Guest blog from Moira McGrath, Director of Integrated Commissioning NHS Lambeth CCG & London Borough of Lambeth and member of Taskforce on Multiple Conditions Expert Advisory Group
I have worked for 27 years as a commissioner in the NHS. For the last five years I have commissioned health and social care in Lambeth.
Commissioning isn’t something that is well understood by the public or, often, by health and care staff. If people ask me, I say I am responsible for planning and funding care. This definition is essentially accurate, but it also misses a lot of the nuance in my job – ignoring the importance of empathy and of personal and social relationships in the work I do. Some people assume that, as a manager, I am a bureaucrat who does not understand the people I serve or appreciate the impact that my decisions have on their life.
About 18 months ago we started a new approach to our work with carers. We started by bringing professionals from the NHS and local councils together with representatives from carers in the community. At our first meeting we went around the table and asked people to share their experiences of caring. Everyone at that meeting – staff and members of the public – was, in some way, a carer. When I talk to people about caring for older people and the impact of dementia I am always struck by the fact that this is an issue that touches almost everyone through their friends and family. Recently my colleagues have talked to me about their family experience of coping with diagnoses of cancer, neurological disease and mental illness.
What is interesting, however, is that we rarely talk about our personal experiences in public. It is as if those insights are not valid in our professional lives.
This is not to say that reflecting on our own experiences is the same as understanding the experiences of local people or appreciating the difficulties of overcoming structural inequalities. I can empathise with the issues that people face in managing their health and wellbeing but I am always aware that this is very different from the cumulative experience of surviving every day with these problems.
Sean Rigg died in police custody in 2008. He was a young black man with serious mental illness. In response to this tragedy Lambeth Council created the Black Health and Wellbeing Commission and their recommendations have informed one of the most ambitious and challenging pieces of work I have undertaken at Lambeth: Black Thrive.
Black Thrive is a partnership between local health organisations and the African Caribbean communities. We are working at redesigning our community and crisis mental health services, working with children to promote their understanding of mental wellbeing, building networks of community connectors and reducing the use of restraint in hospital.
A lot of my work involves working with our public health team to review the impact of policy changes at a population level. For example, we know from our data that amongst the 430,000 people registered with GPs in Lambeth there are over ten thousand who have three or more long-term conditions. It’s well known that, as people get older, they are more likely to develop multiple conditions, but in Lambeth this tends to happen earlier in people’s lives.
Lambeth has a diverse population and people from African Caribbean and South Asian communities are more likely to be diagnosed with blood pressure, diabetes and serious mental illness. This is driven not least by poverty and its impact on the social determinants of health. While Lambeth has high levels of employment, our long-term unemployed residents are often people with mental illness and disabilities – particularly musculo-skeletal conditions such as back pain. At a recent meeting of the Taskforce on Multiple Conditions I was struck by one participant’s description of the way in which their working life had been cut short – long before the average age of retirement – by the demands of health appointments and the impact of medication. An individual’s story, but one supported by evidence from a range of research.
We are working with GP and community services to identify those living with long-term conditions and inviting people to work with GPs and other health services, social care and the voluntary sector to work out how we can provide the services that matter to them. We want to tailor our approach to meet their personal circumstances and to support them, their families and carers appropriately.
These issues can only be fully addressed by working across the whole council. We are challenging ourselves to think more broadly about aligning health and council resources – bringing together money, knowledge and expertise. Lambeth is developing a “health in all policies” approach so that all our work is supporting the health and wellbeing of local people. Drawing together issues such as housing (in Lambeth we have over twenty thousand people on the waiting list for council housing), the regeneration of the built environment, air pollution, planning decisions (for example in licensing) and employment we can build health into all our work.
What motivates me most are the stories of individual people and staff members who are frustrated and badly served and finding solutions for them. What gives me real satisfaction is hearing that the changes I have promoted or supported have made a lasting impact we can have on people’s lives by making good choices in health and social care commissioning.