If you were sat at the top of one of the Department of Health’s Arm’s Length Bodies, what would you do to create a step change towards more person-centred health and care?
Earlier this month, Simon Stevens, chief executive of NHS England, asked the People and Communities Board (PCB) – a working group I chair - to recommend a small set of actions that would give the next big push to the spread of person-centred health and care.
About time. We are looking for things which would:
- Make a concrete reality of the “new relationship with patients and communities” set out in Chapter Two of the Five Year Forward View, and further articulated in the PCB’s ‘Six principles’ documents
- Address key issues for patients, service-users and the voluntary sector
- Provide solutions to key problems, challenges and “pinch points” for the health and care system, as they impact on population health, care quality and sustainability of services
- Address issues of equality
- Be practical and helpful to those driving system reform eg in the STP “footprint” areas
- Help to mainstream the most promising approaches already emerging from current policy, evidence, programmes and practice
Quite a lot to think about.
The ‘what’ and the ‘how’
There are two elements to this challenge, and we would love your help. There is the question of what needs to be adopted and how it is adopted. We will have things to say about both.
We want to see wide scale adoption of approaches that will give people more voice, choice and control over matters that affect their health and wellbeing. That argues for whole system changes rather than small scale interventions. They will be actions that can be given meaningful drive and support by NHS England and the others Arm’s Length Bodies, as well as by colleagues in the local NHS. And this is not just about the NHS. The system that supports health and wellbeing includes local authorities, the voluntary and community and social enterprise (VCSE) sector and people and communities themselves. We are keen in particular to clarify offers from the VCSE sector.
Be careful what you wish for
The timescale is tight (first phase recommendations by December), but undoubtedly this is a great opportunity to make some real change. At the same time there are risks.
‘Top-down’ is not the default approach for champions of person-centred ways of working. What we are really looking for is to change the culture of health and care, and a cultural shift cannot readily be mandated from the centre. Prescriptive instruction from national bodies, ‘hard levers’, regulatory imperatives or financial incentives are strong medicine. They can cause harm, have unintended consequences and lead to gaming. See the four hour accident and emergency target as a case in point.
But we also know that the policy vision set out in Chapter 2 of the Five Year Forward View remains a second-order priority for national decision makers. It too readily gets squeezed out by the focus on costs, on targets and by the relentless pace of change. So we do need Simon Stevens and colleagues by their words and actions to signal that they are going to make “a new relationship with patients and communities” their priority.
What would you do?
Next week we will be holding two webinars.
On Thursday 3 November between 9–10am there will be an open webinar for voluntary sector staff, patients and carers to input into the process. A similar webinar for health and care professionals and practitioners will take place on Friday 4 November between 9–10am.
Whether or not you can take part in these webinars, please give us your thoughts. You can contact Sarah Hutchinson for further information.
If you were Simon Stevens what would you do to create a more person centred system? Please inform our thinking during this fast-paced project.
Jeremy Taylor is chair of the People and Communities Board and chief executive of National Voices.