Visit to Surrey Downs Health and Care

This week, Daniel Elkeles visited Surrey Downs Health and Care, part of St George’s, Epsom and St Helier University Hospitals and Health Group, where he saw an impressive example of integrated care across a complex geography of 300,000 people. The area has delivered a new model of care for older people with remarkable results: a sustained drop in elderly admissions, shorter hospital stays, significantly reduced social care costs, and 50% fewer nursing home admissions. 

Daniel said: "Roles that were once hard to recruit across hospital, primary, and community care now face almost no vacancies, as staff are drawn to the new way of working. Surrey Downs also reports the lowest spend on elderly care per 10,000 people among ICS peers. 

"They’ve built a single, cross-sector team for older people’s care, spanning primary care neighbourhoods, voluntary sector partnerships, MDTs, planned long-term condition care, same-day urgent care, virtual wards, a single referral point, seven-day urgent care, and integrated inpatient and community beds, all centred on a home-first approach."

The model is delivered through a formal partnership including Epsom Hospital, three GP Federations (Dorking Health Care, Surrey Medical Network, and GP Health Partners), seven PCNs, Surrey County Council, four borough councils, Surrey and Borders FT, Princess Alice Hospice, Central Surrey Health, and numerous voluntary organisations. Funding has grown from £3 million to over £40 million through the Place Alliance.
 
They credit their success to:
 
🔵 Clinician-led ambition for patient care.
🔵 Strong relationship-building.
🔵 Investment in frontline leadership.
🔵 Cross-setting clinical care.
🔵 A unified team approach.
🔵 Designing the care model before the governance.
🔵 Consensus-driven governance combining acute trust strengths with primary care’s clinical voice.
🔵 Devolving community services to PCN/neighbourhood level with a manager, nurse/therapy lead, and GP lead.
🔵 Shared resources across providers, including PCNs.
 
"Thank you to Thirza, Nikki, Clive, Chris, Malin, Tom and Binu for arranging such an informative and inspiring visit."