In this co-authored piece, NPC's CEO Dan Corry and Partnership Director of the Richmond Group of Charities, Charlotte Augst, reflect on the current challenges faced by the NHS, and the role of charities in supporting the health of the British public.
One does not need to concur one hundred percent with the recent assertion that there is a humanitarian crisis in health and social care to agree that things are getting pretty tough. With the NHS secretary of state feeling it was better to severely weaken the 4 hour A&E wait guarantee than watch the figures keep dropping, you just know he feels the same, whatever the rhetoric.
Given all this, we are probably in for one of our regular debates about the future of the NHS, with privateers coming in from one angle, those who want to ban obese people and smokers getting treatment coming from another and others defending hard the status quo for our ‘national religion’. Meanwhile the public spend their time just trying to get to see their GP within a month.
Of course the sums going into the NHS and social care are huge and the answer somewhere has to be about resources going in—just as it is in every health system around world. But we are at risk of ending up with a debate where one side shouts that all is needed is extra money, whereas the other side shouts that all that’s needed is a better way of working.
This makes it hard to make a more nuanced argument. Population change, growing complexity of needs, and our expanding ability to do stuff that was impossible decades ago translate into a need for appropriate funding and new ways of working—more upstream, more long term, more enabling. And this is, we believe, where new ways of working with the charity and voluntary sector need to be designed and delivered urgently.
This is not just a case for saying that, come the annual Winter or other health crises, the sector can be asked to throw thousands of volunteers at the issue. This is not a sustainable solution anyway, and also labours under the assumption from central government that volunteers come totally for free.
But it is about saying that in many areas charities—whether national and big, or local and small—can help improve the service people get and the outcomes they experience, as well as helping the system spend its money more effectively on those who really need expensive medicine. They don’t do this in some magic, make believe way but they do this because;
- they are more focused on the individual and their journey than the large clinically focused NHS can ever be;
- they specialise in prevention and early intervention that, if effective, reduces demand for both acute services and primary care;
- and because they are often better than the NHS and existing social services at joining up the services that individual patients need.
Of course the charity sector would say this. But analysis carried out by NPC for the set of major health charities that go under the title the Richmond Group, (after Richmond House, the home of the DH and, once upon a time, the NHS) showed that it is a lot more than hot air. And other work suggests charities that, for instance, look after older people are important in keeping them out of a hospital environment for longer (avoiding entry or being released home quicker). This again transforms their experience and reduces demand.
To really put this to the test, the Richmond Group of Charities is currently working hard with the health system in one particular area, Somerset, to see how these things can be joined up. Somerset, like many areas, has major health challenges and its Sustainability and Transformation Plan—that all areas have been told to undertake by NHS HQ—is supposed to find some very major cash savings in the years up to 2020. That will in some areas undoubtedly involve difficult decisions, and not always those that work in the interest of patients and service users.
The charity and voluntary sector is not the answer to all these problems—and part of its role is to reflect back to policy makers what is really happening on the ground and where things fall short. But now that we are all getting aboard the new 'shared society', surely we must get the statutory and voluntary sector to work better together.