Realising the Value in health systems
There is a growing policy focus on how to empower and engage people and communities in their own health and care. The NHS Five Year Forward View talks about "harnessing the renewable energy" of patients and communities.
References to person-centred care and community-focused approaches abound in policy documents across the UK and they are increasingly referenced in national programmes such as the New Care Models. So far so good, but often policy makers struggle with precisely what they can do to make this vision a reality.
As part of the Realising the Value programme, we were specifically tasked with examining the effectiveness of national policy levers in driving the adoption of more person- and community-centred approaches for health and wellbeing, to help achieve the Five Year Forward View ambition to embrace the ‘renewable energy’ of patients and communities.
The result of this work, 'What the system can do: The role of national bodies in realising the value of people and communities in their health and care', sets out a large number of specific recommendations for how national bodies can better support the implementation and spread of approaches which seek to empower and support individuals and communities to be active partners in improving their health and wellbeing.
Perhaps unsurprising for anyone familiar with this area, a key finding from this work is that the answer lies not in a single lever that national bodies can pull but is significantly more complex
How different policy initiatives interact with each other, various competing objectives for the health service, and a lack of alignment of key policies can all unintentionally hinder efforts to ‘realise the value’ of people and communities.
A key insight for us was that finding the right balance between national policy and local action was essential – and hard. While local factors such as relationships, leadership, local partnerships, are likely to be the key drivers of successful person- and community centred approaches, supportive national policy is also essential.
In addition to the specific recommendations for national bodies, we identified six key findings relevant for policymakers and national system levers to help create the conditions to support local teams and organisations working with people and communities to create better health and wellbeing. Below, I highlight four of these which feel particularly timely given the current pressures facing our health and care services.
National bodies should focus on people and systems
When looking for solutions to person- and community- centred approaches for health and wellbeing not being more widespread, there is an understandable temptation to gravitate towards ‘hard’ levers like payment systems, legislation or regulation.
These are important issues to address but are not on their own sufficient. Our report highlights the immense potential and benefits of focusing on people and, in particular, the health and care workforce. Currently, staff are working under pressure: in the latest staff survey, 37 per cent reported feeling unwell due to stress and almost one in three (30 per cent) felt unable to meet all the conflicting demands on their time at work. This impacts on their ability to provide compassionate, person-centred care.
While much of what impacts on workforce is determined at a local level, we highlighted that national policy could go further in encouraging local bodies to focus on issues such as staff engagement and morale, supporting the informal workforce of patients, service users, carers and volunteers, and using values-based selection and recruitment.
'How' is as important as 'what'
National initiatives, like the New Care Models, Integrated Care Pioneers and Integrated Personal Commissioning programmes offer significant potential to support the greater take up of person- and community-centred approaches for health and wellbeing.
An ambition to engage and empower patients and communities is included in many of these models. At their best, they can support local partnerships across health, care and wider public and community services to come together, to develop and trial new approaches and models of care and to work with local people and communities.
But to see these benefits, how these initiatives are implemented is key. Our report identified a number of things national bodies should pay attention to in order to give these initiatives the best chance of success. These include capturing and sharing learning to support the spread of approaches beyond mature and high performing areas, and providing time and flexibility for local sites to develop; resisting the temptation to overload programmes with objectives or specific activities.
A sustainable voluntary and community sector
Echoing the findings of the recent Voluntary and Community Sector review, our report emphasises the need for a strong and sustainable voluntary and community sector if person- and community-centred approaches are to become much more widespread.
Our partner sites highlighted many of the current challenges particularly for smaller organisations caused by fragmented commissioning, short-term contracts, and a lack of understanding or focus by health commissioners on commissioning for social value.
There is also more supported needed to help the voluntary and community sector to build their capability and capacity to work with commissioners and to develop skills in capturing and sharing their impact.
Co-production, co-production, co-production
"The goal is not for patients and carers to be the passive recipients of increased engagement, but rather to achieve a pervasive culture that welcomes authentic patient partnership – in their own care and in the processes of designing and delivering care.” A promise to learn, a commitment to act, Berwick Report
While many organisations, nationally and locally, seek to involve patients, service users, carers and the wider public in different aspects of their work, examples of true co-production are much rarer.
We think there is a lot that national bodies can do to both model the importance of co-production in the work that they do, while supporting local teams through simple actions like promoting tested models of co-production and developing and supporting patient leaders.