CEO blog - Thoughts on Neighbourhood Teams (Part 2)
Thoughts on Neighbourhood Teams (Part 2)
I ended the last blog with the suggestion The real problem is, who owns the delivery of Neighbourhood Teams?
If you strip away the gobbledygook of NHS policy language, the pretty strategic diagrams and new terminology, most systems are still wrestling with the same operational problems they have had for the last 25 years. Successive political dogma has meant tinkering with internal relationships, structures, and funding. They have fragmented pathways, hidden workload, caused the potential for duplication, delivered system change with unclear ownership and even workforce pressures.
Patients are moving between services that were never truly designed to work together operationally. That is why Integrated Neighbourhood Teams matter. Not because integration is a new government idea. The NHS has talked about it for years. What is different now is the pressure behind it which I noted in part 1 of this Blog.
Patients are living longer with more complex needs that do not fit neatly into organisational boundaries. Hospitals cannot continue absorbing demand indefinitely especially when they are under pressure to reduce beds. General practice cannot keep carrying more complexity with a smaller slice of the total budget and without redesign of its core contract. Community services cannot simply inherit more work without capacity and estate.
The real issue is not whether neighbourhood healthcare sounds sensible. It does. The real issue is whether anyone has a practical delivery method for making it work. That is where the conversation becomes harder, because once neighbourhood healthcare moves from ambition to delivery, uncomfortable questions appear.
Who does the work?
Who carries the risk?
Who funds the model?
Who owns escalation?
Who absorbs the hidden workload?
What happens when demand rises?
Those are operational questions and they are all difficult to answer. Often people talk about goodwill. But what happens when goodwill runs out? Goodwill is not an operating model.
Goodwill often starts things, it gets people into rooms, it helps teams work through uncertainty, but goodwill sometimes masks fragility, unfunded work, workforce gaps, uncertain ownership, and the fact that the pathway only works because a few committed people are holding it all together. That may be enough for a pilot, but it is not enough for a system reset.
Have you had the difficult conversations yet in your neighbourhood team?
William Greenwood
Chief Executive