Professor Sir Sam Everington, Tower Hamlets GP and Chair of NHS Tower Hamlets Clinical Commissioning Group, has recently been appointed Chair of the London Clinical Commissioning Council.
Healthy London Partnership caught up with him to chat about his new role and to find out more about his plans to create a ‘health voice for London’.
Hi Sam. Congratulations on your new appointment as Chair of the London Clinical Commissioning Council. Tell us about your new role.
I have been elected as Chair of the London Clinical Commissioning Council – the Chairs of the 32 Clinical Commissioning Groups (CCGs) in London. My role is very much about supporting people working to deliver health services across London and to facilitate innovation.
The aims include creating a ‘Health Voice for London’, particularly on public health issues and driving out inequalities in Londoners’ health outcomes.
What is your vision for achieving coordinated and seamless care for Londoners?
As a group of CCG leads, we agreed that we need to have a collective voice for London and put something in place whereby the leaders of the 32 CCGs and London’s five Sustainability and Transformation Partnerships (STPs) can come together to support the NHS workforce with local delivery. So we formed the London Health Executive.
The question for us as chairs is what more can we do to improve care and outcomes? Traditionally, the NHS has seen a lot of top-down ‘command and control’. What we want to do is to stimulate innovation and cooperation in every part of the NHS to deliver what’s best for patients.
We will be finding out what we can do to make life easier for commissioners, health providers and, most importantly, for patients.
What are your immediate priorities in your new role?
We need to focus on prevention and intervening in the disease process way before it ends up in a hospital admission and, if patients are admitted, support them to get home as soon as possible.
We also need to do more to empower patients by putting them at the centre of their care.
One of my first tasks was to write to NHS England and NHS Improvement identifying the things London CCG chairs believe need to be done to support their aims around transforming outpatients.
The national roll-out of paperless referrals from general practice to hospitals is reducing waiting times, improving patient experience and reducing administration. It is only fair that the same requirements should apply to hospitals; all hospital “letters” should be sent back to GPs electronically.
We estimate that we could reduce physical attendance at outpatients by 50% and deliver specialist support in a much more timely fashion than the current system. For example, instead of the old fashioned approach of typically waiting for three months to be seen as an outpatient, we want to see immediate triage by a specialist team; where they can access your notes and react, by perhaps booking a test, giving a telephone consultation or responding with advice to your GP. To support this, we need the NHS to provide a new financial model for paying hospitals.
50-60% of patients, with a terminal illness, die in hospital. Most would choose to die at home surrounded by their loved ones. We can make this happen by providing more out of hospital support, ironically at less cost than a hospital bed.
Childhood obesity, as part of the spectrum of poor nutrition, is a ticking time bomb. Schools need support to be part of the healthy schools programme and we need to encourage more clinicians and health experts to join governing bodies of schools. I recently ran a mile with the chief executive of the Tower Hamlets Council and 1,000 children around Mile End stadium in the Run a Mile a Day initiative!
How will you deliver this? How will you ensure clinicians have a voice?
My role is to find ways to support our clinicians to share their expertise and to help secure more resources for them. We have learnt through clinical commissioning that clinicians are compelling when they argue for change.
We are exploring a kind of ‘NHS ideas dating agency’, where we match people with ideas with people who are looking for solutions. People in the NHS are incredibly generous with their time and we know that many want to help but connections are rarely made across different organisations. In the same way that NHS Professionals matches people looking for jobs with vacancies, we’re looking at how to connect people with interesting ideas to people who are looking for solutions.
This idea is also about expanding leadership in the NHS. Our focus is often on the top leadership but the NHS thrives on teams and leadership throughout the organisations. Everyone needs support in becoming a leader to deliver innovation and quality improvement.
The recent King’s Fund report, which reviews the progress of London’s STPs, claimed that London’s ‘complex and cluttered health and care systems is hampering plans to improve Londoners’ health’. How would you respond to that?
The King’s Fund report accurately describes the challenges we face when major systems are restructured. We have faced significant changes in recent years – the Lansley reforms, the formation of the STPs and now the merger of NHSE and NHSI and the formation of integrative care organisations. There may be good arguments for these reforms, but we need to accept that each restructure delays delivering change for the NHS, sometimes by years because of the reduced capacity to focus on delivery.
How can we be better about communicating the complex structure of the NHS to patients and the public?
We need to ensure that when patients need help, the system for them is as simple as possible, to get the right help for them in the right time.
What is the biggest challenge facing health and social care at the moment? How do you envisage overcoming this in London?
The social care budget is under enormous pressure, which in turn leads to difficulties in getting people home from hospital. Primary care is also under enormous pressure due to workload and staff shortages. We need to support the expansion of out of hospital to take the pressure off hospitals and deliver care in the community wherever possible.
Why is it important for patients to be actively involved in their own care? How is this being achieved in London?
Patients who are actively involved in managing their care achieve much better outcomes, particularity when there is a focus on what matters to them rather than what the matter is with them.
An example of this is the simple technique of patients measuring their own blood pressures. Research shows that patients who do this, have a lower blood pressure by 5 points.
Social prescribing is also a critical support for patients and we would hope to ensure that a patient has access to this scheme, in the next three years, throughout London.
Finally, how do you see the role of The Mayor in improving the health and wellbeing of Londoners and how do you see your relationship with the Mayor in relation to making London the healthiest global city?
My role is to work closely with the Mayor, who has a clear focus on tackling mental health, obesity, inequality, primary care and violence reduction. He wants to see measurable progression in those areas and that fits in entirely with our ambition for making London a healthy place.
To support this, I will be reviewing our resources for joint working. I’ll be looking at how we integrate our team with City Hall and avoid duplication so that we add value to each other’s work and build effective relationships.
Glasgow has been very successful in reducing knife crime among young people with a partnership and public health approach. We will be a part of the Mayor’s Violence Reduction Unit which is aiming to do the same for London.