Following on from some roundtable events held at the NHF, our Housing and Health Intern, David King, looks at how we can make better use of pathways.
Clinical pathways have been used in healthcare for years, providing simple ways of understanding complex processes. The wide range of interactions a person might have with the health and care system are reduced into a clear flow chart, allowing service providers and commissioners to share the same view of a system. If housing providers can understand how health pathways differ from the other pathways, then we might come a little closer to the near-mythical state of integrated healthcare.
Accurate pathways should elucidate the points at which support from housing providers could be most easily supplied to the greatest effect. For instance, if a health service is over capacity at one point of the pathway, housing providers can offer a service to extend local capacity rather than send patients to expensive out of area facilities. The benefits of keeping a patient close to their community range from improved wellbeing to a simple cost saving.
So long as they are understood correctly, a strength of pathways is that the limits of savings are just as clear. People will not necessarily progress, step by step, along a pathway. As with any framing of life, complexity is necessarily obscured. Expensive health services may be drawn on despite the use of a good quality and cost effective service supplied by housing providers.
Pathways represent a macro view of health facilities and the population. Reducing out of area placements can provide an immediate saving, but is less important once a facility is brought back to capacity. ‘Cashable savings’ that come from closing down facilities, not theoretical figures, are what NHS Trusts are in desperate need of. Unfortunately, these big wins take time to develop. What should providers focus on in the meantime?
Taking a collaborative approach, providers can think about which parts of the pathway are not being addressed by health services. Early detection of illness, which can help people to recover out of a pathway, is clearly preferable to being plunged into the later intensive stages. The NHS is certainly pivoting toward this sort of ‘primary prevention’, but lacks the community facilities from which to base their operations.
As we found out at roundtable events hosted by the NHF, housing providers already invest in their communities in ways that are incredibly useful to health, but they may not be translating their work into the language of health economics. Successful integration rests on the use of common terminology and evidence. The NHF's guide to the health economy is an excellent summary of all the ways in which housing and health can learn to talk.
Pathways are just one aspect of that conversation, but learning from the NHF roundtables we will produce two reports on mental health and dementia pathways which we hope will be valuable to innovative providers.