RESUMO
There are great disparities in health between places in the UK. People living in poorer areas are dying on average 9 years earlier than in wealthy areas, largely due to regional economic differences, including high unemployment, low wages and social inequality, unrest and injustice that accompany economic disadvantage. Preston in the north-west of England has been developing a community wealth building project known as the Preston Model, which shows signs of successfully increasing and retaining local wealth. The anchor institutions—large local organisations that are ‘anchored' in places, such as hospitals, universities, housing associations and local government—have developed social value policies and policies of cooperation with their communities that attend to a heightened awareness of corporate social responsibility and enhanced working relationships with local communities in order to turn around local fortunes in an allied economic and health initiative. Corporate social responsibility is the essence of cooperation and cooperatives and is a central feature of the Preston Model. Ultimately, CSR within the Preston Model is concerned with quality employment. The pandemic has highlighted the need for CSR and cooperation. This chapter brings together researchers from the University of Central Lancashire, Lancaster University and stakeholders from two of the anchor institutions—the Lancashire Teaching Hospitals NHS Foundation Trust and Community Gateway Association—to combine an academic framework, including local responses to interviews and participatory community groups in Preston, with two major anchor institutions as case studies. The chapter will investigate a broad range of initiatives, from directly focussed health policies, such as social prescribing, to wider, ‘softer' approaches, such as developing participation, cooperation and democracy within and between organisations, groups, teams and communities and the corresponding networking and mutual support systems that may affect greater agency, empowerment and enhanced mental health outcomes among people in Preston and Lancashire, ultimately transferable to other UK regions. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
RESUMO
Introduction: The 2018 GIRFT report and 2019 NICE renal and ureteric stone guidelines recommended regional, fixed-site lithotripsy units to provide elective and emergency extracorporeal shockwave lithotripsy (ESWL) for urinary tract calculus <20 mm. In our region, Trusts were serviced by a mobile lithotripter, which was unable to provide adequate emergency treatment, as such a new fixedsite regional service was developed. Methods: The ongoing pandemic resulted in many challenges in the service development, including a reduction in urological operating by 25% during the COVID-19 pandemic, with additional loss of capacity as only patients ASA 2 or below was able to be treated in peripheral centres. A new pathway was introduced aiming to reduce admissions to surgical wards, instead moving directly to treatment and pain relief at home, in line with the 2019 NHS long-term plan. After 6 weeks of treating local patients, the service was opened to Trusts across the region to enable equal access for all patients' for both emergency and elective ESWL. Results: In the first 6 months, 144 local stones were treated with ESWL (38 ureteric and 106 renal), of which 118 (81.9%) were successfully cleared, with the NICE guidelines quoting success rates between 72.4% and 83.8%. Across that period, this would have required 40 additional operating sessions (160 operative hours) to treat these stones ureteroscopically. With ureteroscopy £2347 more expensive than ESWL to get stone clearance (Constanti et al. BJUI 2020;125: 457-466), the treatment cost saving in the first 6 months is £281,666. In addition, 53 stones were treated as an emergency from the region, with a stone clearance rate of 81% and 53% treated within 48 hours. Conclusion: The new ESWL service has resulted in regional stone treatments with success rates in line with published data, in addition to providing economic and operative capacity benefits during a global pandemic.