Fiona Dalton, CEO

Chief executive's blog - 2 November 2015

Nationally, the buzz words in the NHS right now are integration and collaboration - and I think these words sit very naturally with most people in healthcare. As healthcare becomes more complicated, bigger and bigger teams are required, and increasingly we need to work in multi-professional and multi-organisational teams to really get things right for patients.

We have described our approach to this agenda as our ambition to become a "hospital without walls". I believe that this means breaking down the walls which patients hit when they try to move between organisations, and the walls which force them to be in hospital when they would rather be at home. And we are trying to do this in partnership with other organisations, allowing each one to provide the services where they add most value, without us being so arrogant as to think that we can do everything best.

I felt that I saw this vision in action last week when I went to visit the respiratory centre.

Acute and specialist respiratory services have always been strong at UHS – and sadly there is a specific local population need for this service because of the high prevalence of smoking locally – so the strong emphasis on smoking cessation and the links to the Quitters service are very important.

However most respiratory problems are chronic, and we need to support patients in the community as much as in hospital, and to put as much effort into preventing hospital admissions as we do into giving the emergency interventions when patients are in crisis.

So I think the respiratory team were ahead of their time when they established an ambulatory respiratory care unit (the respiratory centre) in 1999, with the aim of reducing inpatient admissions and length of stay for respiratory patients. This initial objective has grown into a team that tries to “provide and coordinate responsive, compassionate and high quality respiratory care at the interface between specialist services, community services and the patient’s home”.

The team now provides ambulatory, virtual (non-direct patient contact) and integrated respiratory care, including:

  • Integrated COPD services - having won tenders for both local CCGs for community COPD services (in partnership with Solent, Southern and Hampshire hospitals) we can now provide integrated specialist care for this group of patients, with the same clinical team looking after them at home and in hospital.
  • Support at home - in partnership with a private provider, the team supports the provision of home oxygen for over 400 local patients. The centre is also a regional referral unit for the provision of complex home ventilation to just over 230 patients with progressive respiratory failure due to neuromuscular disease or COPD (another wall being broken down – that between the traditional ‘specialist’ and ‘local’ services delivered side by side - “no patient more important than any other patient”).
  • Virtual clinics - most patients admitted to hospital with pneumonia should have a follow up chest x-ray, but many of these patients do not require a physical review. This ‘virtual pneumonia clinic’ allows consultants to review the chest X-rays of about 300 patients per year without requiring those patients to come back to hospital for an outpatient clinic.
  • Treatment at home - co-ordinating and setting-up home administered intravenous antibiotics for patients with complex lung infections - allowing patients to be treated at home rather than having to come into hospital for at least two weeks, as would previously have happened.
  • Admission avoidance - providing a referral pathway for rapid outpatient respiratory from the emergency department and acute medical unit, to allow patients to go home wherever possible as soon as they can.

The current healthcare climate demands inter-organisational, responsive and integrated care. It’s a big ask, and the pace of change will only get quicker - but when I saw what could be done out of four rooms on D level in West Wing, I felt really positive that our vision of a ‘hospital without walls’ can truly be delivered.

Fiona Dalton


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Page comments

I’m sorry to hear about the problems you and your father are experiencing. We would be happy to discuss this personally with you if you would find this helpful.
I absolutely agree that we have a long way to go in terms of integrated care with other organisations and unfortunately there are currently significant capacity issues in the home care sector. We are very conscious that hospital is not the right place for patients unless they are acutely unwell and we are doing everything that we can to work with partner organisations to try to help patients get home as quickly as possible.
Fiona Dalton (11/11/2015 19:22:13)
Dear Fiona,

You have a long way to go in integrating care in the Southampton area, in my experience. My father is in hospital now and has been occupying a bed on G9 unnecessarily for the last 5 days. His discharge summary has been written and his meds are ready to go. I have offered to pay privately for his aftercare but there is not a single home care company in Hampshire that will even give us a date for an assessment so that healthcare at home could start. I have wasted 4 days of phone calls and Dad is now getting depressed about being in hospital with absolutely nothing to do. No bedside phone , no TV, not even a bedside light so he can read. This is the reality of integrated care in Hampshire now.
I thought I knew my way around the system. I was the Dean of Medicine at Southampton from 2000 to 2004 and Professor of Psychiatry from 1988 to 2004. But it now feels like I am stuck, like Alice, in Wonderland, without the poetry. Can you help?
Professor Chris Thompson MD FRCP FRCPsych (09/11/2015 20:16:52)