Guest post by Paul Corrigan, member of the Doing the Right Thing National Steering Group
As the centrepiece of British society, the NHS enters its 70th year needing more from the population than paying their taxes. Over the last couple of decades the public have been prepared to pay more taxes if they can be certain of the money going to the NHS. However, in the modern world, money for professional staff and medicine is not enough to create a service that meets the needs of the many people with 21st century illness.
The needs of an 80-year-old with two long-term conditions (increasingly the average patient for the NHS) go beyond those of medicine. For most people, the diabetes and dementia they have will not be ‘solved’ by medical staff and drugs. While some of their needs are of course medical, they are also social, environmental and psychological. Some of those psychological needs may be met by the NHS, but companionship - having someone to regularly pop in - probably won’t be.
For people with long-term conditions to live better lives, they will need a wide range of other British institutions to collaborate with the doctors and nurses of the NHS. Nearly everyone with a long-term condition will manage a better life if they take regular exercise. Even better if that involves getting out a bit. Even better if it's with other people. Nearly everyone with a long-term condition will learn how to better manage if they meet and discuss their needs with others with similar experiences.
"Most clinicians now recognise the limits of a purely medical approach to helping people better manage their long-term conditions, but the NHS has not proved dextrous at creating relationships with other organisations to provide that assistance".
Across the country there are thousands of small examples of voluntary organisations working with patients in alliance with NHS clinicians to improve patients’ capacity to manage. The Richmond Group of Charities wanted to achieve something at a greater scale through their Doing the Right Thing programme. Their learning report with New Philanthropy Capital, ‘Tapping the Potential’, was published on Monday and is well worth a read.
Doing the Right Thing is a much bigger approach to the issue. Over the last 18 months the Richmond Group has been working with Somerset's STP and wider voluntary sector to develop a much closer relationship between voluntary organisations, local NHS and its statutory partners. (And in the interest of full disclosure I have been an unpaid member of the National Steering Group).
The Richmond Group funded and recruited two programme managers to work part time for six months – one in Somerset and one nationally. The local programme manager met with people across the county to introduce the collaboration and learn about the area, its people and its health and care system.
Everyone reading this who spent any time in 2016/7 trying to create new partnerships will recognise that this is far from an easy task. Across the country GPs are beginning to work differently with hospital doctors; community nurses with hospital discharge nurses; and paramedics with primary care staff. Most people recognise how important this is for the more coordinated experience of patients, but everyone also recognises how hard it is.
Add the different culture of local government social care services and its gets a little harder. Add the passion of the voluntary sector for their very specific causes, and creating relationships is far from a simple task.
And, like most analyses of creating new partnerships, the one obvious issue was needing time and effort to invest into developing those relationships.
"You can’t expect that having ‘Developing better relationships with the voluntary sector’ as item 13 on a 17-item agenda will work. Getting to know and respecting different cultures takes time and energy in its own right".
As these partnerships grow across the country, there are clear practical things to achieve. In the Somerset collaboration, we’ve agreed to focus on scaling social prescribing. Classically, ‘social prescribing’ (as it is known by the NHS) aims to link people with practical and emotional support from the voluntary sector, via their GP. It's also about building communities. These approaches are working well, but are only available in a few parts of Somerset, so it feels sensible to work together to improve access across the county. A similar collaboration in another area may decide to focus on something completely different.
Please have a read of Tapping the Potential. We think it outlines a new and productive kind of leadership in health and care – one that is not centralised; that is pragmatic and consultative. It’s not easy, but given the nature of the needs of the public in the NHS’s 70th year, it is important.
Paul Corrigan is Adjunct Professor of Health Policy at Imperial College and a CQC Board member.