What to make of “the NHS belongs to the people – a call to action”

I have now read this document three times – and am still unsure what to make of it.

The Call to Action – is spearheaded by NHS England with signatures from a number of NHS bodies and the Local Government Association. It sets out a challenge – how to maintain a National Health Service that is free at the point of use and able to effectively respond to 21st Century health and policy challenges.

With the exception of Cllr Zoe Patrick who is the Local Government Association (LGA) Health and Wellbeing lead all the signatories are the senior officers of the signatory organisations. However, I can find no evidence that this has been discussed at the LGA Community Welleing Board (which Cllr Patrick chairs) in May or July of this year.

There are no signatories from provider organisations such as the NHS Confederation (with the exception of local government) or from interest groups such as the NHS Alliance and of course there is no ministerial name here.

• While the call to action is clearly a commendable attempt to generate some debate about our approach to health services in this country and influence their future shape it is also of its time.
• It is also a statement of mandate and independence – creating clear space between government and the system management organisations it has created. This is the first time I can remember that national NHS bodies  have sought to create a dialogue which seeks to inform and influence government policy.
• It is an attempt to connect more with the public – it fits  with NHS Englands ideas around the NHS as a ‘social movement’ which I touched on in an earlier blog.
• Finally – although there are no timetables in this document I would guess this is in part an attempt to influence the manifestos of parties prior to the next election.

 Where is mental health? As is far too common in official NHS and Government material – there is little about mental health in the document a passing reference to “we need to do far more to help those with a mental illness” will not do.

The Analysis states that….

• There needs to be a greater focus on prevention
• The quality of life of people with long term conditions needs to be enhanced
• There is more demand on A&E and urgent admissions – which is concerning
• Patient experience and safety while good need to be improved
• Health Inequalities – there remain persistent and unfair differences in health, illness and life expectancy

It identifies a number of challenges….

• Ageing Society – according to a report by McKinsey the largest proportion of health and care spend is concentrated on providing health and social care to people over 75. This proportion will increase both with regard to physical health and mental health – in particular dementia.
• Long Term Conditions – people with long term conditions (many of whom are elderly) place a significant demand on the healthcare system.
• Impact of non-communicable diseases in the future – predictions are that by 2035 46% of men and 40% of women will be obese.
• Health services are getting more expensive. The huge investment in technology led medical improvement has led to higher expectations from the public and an increase in expensive interventions.
• Limited financial resources –  A recognition that the NHS budget will at best not grow and that government cuts in social care increasingly affect the NHS.

The document identifies some possible areas for debate such as….

Prevention – Should we invest much more in in prevention? I think the question here is still framed too much around health and care – and needs to be broadened to include the social determinants of health.

The Public – How do we give patients (the public?) greater control over their own health?

Targeting – Services need to be more tailored. Although it does not say this – this is of particular relevance to easily ignored communities and people.

Economic Growth – “the NHS is the single largest customer for UK health and life science industries”. There is a bit of an irony here – NHS and Government funding into such institutions as the NIHR are overwhelming focussed on clinical and technological interventions – yet the document calls for greater investment in prevention and personal control. Its no good making the economic case for change and calling for continued investment in expensive high tech interventions.

Call for debate

This is the bit where I start to struggle – the proposition is that NHSE will lead a national debate on priorities and that this (“biggest debate ever”) will feed into Clinical Commissioning Groups in 2014/15 and 2015/6! What happened to localism?

Like many other people I am involved as health and wellbeing activist where I live. Yet this call to action does not engage with me – it feels like a distraction to local work –  I struggle to see how this helps us develop a stronger local voice.

This feels short term, exhausting and top down.

We need more than what is proposed. Here are two things that I think would help:

• NHSE and all its partner organisations need to support an assertive and practical programme of long term investment in building local understanding about health and wellbeing and how to influence and change it. As it stands the “call to action” feels like yet another short term consultation. We need a sustained programme of significant investment in building citizen led confidence and capability at a local level in what works with regard to health and wellbeing. This means investing in local organisations – local authorities, Clinical Commissioning Groups, local Healthwatch and voluntary sector organisations, adult education institutions and others to build ongoing local democratic debate and engagement in health and wellbeing.
• Local government has to lead this through Health and Wellbeing Boards. This means that national NHS organisations need to embark on a humble dialogue with local authorities to co-produce a joint approach to this process. I am unconvinced that the current document is a product of such a collaboration.

It means letting go

What do you think?