Blog written by Steve Tathata - Community Anchor Development Adviser
I thought I’d start this one with a quick quiz.
What’s missing from the following three images? *
*answer at the end
Five Year Forward View
I ended a previous blog with a quote from the NHS Five Year Forward View:
“So this Forward View sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health.”
Too often any initiatives arising from statements like the one above are health service centric, that is to say they tend to put health services at the centre of any ‘health’ developments. Broadly speaking they usually look at how people can fit better into ‘health’ services, with a belief that improvements in health will come about as a result of increased provision and easier access. They don’t engage with, they do to. The underpinning principle is ‘not only do we know what’s best for you, we know best how that should be done and how and where it should be provided’. And often the very initiatives that were intended to meet rising demand actually increase it and in so doing add further pressure to a system that is struggling to cope.
Making people passive recipients of health services won’t ‘promote wellbeing and prevent ill-health’. People are not lifeless mechanisms that simply need to be fitted in and fixed, they are living, breathing, thinking, feeling organisms. They don’t fit neatly into categories, care pathways, complex systems and one-size-fits-all services.
So, instead of creating demand which then has to be met (by a dwindling workforce), how about seriously considering how demand might be reduced and how health and wellbeing can be promoted? How about placing ‘health services’ on the periphery of health and wellbeing developments and positioning the determinants and enablers of good health, and the people they affect, as the central focus?
The Forward View emphasises the need for health services to develop and evolve in order to meet the changing needs and demands of the population. But do they? Is that really the best approach to solving the challenges of spiralling (preventable) ill-health and the promotion of wellbeing? Or (option b) does the population need to develop and evolve to reduce the needs and demands on health services?
Personally, I’d put my money on option b.
There seems to be a belief at some level in the NHS that the NHS has to be everything to everybody and that if something needs to be provided then the NHS, in some way, shape or form is the body to provide it.
And because of that, despite the rhetoric about how things could be different if the NHS ‘engaged with patients and carers’ or ‘harnessed the renewable energy represented by patients and communities…’, it doesn’t seem to happen to the extent that it could.
When healthcare isn’t health care
We’re caught up in a particular paradox when we refer to the NHS as a provider of health care services because in the main it is not. It is a frequently cited argument that the NHS is actually a provider of ill-health services. This is recognised for example in the document ‘A Call to Action: Commissioning for Prevention’ (pdf) a challenge is presented to the door of CCGs (Clinical Commission Groups) encouraging them to be bold if they are to make the changes necessary to meet the health demands of the future by ‘transforming the NHS from an illness service to a wellness service’.
Nice idea, in principle, perhaps.
But I’m going to go against the grain of almost everything I’ve read for quite some time now and suggest it might be an idea for the NHS to stop trying to be everything, and for commissioners to be bold and commission excellent ill-health services separate from excellent wellness services.
I think there’s more mileage in freeing up the professionals to do the job they trained long and hard to do, in environments that allow them to do that to the best of their ability, than there is in expecting them to become experts on everything, including wellness, and then constantly beating them over the head for all of the things they haven’t done.
The notion of less is more could offer a more realistic direction for the NHS than the current position of doing more with less, coupled with the increasing demands and expectations placed upon services and staff. The latter can only have an adverse impact on staff morale and, of course, patient care. And no one wants that. Unless of course there’s another agenda behind intentionally driving quality and deliverability into an ever descending spiral whilst stating that things could and should be better?
'A Call to Action' suggests that reallocating resources is one of the ways the NHS could be transformed and one of the ways that commissioners can really make a difference. It also identifies how much money could be saved if the public could be encouraged to look after themselves better.
In thinking about health and how people themselves have the greatest role to play in their own wellbeing, including their capacity to cope, adapt and self-manage, perhaps it’s time to seriously consider the possibility of reallocation not being within the NHS, but in initiatives that work with the NHS? Time to realise the potential within communities, to explore the what of health and wellness and the how and where of commissioning to greatest effect. Because there are other ways of doing things and others who are extremely capable of doing them.
If we’re serious about addressing the health challenges facing our communities then we must look beyond health services to do that.
The increasing medicalisation of life experience, together with the professionalisation of any solutions, is not the answer to transforming health and wellbeing. When we also consider social perspectives and facilitate the creation and development of environments and opportunities for connection, growth, and contribution - tendencies inherent in every individual - people are likely to flourish and thrive and a by-product or side-effect is good health and well-being.
And the quiz?
The simple answer to what’s missing would be wholeness: whole person, whole life, whole system.
1. A head without a body is going nowhere, and vice versa. Physical health is inseparable from mental health and we need to consider the whole when considering health and wellbeing.
2. People are inseparable from the contexts in which they live their lives and so we need to consider how life and living impacts on health and wellbeing, physical and mental, and what strengths, assets, supports and resources people have in their lives that they can draw on.
3. When people do need input from others there’s a whole ‘system’ of support available, not only statutory services but including the all too often overlooked network of voluntary and community provision. And we need to get better at doing that in a joined up way.