave hospital. Many have multiple, complex needs, such as mental health problems and addictions, and are trapped in a vicious cycle of ongoing health issues and repeat admissions.

Over a 12-week period, staff work intensively to find housing for patients, settle them into their new homes and help them live independently – while making better use of primary care, rather than relying disproportionately on acute services.

“Sometimes it’s because they don’t manage their health, so they actually get ill enough to need to go in [to hospital] all of those times,” Gillespie says. “We’ve also got people who are going in because it’s their social contact. They’re so isolated that the only kind of love and nurture they get is a trip to A&E, where they get a sandwich and a cup of tea and a ‘there, there’ from the nurses. When someone has nothing else they’re going to keep coming back for it.

“It’s like they’ve got a dependency on acute care. We transfer that dependency to us, and then take the time to wean them off it. If we get someone who’s in A&E three times a week, the next step down from that is a walk-in centre. Then their GP, then the pharmacy.”

Healthy Futures, which also offers brief interventions to help with the timely discharge of inpatients with less complex housing and support needs, has worked with more than 330 patients since it began in October 2013. Some 170 patients have received ongoing community-based support.

In the six months before becoming Healthy Futures clients, those patients had been admitted to acute beds on 487 occasions, had gone to A&E 616 times, and had called 999 and been taken there by an ambulance 364 times.

The project has led to an 88% fall in avoidable admissions of clients, a 90% drop in clients’ visits to A&E, and 84% fewer 999 ambulance transfers. Hospital stays have also been cut by an average of 16 days. Two thirds of patients felt their physical health had improved, and the same proportion reported better mental health.

Healthy Futures’ achievements come despite working in a climate of cuts to adult social care, at a time when finding housing is harder than ever. Key to getting funding has been its use of robust data proving its impact and efficiency. Patients give consent for their health records to be accessed, so their use of acute care before working with the project can be tracked – and commissioners can clearly see the positive effect.

Great staff are also vital, Gillespie says. “They’re just amazingly capable and patient and resourceful. I’m immensely proud of them.”

Guardian Public Service Awards 2016 health and wellbeing winner: Deventio Housing Trust

Britain"s most famous pools winner has dementia

Britain’s most famous pools winner, who became a household name with her vow to “spend, spend, spend”, is suffering from dementia, her son has revealed.

He told the Sunday People: “Mum’s always been larger-than-life and to see her dementia rob her of her sparky personality is devastating.

“I ask what her catchphrase was and she can’t remember.

“When I tell her, she smiles as if she recognises it – but I don’t know if she does.”

Following her husband’s death, Mrs Nicholson moved to Malta, but was deported following an altercation with a police officer.

She also married a further three times, with one marriage lasting a matter of just days.

Mr Nicholson, his brother Tim and sister Sue, were sent to a private boarding school in Lancashire when he was just three, but they returned home every two weekends.

He recalled: “Mum would be dancing and Dad would be drinking.

“It [life] was a rollercoaster, but we always knew she [his mother] loved us.

“Mum did her best for us so I’ll do my best for her.”

He is planning a sponsored walk along China’s Great Wall to raise funds for Dementia UK and said: “If she could, Mum would urge everyone to spend, spend, spend – this time to fight dementia.”

Britain"s most famous pools winner has dementia

Apprentice winner Dr Leah Totton: "Botox is not the identical as a manicure or pedicure, it"s a healthcare intervention"

This is not what I anticipated to hear from the ambitious younger girl carving out a job in cosmetic therapies. After winning The Apprentice last year, she has embarked on a plan to set up Dr Leah (the name of the brand) clinics across the United kingdom – the first of which she has recently unveiled in Moorgate.

Currently, she has faced extreme criticism for her clinics, which are stated to inspire females to have cosmetic therapies, and have been branded “amateur”. A former BAAPS (British Association of Aesthetic Plastic Surgeons) chairman even in contrast it to “putting a hairdresser in charge of cosmetic surgery.”

“As a fully qualified medical professional, fairly frankly that is insulting,” cries Dr Totton. “That’s a ridiculous comment. My head of instruction is a BAAPS advisor – a truly properly-acknowledged a single. You’ve received to remember that everyone that’s speaking out is a competitor. We’ve acquired over 50 years’ expertise in our group.”

She adds that the criticisms have died down given that she announced her skilled personnel, and set out the information of how her clinic would run. She has also produced it clear that she will not treat anybody below the age of 18 – she not too long ago had a Botox inquiry from a 14-yr-previous lady coming into the clinic with her mom – but I cannot help but consider her age restrict tends to make cosmetic therapies appear ‘normal’ for all adult ladies.

Actively encouraging Botox?

“It’s not really encouraging,” she says. “The point is, if they’re troubled by lines and wrinkles on their encounter they will have their method anyway. We’ve noticed in the press in the past weeks folks aged 17, 18 are getting these procedures. So if someone 28, 29, if they’re troubled by it, I’d rather they came to me and had it assessed by a doctor who can say objectively say yes or no, and have it carried out in a clinical surroundings.”

Dr Totton’s general argument is that there is a demand for the injections, and individuals will have them done in unsafe, unhygienic environments if they can not accessibility them effortlessly, so she is supplying a risk-free option. Recent statistics show cosmetic surgery as a entire is on the rise, with encounter lifts and eyelid surgery getting to be increasingly popular.

Botox, too, is seeing a massive demand and that is why Dr Totton is setting up her chain of clinics. It is a affordable business plan, and has persuaded Lord Sugar to cough up the money for her elegant London clinic, but is it really ethical to set up a franchise dedicated to shifting the way ladies look?

“Everything we provide is non-long lasting,” she says. “I think that is a important message. It is about offering non surgical effects so folks really feel they don’t have to go underneath the knife. It is not my place to tell any individual what they should and shouldn’t do.

“We’ve noticed a boom in plastic surgery. I believe [it is due to] societal stress to a specific extent. I do not advocate that societal strain, I’m not saying you need to have it – that’s not what we’re about. I think in female and male empowerment and personalized choice. I don’t believe it is forcing ladies to have it.”

Strengthening specifications

I am not convinced that giving Botox and lip fillers are a crucial element of female empowerment, but at least Dr Totton is employing her media spotlight to improve the conditions and rules of the cosmetic market. She is keen to encourage standardised training in the United kingdom, as though she has two and a half many years knowledge, other practitioners could have only two days on their CV.

“We’re very stringent about who we deal with,” she says. “We try out and give realistic expectations and I think even much more so with the plastic surgical treatment side of items there needs to be an extensive consultative method so you are managing expectations.

“During The ApprenticeI feel we have shone a light on the market. I hope the Dr Leah brand will be capable to begin a precedent, a standard. Regardless of whether we like it or not, these are done in hairdressers, garages, sheds, all over the place but what we’re about is carrying out it in a regulated, healthcare atmosphere.”

She has deliberately produced certain her charges are in the mid to upper assortment – and apparently that’s not just to bring in far more of a revenue. “We are not about making these low cost, so men and women believe it trivialises it. This is not like a manicure or pedicure, it is a healthcare intervention. We need to be cautious – when you begin supplying things on the cheap then you are incentivising possessing these procedures. It ought to be a determination you come to in your own correct.”

As I leave Dr Totton’s clinic, my opinions on Botox have not modified – I’m nonetheless not a massive fan. But I am comforted by Dr Totton’s perspective in direction of it. She assures me she would in no way inject anyone who did not need to have the process, and does not supply sufferers the ‘Botox look’ with raised eyebrows and a startled expression.

In fact, she visibly recoils at the thought: “It’s not a search that … I do not want to be vital … but I feel that subtlety is key, and that is my individual opinion.”

Dr Totton’s viewpoint is all over the clinic – from it is identify, branding and pictures. But, possibly that is not always a bad thing.

Apprentice winner Dr Leah Totton: "Botox is not the identical as a manicure or pedicure, it"s a healthcare intervention"

Competition in healthcare doesn"t have to be a case of winner takes all

Like opponents in a judo match, neighborhood NHS providers are interdependent with every single other in spite of currently being in competition. Photograph: David Finch/Getty Images

Numerous commentators market competitors within the NHS as a key lever in efforts to boost good quality. However, the continued policy route toward competitors has also been met with resistance given that its inception in the 1990s.

Most just lately, this was illustrated by criticism of the government’s draft laws for commissioners on procurement of NHS providers, patient selection and competition under section 75 of the Well being and Social Care Act 2012. The laws empower financial regulator Keep track of to ensure clinical commissioning groups act to shield patients’ rights and prevent anti-competitive behaviour.

Many take into account competition as a “winner takes all” proposition, rather than seeing the prospective for a number of winners in the marketplace. Distinct forms of competitors can exist in business, and healthcare is no various. Competition in the market place exists exactly where individuals are ready to decide on the ideal place or physician for their therapy. Competition for the market can also exist for instance various providers doing work collectively to supply longer-term integrated care contracts for systems, as implemented in musculoskeletal care in Bedfordshire, or the care of older individuals, as implemented in Cambridgeshire and Peterborough and Oxfordshire.

Commissioners may possibly in truth maximize value for money by embracing a nuanced technique encouraging each competition and co-operation. In their guide Co-Opetition, Adam Brandenburger and Barry Nalebuff offer the analogy of a judo match – rivals use their personal strengths and their opponents’ weaknesses as they face each and every other. The fate of 1 individual is interdependent with the other the move one particular person can make influences the moves produced by the other. Suppliers will fare far better if they function with each other rather than working in isolation.

They say co-operation and competitors are each needed and desirable when undertaking business. Co-operation might advantage all players by escalating the size of the market place although competitors divides the benefits.

With this strategy in thoughts, commissioners should generate a strategic framework for each pathway or bundle of care, in order to help them comprehend which providers can supply the very best well being outcomes specifically for their nearby population.

Commissioners provide a flow of sufferers to the providers inside of their nearby health economic system. Rivals are individuals companies who supply the very same elements of the pathway of care. For instance, imagine two hospitals delivering joint replacements to the very same population of patients needing musculoskeletal care. Improvements in worth are developed when the competition amongst the two drives up good quality in that element of the care pathway for the very same or lower fees.

Complementors include worth to a services by providing diverse actions in the all round pathway of care – for illustration, podiatrists and diabetologists complement every other in the care of people with diabetes. Their personal merchandise are more valuable when combined simply because they provide far more of the care pathway together than they do individually.

Suppliers should comprehend that they could have more than 1 position concurrently. A support can be the two a competitor and complementor at the identical time. For illustration, in the management of low back pain, both physiotherapy and spinal surgical procedure can be efficient interventions both simultaneously, or at distinct points on the care pathway – and 1 supplier might supply both services.

So, competition in healthcare is not automatically a “winner will take all” situation. Providers can concurrently have a competitive and a co-operative partnership with each and every other. As commissioners start to use new contracting types, such as prime contracts and final result-based contracting, suppliers will increasingly need to define their spot in the co-opetition market landscape if they are to obtain the very best outcomes for sufferers.

Dr Na’eem Ahmed (@DrNaeemAhmed) is a clinical fellow at the Faculty of Healthcare Leadership and Management. Dr Diane Bell is director of strategy and technique redesign at NHS Bedfordshire Clinical Commissioning Group and advisor at Far better Worth Healthcare. Dr Farooq Rafique is a London GP companion with a background in method consulting.

This write-up is published by Guardian Skilled. Join the Healthcare Pros Network to acquire normal emails and exclusive provides.

Competition in healthcare doesn"t have to be a case of winner takes all