My colleagues Chris Ham and Richard Murray have today published a clear and important report setting out the main policy priorities needed to implement the NHS five year forward view. It focuses on areas where a fundamental redesign of policy is required – from commissioning and payment systems to regulation and leadership and improvement support.
In many recent conversations with other researchers and with leaders in the system, I’ve been struck by how often ‘implementing the Forward View’ is essentially synonymous with ‘establishing multispecialty community providers and primary and acute care systems’, with the occasional mention of some of the other care models listed in chapter three. It’s entirely understandable. Organisations define how services are funded, organised and delivered. And for many of us, organisations define what we do if not who we feel we are. When faced with the immense challenge of refocusing the mammoth NHS into a service fit for our needs in the 21st century, the neat leap to a suite of structural solutions and priorities is too tempting to ignore.
But I’m worried that this risks leaving behind what, for me, is the more radical and more fundamental chapter of the Forward View – chapter two, on engaging patients and communities.
This chapter eloquently makes the case for the importance of radical change to the relationship the NHS has with the patients and communities it serves, and points to some important national initiatives in support of this, such as NHS Citizen and integrated personal commissioning. But it doesn’t offer the same jump to an appealingly neat set of answers.
You could argue this is a good and sensible decision. But to me it misses an opportunity to make the case to local leaders that there is no shortage of interventions and approaches to choose from.
Indeed, in a competition for the best acronyms, a differently written chapter two could have easily given chapter three’s multispecialty community providers (MCPs) and primary and acute care systems (PACs) a run for their money. To name but a handful, it could have recommended a focus on:
asset-based community development
patient and family-centred care
care and support planning.
Looking at individual engagement, at the end of last year we published a report in association with National Voices that set out the eight key ways in which the health and care system needs to be working to give individuals greater control of their own health and care. And looking at community engagement, just recently this excellent summary from Jane South and colleagues of community-centred interventions to improve health and wellbeing has been published.
I’d be the first to say that putting people and communities genuinely in control of their health and care requires fundamental cultural changes and a shift in power that goes much deeper than a set of models or interventions.
But as local areas make their choices between multispecialty community providers, primary and acute care systems and variants thereof, we must make sure that we are also embedding and extending evidence-based approaches to individual and community engagement into these new models of care.