During these tumultuous, post-Brexit days, the myths and realities of NHS funding have been at the heart of the fallout. Writing in the Telegraph last week, Simon Stevens, Chief of NHS England sought to refocus the debate on NHS transformation: ‘the need for radical change is now. We know what needs doing. Let’s get on with it.’ Innovation Unit agrees that ambitions for a radically different, better, lower cost NHS must survive life after Brexit - and we agree entirely that investment in prevention, primary care, and social care are key priorities.
Our experience suggests that there is currently a crucial ingredient missing from Simon Stevens recipe for radical change - the NHS cannot deliver transformation alone. It must reach out and work in partnership with patients themselves, and with colleagues in social care, housing, policing, education and beyond to tackle challenges as complex as childhood obesity and mental ill health. These are systemic challenges, and if the NHS defines its priorities and investment alone, Simon Stevens’ radical ambition will be curbed.
In partnership with patients
The NHS five year plan puts transformation of primary care at its heart. The current pressure on GPs is clear. We know that 20% of GP time is spent on non-health issues. This shouldn’t be a surprise. People's’ lives are knotted and complex so our health is grounded in a mix of physical, social and emotional wellbeing. Helping people to get and stay healthy must therefore engage patients in exploring this picture fully, designing solutions that speak to it and growing their agency to maintain their health over time. Patients can no longer be passive recipients of care, but be supported to become active managers of healthy lives.
Lambeth demonstrates that for primary care to work effectively, it isn't just about increasing access. It is about transforming the partnership between patients and GPs to design better services, and to build the capability of patients to manage more for themselves.
The Lambeth Living Well Collaborative is a group of service users, GPs, providers and commissioners working together to co-design radically different, better mental health services, like the Hub and the Evening Sanctuary at the Mosaic Clubhouse. Patients are in an equal and reciprocal relationship with professionals as designers of the overall service offer, of their specific support plans and managers of their own health. Crucially, this is helping patients to live well with their conditions and avoid crisis moments. They are more confident and able to approach a service that is staffed in part by their peers, and which they are confident can actually help them. As a result, Lambeth has seen a dramatic reduction in the use of secondary care, in the context of budget reductions of 40%.
In partnership with others
Stevens also calls for a renewed focus on prevention to help people live longer, healthier lives. This requires partnerships that draw on the valuable assets found in schools, local authorities and others, not just in the NHS.
Take for example child obesity. Weight management programmes and public health campaigns struggle to make a dent in the issue. Even adding in regulation of food labelling and advertising cannot tackle this growing problem alone. Data shows us there is a strong relationship between socioeconomic status and childhood obesity. And intelligence from local providers suggests that this is even more stark - that many children with the most severe weight problems, often come from chaotic families, and are already known to social care. Both the factors that influence obesity, and the potential solutions span multiple organisations and sectors.
The team at Better Food Wirral recognised this and saw a clear need to encourage more positive diet related behaviours while also helping to build a healthier and fairer local food system. We trained a cohort of professionals from across local government to work as community researchers. Staff members from various parts of the system – including the public health team, schools, CVS and the Back to Work programme and Involve North West – volunteered to take part in the project.
The community researchers gained rich insights into the realities of people’s lives and the full range of problems that a local food plan might need to address. One researcher spoke how the opportunity felt like “a real call to action.” Another local councillor joined a local board specifically working on the dual issues of social isolation and poor diet by connecting people through food.
It was clear that obesity was not a problem that could be solved by weight management programmes alone. The whole local system from business and schools to local politicians and community organisations were need to craft solutions that could really help.
Partnerships with patients and with colleagues in social care, housing, policing, education must be at the core of ‘radical change’ in the NHS. This will require shifts in priorities, resource, accountability and leadership to name but a few. Simon Stevens is right to move the debate on from where the money is coming from, to where it is going. Let’s now go further still and design a plan for radical change to our health, not just to the NHS.