People exist in their local area and we have to connect around that

Angela Hillery profile picture

20 June 2019

Angela Hillery
Chief executive
Northampton Healthcare NHS Foundation Trust


As a combined community and mental health trust, we see our services very much through a community lens. We have inpatient and community based services in our community and mental health parts of our trust. Our perspective is very much around population  we see mental health very much in that regard and being a combined trust allows us to think about the models of care quite similarly.

Integrating care around a community asset base

We’re very much working on a community asset-based model. What we’ve increasingly tried to do is recognise that people exist in their local area and to make sure we are connecting as a partnership around that, whether that’s sexual health services, community nursing, school nursing or crisis care. We want to increasingly use assets like schools and work with local communities. We’ve got crisis cafes and breastfeeding support services, for example, making sure there are natural community opportunities to access services, not just services being available for people to come to us. We use what’s available in the community and dovetail our services to it.

I’d like to think service users engage with us differently as a result. We’ve tried to listen very much to what people want and have a real golden thread at the trust around co-production, which means that we’re trying not to determine or dictate in any way how services look – we’re trying to shape them around what people feel is needed to maximise their outcomes.

Everybody is always busy and very much focused on their particular perspective, so we’ve tried to create ways to exchange information across the trust, for example with intermediate care for older adults and mental health. We still have to work at bringing people together but we’re very conscious of it so we do create those opportunities.

What we’ve increasingly tried to do is recognise that people exist in their local area and to make sure we are connecting as a partnership around that, whether that’s sexual health services, community nursing, school nursing or crisis care.

Angela Hillery    Chief executive

Commissioning challenges

You can be commissioned from a very different perspective in mental health and community services and that lends itself to different emphases. While we have our local clinical commissioning groups commissioning both community and mental health services, we also have commissioners that are outside the county and clearly there’s sometimes a challenge around how those things fit together. That can mean keeping that localism and understanding its relationship to community assets can be difficult.

Making use of patient feedback

We put a lot of emphasis on engaging with our local communities. We work extremely hard to get feedback and we use that in all of our teams across our community to understand how people feel about all our services, so that teams can be responsive. It can be things like people saying appointment times were not necessarily suitable for young people coming out of school. We’ve got a service for childhood and adolescent mental health services called CAMHS Live where we developed an online chat facility where service users can talk to a healthcare professional through a forum when they want to. That sort of thing was directly in response to what young people wanted and in a medium that they wanted to use.

In our children’s services, we had – as many do – examples where services were very disparate. We looked at that in order to connect all the handoffs between services. We developed a referral management centre that now receives all of our referrals so we can screen, triage, and get a response according to need. This has been very well-received.

We put a lot of emphasis on engaging with our local communities. We work extremely hard to get feedback and we use that in all of our teams across our community to understand how people feel about all our services, so that teams can be responsive.

Angela Hillery    Chief executive

Outcomes over structures

Does the organisational model of the community provider matter? It’s less the variability of the type of community service provider and more about what they are delivering in terms of outcomes and how they are interfacing in partnership terms. I welcomed the long term plan’s focus on community service and mental health. The fact that there’s going to be a range of PCNs, that community services will play a pivotal role in creating the primary care workforce of the future in partnership, is very beneficial. Doing that around populations is something that I would support.

Having said that, we need to get that right, because there are services that do need to exist at scale, that do need to be managed at a specialist level, and we do need to make sure that we can deliver localism but also at a scale that is safe and effective.

We are in partnership with a couple of GP federations locally. We deliberately took that step to create a way of transforming community and primary care services together. Within that, we’ve trialled things like physiotherapy in primary care teams. We’ve looked at paediatric nursing, we’ve got some very successful examples, well-supported by primary care, where we’ve made a real difference to access to paediatric support. Those sorts of things are very much where we want to be.

I welcomed the long term plan’s focus on community service and mental health. The fact that there’s going to be a range of primary care networks, that community services will play a pivotal role in creating the primary care workforce of the future in partnership, is very beneficial.

Angela Hillery    Chief executive

For me, it’s about accepting that transformation is necessary and that actually we should all be receptive to it. This is, in my view, a fantastic opportunity for community service, but it won’t be realised if we don’t transform – and by transform I mean that we are cognisant of the role of PCNs and want to work in partnership. If we don’t genuinely challenge ourselves around productivity and technology, we won’t be able to satisfy the requirements of the long term plan. We do need to be able to demonstrate that we are making productivity challenges to ourselves – that we are recognising that there are different ways to do things.

Using apprenticeships to expand the workforce

We’ve got a really big push here on apprenticeships. I really do believe that community services are natural bedrocks for apprenticeship into the NHS, so we can play a big role in creating a pipeline for a career there.  Apprenticeships can give us an opportunity to encourage people to come into the NHS through community services – to get a foot in the door and get a taste of what the NHS has to offer, whether through therapy apprenticeships, research apprenticeships, or others. Community services give us a platform to attract people into that work and then give them routes into the NHS. There are more and more different types of apprenticeships being developed here. We’ve got a number now who have tried it and gone into other roles – for instance they’ve decided to become a nurse and do more training.

Apprenticeships can give us an opportunity to encourage people to come into the NHS through community services – to get a foot in the door and get a taste of what the NHS has to offer, whether through therapy apprenticeships, research apprenticeships, or others.

Angela Hillery    Chief executive

A future of changing and adapting to local systems

It’s hard to crystal ball gaze too far, but as for the future of the sector I think we’ll see a journey of forms changing and adapting to local systems around populations. I’d want to be playing a very significant role in these alliances around population, with community being at the centre of any integrated system and, within that, the voluntary sector and local communities very much being at the heart of integrated care systems.

I’d like community and mental health services to be involved in a number of provider alliances that will allow us to adapt and flex capacity according to different needs and outcomes, much more organised around need and population rather than services. That’s why we took deliberate steps to take a partnership approach here.

I’m hopeful that commissioning will go on its own journey - in many ways it’s essential it does, or we won’t get the focus on population health that we need. My vision for that is that commissioners would be much more focused on outcomes, very much linked with public health, local authorities, and adopting a common perspective on outcomes, enabling providers to for the most part work in alliances to deliver them.

About the author

Angela Hillery profile picture

Angela Hillery
Chief executive

Angela is chief executive at Northampton Healthcare NHS Foundation Trust which provides mental health and community services in Northamptonshire. She has worked within the NHS for 31 years. In 2018 Angela was listed 15th in the HSJ Top rated chief executives and in 2015 was a finalist for 'chief executive of the year' at the HSJ Awards.

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