Thanet Health CIC

Social Impact Statements

The Social Enterprise Mark criteria includes a requirement that the applicant can demonstrate that social and/or environmental objectives are being achieved.

In support of this, new applicants and renewing Mark holders are asked to respond to a set of social impact questions, which are designed to help them think about the social impact they create, and to articulate this clearly and succinctly.

 

Updated May 2020

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1) What are the main social differences you have aimed to make (or supported)?

There are clear links between health and wellbeing and social issues. Thanet Health CIC is providing services in an area which has some of the highest deprivation indices in England.

“The health of people in Thanet is generally worse than the England average. Thanet is one of the 20% most deprived districts/unitary authorities in England and about 24% (6155) children live in low income families. Life expectancy for both men and women is lower than the England average.” (Public Health England Local Authority Health Profile Thanet 2019).

As such it is imperative that those services contribute to improving the health and wellbeing of local patients, and by so doing reduce health inequalities and address some elements of social need.

Access to services is a key issue for Thanet Health CIC. In particular, access to urgent care and routine primary care. For example, the Urgent Treatment Centre is designed to provide patients with urgent access to an appropriate clinician. Prior to the service being established many of the patients with these needs would have waited for a number of hours in the local A&E department, or wouldn’t have sought treatment at all.

One of the by-products of our services is that they reduce the pressure on local GP practices by shifting demand from those practices to our services. This also improves access to routine GP services as capacity in those services is freed up to see patients whose needs are most appropriately met in primary care. For example, the Home Visiting Service was able to undertake 2486 home visits to patients during 2020. This equates to 2804 GP hours saved for local Practices. This resulted in a financial saving of £228,526 for local Practices (based on average GP locum costs which would have been required to deal with the home visits).

A key Thanet Health CIC project is the leadership of a proposal to create a health and wellbeing hub which will house a range of routine primary care and third sector services. There is a direct synergy between this project and the organisations desire to improve the health and wellbeing of the local population.

In summary, our key social aim is to contribute to improvements in patients health and well being by providing services which are easy to access and which provide the most appropriate care for those patients.

 

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2) What actions have you taken to deliver the aims described above?

We provide a number of services which address a range of urgent, complex and routine health needs as follows:

• Complex Acute Response Team – provides community based care for patients with complex health needs who are at risk of admission to hospital but can be cared for in the community with appropriate care from a multidisciplinary team. During the period Jan-May 2021 we supported 1720 patients in their own homes. Leaving aside the obvious benefits for patients of being able to be cared for in the community there is also a benefit to the local health system resulting from a reduction of admissions to the local hospital. Whilst activity figures for admissions to hospital have shown a reduction in the past year it is too early to suggest a direct correlation between this service and that reduction activity. This is due to 2 factors (i) there are a number of variables in play which impact on hospital admission rates, and (ii) the Covid pandemic has had a marked impact on hospital activity in general.
• Urgent Treatment Centre – provides urgent minor illness and minor injury services. Patients would previously have been seen in A&E. For the period Jan-June 2021 we have seen 21,000 patients in this service.
• Home Visiting Service – takes referrals from local GP practices for patients in the community who require a home visit. The service can provide a faster response than the patients GP practice. For the period Jan to Dec 2020 the service undertook 2486 home visits to patients. This equates to a saving of 2804 hours of GP time for the same time period. This equates to a financial saving to Practices of £228,526.
• Extended Access – provides routine primary care services at the weekends and Friday evening. This service has increased the routine GP appointment capacity in Thanet. See activity data in the following section.

 

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3) What has changed, what specific outcomes and benefits have been realised as a result of the above actions?

Patients have improved access to the care that they need. See Sec 50 for activity data.

We expect, in the future, to be able to quantify the impact that this increase in capacity has had on the rest of the health and social care system. However, this is currently extremely difficult to measure given the impact of the Covid 19 pandemic on all services. What we know with certainty is that without these services

• There would be less routine GP appointment capacity in the local primary care system. For example, during 2020/21 the Extended Access service provided by THCIC provided 26.500 additional routine GMS appointments for local patients.
• There would be longer waits in the Emergency Department (ED) as the patients who are seen in the UTC would be seen in the ED
• Patients who are unable to attend their GP surgery for an appointment would wait longer, and there would be increased pressure on GP practices who are already struggling to meet demand due to the high numbers of patients per GP in Thanet
  • Longer waits for urgent care
  • Longer waits for routine primary care
  • Unnecessary admission to hospital
  • Delayed discharge from hospital
  • Patients being cared for in an inappropriate setting e.g. A&E
  • Patients not receiving care if they decide not to access alternative services due to long waiting timesAnecdotally our expectation is that there are a cohort of patients who in the absence of these services would have experienced one of the following outcomes:

As these services become embedded in the local health and social care system we will work in partnership with other local providers and commissioners to audit and analyse the impact of these services on the local system. Currently this is challenging because of the impact of the Covid pandemic on local services.

 

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4) Please describe how your income and/or any profits generated from previous years has been maximised in delivering social outputs and adding social value.

There are a number of initiatives we have undertaken which have been over and above the contractual obligations we have to our commissioners. For example:

• During the first wave of the Covid 19 pandemic 2 local GP Practices (Newington and St Peters) were at risk of closure due to workforce issues. Thanet Health CIC was able to utilise our own staff, both clinical and administrative, to ensure that the Practices remained open. Given the demands on primary care during the pandemic this was a vital contribution to ensuring that 13000 patients were able to continue to access primary care services. We were able to provide this support from within our existing resources.
• The Covid Oximetry service, described in Section 11, was provided at cost. The surplus investment secured from Kent and Medway CCG was invested in local GP practices to improve their sustainability.
• We have invested a significant amount of time during the last 6 months to develop our relationships with the 3^rd We expect that this will, in the near future, result in joint funding bids between the CIC and 3^rd sector organisations. The primary aim of these bids will be to further develop services which are aimed at improving the health and wellbeing of people who live and work in Thanet.
• Thanet Health CIC is facilitating the local Community Pharmacy Consultation Service. This service is aimed at patients who have minor illness and who could be appropriately seen by a Community Pharmacist. We are working to develop and improve the communication links between those Community Pharmacists and local GP practices. The result of this will be a significant improvement in the sharing of information between pharmacists and GPs, thereby delivering better consistent care for patients. This is an initiative which we are using existing resources to support.
• Recognising the accommodation pressures on local GP practices we have now leased and equipped office space which can be used for free by practice staff and PCN staff. As this develops we expect it to contribute to the estates sustainability of local primary care services.
• We have been able to facilitate and support Covid 19 vaccinations for a group of 100 homeless people.

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Supplementary details

The below questions are not mandatory, but Mark holders are encouraged to answer them where possible, to provide a fuller account of their social outcomes and the social value they create.

5) How do you and other people know your aims are being achieved? Or how will you know?

There are a number of mechanisms which the organisation utilises to measure our performance against our aims:

• Delivering on KPIs and broader aspects of the Contracts and Service specs. We regularly report both internally and externally (primarily to commissioners)
• Feedback from patients. We have undertaken a number of patient surveys to collate patient views about the services we are providing.
• Feedback from staff. We encourage staff to feedback their views regarding the organisation and its services. This can be undertaken on an informal and more formal basis, for example the Staff Away Day proved to be a valuable source of feedback.
• Feedback from other stakeholders, including CCG. With regard to the CCG we receive formal feedback about our performance through contract review meetings. This is in addition to more informal feedback during meetings.
• Feedback from Practices, particularly in relation to primary care resilience. The organisation is in constant contact with local GP practices. This relationship is a valuable source of information as far as the performance of our services is concerned.
• Overall system performance e.g. 4hr ED target, with caveat that it is difficult to prove correlation between admission avoidance activity and improved ED performance.
• Report on HVS commissioned by Kent and Medway CCG.

 

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6) How many people have benefitted from your actions and what measures of benefit can you report?

See response to question 2 above.

 

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7) What examples can you provide of a typical service user experience, that help illustrate the benefits they have experienced as a result of your actions?

Examples of case studies from the UTC

• An elderly patient attended UTC with toothache on Xmas day. He was initially assessed and treated for toothache and prior to discharge the ACP noticed a suspicious lesion on his face. She asked the patient how long it had been there and had it changed? He stated he had noticed something on his face but was not able to clearly see it for himself, he had been unable to get an appointment with his GP and therefore hadn’t seen anyone about it recently, he had previously been told it was sun damage and as couldn’t see it properly he hadn’t taken any more notice. Having assessed the lesion and on finding it to be suspicious the ACP completed a 2WW Referral to dermatology for suspected cancer. On follow up it was revealed that the patient did indeed have cancer and underwent surgery for this cancer. The patient wrote a letter of thanks after his treatment. This patients outcome would not have been so favourable had the practitioner only focussed on the patients dental problem. Treating this patient holistically ensured that his cancer was diagnosed and treated in a timely fashion ensuring a favourable outcome.
• A 60 y/old lady attended the UTC with a history of abdominal pain for over 2 months. She had already had two telephone consultations with her GP surgery and her abdominal pain was being treated as constipation. The patient attended the UTC as couldn’t stand the pain any longer. She was acutely unwell as pyrexial, tachycardic and hypotensive. The patient was found to have pain in her right iliac fossa and a mass was found. She was immediately referred to the surgeons who formerly diagnosed and appendicitis and abscess formation.  This was a potentially life threatening condition that required a knowledgeable assessment and prompt management – fortunately she received this under our care and made a full recovery following her surgery and stay in hospital.

Examples of a case study from the Extended Access service

• An elderly patient was booked by her GP surgery for the extended access clinic that is held at the weekend as she had been experiencing ongoing abdominal pain. She had previously had a telephone consultation with her own GP who had treated her for likely diverticulitis. On examination of the patient’s abdomen, she was found to have a 7cm infra renal pulsatile mass which would indicate that the patient likely had an aneurysm (a life threatening condition) and not diverticulitis. She was referred for a scan on the same day then was referred to the Vascular Surgeons and had stent fitted the next day.  This patient may well have died had it not been for the thorough examination and prompt action of this practitioner.
• A patient in her 20’s attended with back pain and sciatica. A full assessment and diagnosis was undertaken.  She was very distressed at her levels of pain and worried that she could potentially be in pain for the rest of her life.  A long consultation was undertaken, with a detailed discussed around the causes of back pain, the treatment options and the prognosis. She left happily, having made a decision to take paracetamol and ibuprofen, to continue with physio exercises and to try yoga/pilates. Following her consultation she was also going to ask if she could work differently at her place of work, for a short while to relieve the strain on her back. Back pain is often dismissed as a minor condition that comes and goes and affects most people at some time in their life but it can be debilitating, demoralising and lead to depression. The practitioner felt this consultation empowered the patient to make informed decisions about her care, and to manage her pain.

Examples of case studies from HVS and C-ART

• Mrs A was referred to the HVS for the assessment of a breast issue that had been identified by one of her carers that morning. Mrs A was immobile following a previous illness, and was unable to attend the GP without a co-ordinated approach to her transportation. We visited, and undertook a thorough assessment and examination. As a result of this visit, Mrs A was referred to the rapid access breast clinic via a 2 week wait pathway. This process was initiated, monitored and followed up by the HVS team to enable learning, and ensure that access was not impacted by any administrative delays. Recent evidence has indicated that there has been an increased incidence of delayed presentations of cancer as a direct result of the pandemic (reference here), and as a result timely identification and referral of suspected cancer presentations are key to improving access to further assessment and care.
• Mrs Z was referred to the C-ART team with the request for a medical review. She was seen promptly by one of the team GPs and thoroughly assessed. Bloods were requested and followed up on the same day, and the patient was appropriately referred to secondary care for further investigation. Mrs Z's provisional diagnosis was confirmed by our secondary care colleagues, and she was discharged back home under a palliative pathway as this was her preferred place of death. We met the family at home shortly before Mrs Z arrived by ambulance, and used this time to support them with contact numbers, understanding processes and expected presentations at end of life. We were able to ensure that this key part of her life was not fragmented by delivering a multi-professional approach with key stakeholders.  This meant that she was supported to have a 'good' death at home with her family. This co-ordinated approach is championed within the latest release of the Ambitions for Palliative and End of Life Care: A national framework for local action 2021-2026. It identifies that 'the will, determination and innovation of organisations working collaboratively to find new ways of delivering better care' is key to this, and something that we were able to evidence well within this case study.

Example of C ART Complex Case Support Working Systems Wide

• 77 years old lady admitted to Appleton Blue Unit (Social Services) at Westbrook House from QEQM Hospital Margate. Multiple medical problems and unable to manage at home on her own. Her usual GPs are in Minster. Lost to follow up of her Inflammatory Bowel Disease (IBD) - Crohn’s Disease during the Covid Pandemic. Admitted with acute flare and commenced on complex steroid regime, developed Covid, abnormal liver function as was on Infliximab that needed to be stopped which in turn potentially affects the Crohn’s Disease improvement. She also had low Calcium, Magnesium, Potassium and Albumin.  She has complex abdominal pains, leg swelling due to steroids and possible heart failure. She also has skin lesion on left temple that required complex care as result of infection including potentially some cancer type concerns. She also had COPD, Hypertension, Ischaemic Heart Disease, Malnutrition, Frailty and Low Mood. All the above required meticulous time-consuming assessment for managing multiple issues, assessments, blood investigations, treatment changes and follow up. Required high level coordination with the IBD specialists, dieticians, own GP, our multi-disciplinary team members. Required district nurses’ input with the left temporal complex wound and treatment. Most importantly we had discussions with her and her family to ascertain what matters to her? As she was at risk of repeated hospital admissions whilst offering her the optimal holistic care in the community. Whilst discussing here future care wishes and devising her Treatment Escalation Plans and Do Not Resuscitate Forms, it emerged she did NOT wish any hospital-based treatments or escalations and more supportive care. She also desired to return home for what is likely to be palliative phase of her life and she wished for her end-of-life care to be delivered at home. Our team was a central to all above and most importantly being patient’s advocate and with high challenge and support to aim to get her home rather than hospital or care home as was suggested. Both the patient and professional involved were sharing positive feedback of care shared.

Above case is a typical example of complexity we handle in the community and work across systems including acute, urgent, community, primary and palliative to support our patients. Such patient voices are often lost in complex medical processes and that are hard to navigate but also often involves futile interventions and significant cost implication to the wider health economy. We also communicate to all involved parties and including patient families and fellow professionals.

 

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8) What social and environmental benefits have you created arising from internal operational policies and other actions?

Thanet Health CIC provides access to the Cycle to Work Scheme which has been utilised by some of our employees.

In addition the organisation offers an Employee Assistance Programme (EAP). Support for staff is available on a range of issues including legal, financial, emotional, health issues and work related concerns.