What the UK health sector might learn from the US?

“It’s a unique situation to have a British long-term care provider which also has a sister company in the US,” Chief Executive of Barchester Healthcare, Mike Parsons, told delegates at June’s Care Conversation event. “It’s two companies, different geographies, same ownership.”

The companies – Barchester in the UK and Trilogy Health Services in the US – were both market leaders with “best-in-class, future-proof” facilities and very low rates of staff turnover, he said. Founded in 1997, Trilogy was unusual in that it operated from ‘healthcare campuses’ – large, university-sized sites – offering adult day care, assisted living and skilled nursing services, usually with specialist Alzheimer’s care.

Trilogy had 65 campus communities in five states, predominantly in the Midwest, he told delegates, and was on “a pretty good growth curve”, situated just outside the top ten of American providers. “It’s quality facilities and quality assets – everything is new build – and the target audience is leafy suburbs and market towns rather than the centre of major conurbations.”

Barchester, meanwhile, had been founded nearly 20 years ago and operated 200 homes in the UK and Jersey, with more than 10,000 residents and 14,000 staff. “We decided that an important diversification was to do more business with the NHS,” he said. The organisation had entered into a partnering arrangement that seen the amount of business it did with the health service double within four years, based on “a genuine mutual respect”, he stressed. “It’s a domino effect, so we now have 70 different relationships with different parts of the NHS, particularly the chief executives of forward-looking foundation trusts.”

There were significant differences between operating environments in the two countries, however. In the US there was “a desire to get the patient out of the acute setting as quickly as possible”, he said, based both on what was best for the patient and the fact that the acute setting was extremely expensive. “Acute hospital campuses in the US tend to be very large, but they usually focus on the acute aspect and allow others to focus on the rehab.” Pressure was also growing on the system as a result of healthcare reforms, which had led to a “highly directive” role for the government, he said.

“Trilogy has prospered by working closely with the acute sector, and we at Barchester are trying to pioneer that, with some success, although we do meet with more brick walls than in America,” he told the seminar. “Surely the argument here – if you need to save £20bn a year in the NHS – is to make sure you get people out of the acute setting. It’s acknowledged that 30% of people in acute settings don’t need to be there, to the huge detriment of the NHS budget and the patients themselves, and far too many older people are dying in hospital, in a very distressed state.”

Although issues like NHS pension costs made it difficult to estimate the true cost of a day’s stay in an acute setting, the figure for a care home setting was probably around a third or quarter of the amount, he said. Perhaps surprisingly, the US government was more than prepared to use legislative pressure to force the acute and residential sectors to work more closely together, something that was “very different” from the UK.

“Ultimately, it will come down to a postcode lottery depending on the relationship between organisations like Barchester and forward-thinking NHS chief executives who are willing to look at innovative ways of using their land. A very important point is just how much land is owned by the NHS, and how redundant a lot of that land is.”

The NHS only had 180,000 beds, he said, 120,000 of which were acute beds. “It’s a shrinking estate, and it’s going to shrink a lot more. You just can’t run those 120,000 beds effectively without doing constructive business with the 440,000 beds in the long-term care sector.