Realising the Value
The election threw up some surprises didn’t it?
One was the remarkable consensus over the crisis facing the NHS: a potential £30bn funding gap by then end of the decade. How is this to be addressed?
It seems to have become accepted that most of the money needs to be found through efficiency gains – through the NHS spending less to do the same. There is no doubt there is a huge amount of system inefficiency in the NHS and that a culture of continuous quality improvement will stand us in good stead to use the resources we have more wisely.
But if we focus solely on the NHS, we’re missing half the picture. We risk turning our attention and energy away from other avenues that promise not only equal financial rewards, but other benefits too – better mental and physical health and wellbeing, and social value, alongside NHS sustainability.
£30bn happens to be the sum that Derek Wanless estimated the NHS would save through the ‘fully-engaged’ scenario, based around confident, engaged and empowered patients.
We know the potential rewards: supporting people with long-term conditions to manage their health and care can improve clinical outcomes and reduce use of emergency hospital services; that people are more likely to stick to their treatment plans and take their medicines correctly; that greater knowledge, skills and confidence lead to positive health behaviours; that building community capacity and volunteering bring a positive return on investment; and that peer support benefits the peer supporter as well as their peer.
We know the growing evidence base of what is needed: group-based education, peer support, health coaching, community capacity building and volunteering are just some of the new ‘interventions’ that can change the shape of health care as we have understood it.
We know a lot about how to do it: Co-creating Health and People Powered Health have demonstrated how the NHS and communities can support individuals to better manage their health and care. There are fantastic examples of peer support, selfmanagement support and health coaching flourishing from Newcastle to Cornwall.
We have a framework to make the changes: the House of Care provides us with a model to frame the activity needed to strategically drive change at a national and local level.
Yet, despite knowing the potential rewards, despite an emergent evidence base of the value of asset and community based interventions, despite the laboratories that have shown how to put change into practice in the NHS and communities, many would say that we have continued to disempower patients and disengage communities.
Changing our habits is hard: hospitals are easier to build than relationships; operations are easier to measure than knowledge, skills and confidence; medicine carries more kudos than health coaching; prescribing is quicker than enabling.
If we are going to realise the renewable energy of people and communities, we need to put a lot of energy into changing the way the ‘system’ works: how policy makers prioritise what’s important; enhancing the skills and competence of the workforce; investing in building community capacity and individual capability. Easy to say, but is it too big to bite off? It cannot be if we’re serious about sustaining the NHS.
Enter stage left Realising the Value: empowering people, engaging communities.
Realising the Value is not another programme to invent or test new approaches. Led by the Health Foundation and Nesta, along with National Voices, Regional Voices, NAVCA, Volunteering Matters, the Behavioural Insight Team and Newcastle University, Realising the Value is a programme of activity that works across the chain from evidence to practice.
We will first consolidate the evidence base, build the case for change, surface the system levers stifling change, develop tools and resources to make commissioning key interventions and changing our habits at the front line easier.
From the autumn, we will be taking the evidence and the ‘beta’ tools into partnerships with local areas. We hope to build networks of areas that are delivering person-centred and community-based interventions to test, demonstrate and refine a set of tools and resources that can equip the NHS to make the shift to person-centred care at scale.
Over the next five years, we need a relentless focus on a culture of quality improvement and a culture of person-centred health and care. There is a huge opportunity to change the relationship between individuals, communities and the NHS. There is an equal urgency to do so. Thirteen years after Wanless, it feels we are poised at the starting blocks. We both need to run fast and to pace ourselves.