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New NHS Alliance: Wellness and the power of community assets

Dr Brian Fisher MBE, chair of the New NHS Alliance, looks back at the New NHS Partnership Summit and reflects on how its learnings can help plug gaps within the NHS Long-Term Plan.

In November 2018, the New NHS Alliance held its third annual summit in Manchester. This revolutionary event was attended and supported by over 200 practitioners, systems leaders, patients, and community groups that work in provider and commissioner organisations, public health, local government, housing, and directly with local people. The summit featured speakers who enable, deliver, and have lived-experience of Health Creation and its role is addressing health inequalities.

Chaired by Jeanelle De Gruchy, president of the Association of Directors of Public Health, ‘Health Creation: Wealth Creation – fighting health inequalities using community assets’ explored and identified how the various types of assets – citizen, physical and workforce – can play a role in creating health and in addressing the burning injustice of health inequalities.

The summit was kicked-off by Dr Carolyn Wilkins OBE, CEO of Oldham Council, who spoke about her involvement in, and the findings from, the Civil Society Commission. A key observation from their two years of research was our tendency to ‘other’ other people, and for health professionals in particular to think of their patients as somehow different to themselves. Wilkins argued that this is something that fractures our society and limits our ability to provide services and solutions that are truly preventative.

This, and other key summit learnings, are particularly relevant to all frontline practice given the recent launch of the 10-year NHS plan.

The summit and the plan

Commenting on the summit learnings and their relevance to the plan, Merron Simpson, New NHS Alliance CEO, said: “Delegates heard from Rob Eyers, a former homeless drug addict who, 10 years on, is CEO of Telford After Care Team. The team are commissioned by the local CCG to deliver a ‘Recovery through Discovery’ programme for people with mental health, substance misuse, and housing challenges.

“Delegates were able to tell their own stories of where, given the right opportunities, communities are healing themselves and each other. In terms of the plan, there was only scant mention of the need for better community and public involvement. This comes at a time when community-based and community-led approaches to delivering health outcomes (and not just health services) must now be mainstreamed.

“Indeed, those who truly understand the challenges of health inequalities are people and communities themselves; while frontline practitioners who are equipped with skills In Health Creation are best placed to work alongside them. This learning should become common practice across nursing, pharmacy, general practice, community healthcare, social care, housing, and even frontline practitioners in secondary care. Housing organisations – both providers and strategic housing – must be critical partners in preventative health and care.

“The summit inspired systems leaders and frontline practitioners to change the way they work, in partnership with their citizens, to make better use of the people, physical, and workforce assets on their doorstep. However, the 10-year plan is silent on ‘better use of assets.’”

The summit clearly recognised that health inequalities represent a continuing social injustice, make demands on health and public services, and limit our population’s capacity to contribute positively to society and the economy.

The summit’s speakers, compelling case studies, people with lived-experience, and indeed the attendees themselves, all recognised that health and illnesses are social processes and that assets need to be better deployed to address the social roots of ill-health.

While there is a welcome focus on health inequalities within the plan, there are only tired, ineffective approaches rejected by Marmot decades ago. The plan ignores the social roots of ill-health, does little to tackle them, and it fails to recognise the importance of harnessing the ‘renewable energy’ of people and communities as detailed in the government’s NHS Five Year Forward View.

The summit heard from and identified a wide-range of approaches to achieving this.

This included the winner of the Trojan Mice Excellence in Health Creation Award. Bolton at Home, a leading housing association, showed how a small change in their recruitment practice enabled them to employ local residents as ‘Community Navigators.’ This in turn enabled further people-assets to be unlocked, leading to a series of new approaches to meeting the real needs of local people that wouldn’t have otherwise been possible.

Summit call to action

A key theme emerging from the summit was for better education – of professionals and the public – about what ‘health’ really means. Currently, people tend to associate ‘health’ with ‘the National Health Service,’ whereas the World Health Organisation definition is much more useful: “Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.”

As a result of discussions emerging from the event, New NHS Alliance is calling for:

• A recognition that creating health is everybody’s business and must be everybody’s priority – the NHS, communities, housing, pharmacy, businesses, primary care, and local authorities;
• Better education for all sectors and communities – in schools, colleges, universities, and community centres – on the root causes of health inequalities, why living in poverty can make people ill, and how to go about creating the conditions that make and keep people well;
• Better use of assets – such as getting the best social value from the health estate – in the fight against health inequalities;
• Changes to procurement frameworks to enable local people to be commissioned where appropriate;
• Development of a ‘wellness workforce’ at the frontline of all the sectors, so that practitioners in different parts of the system are equipped to create health with communities.

Commenting on the importance of a wellness workforce in the fight against health inequalities, Simpson said: “Most organisations acknowledge that people are their greatest assets. But this is only true if they are enabled to be their best. How organisations empower vulnerable and disadvantaged people and communities to become their greatest asset in creating health is critical. New NHS Alliance has fashioned a framework that can assist learning within any sector – whether primary care, commissioning, housing, social care, or multi-disciplinary teams.”

In terms of the adoption of Health Creation, there was widespread agreement that the work of Basis Yorkshire in addressing the needs of the Leeds female street sex-worker community was a great practical example of Health Creation in practice. Through adoption of the Health Creation framework, a multidisciplinary group of specialist, primary care, and community providers were able to identify new approaches that have successfully supported an increase in the numbers of people being cured of hepatitis C.

Summarising the success of the summit and its relevance, Fisher said: “There is now plenty of evidence that asset-based approaches work when done well. With the launch of the 10-year plan, perhaps the biggest opportunity rests with ICSs and CCGs which have it within their power to adopt and commission people- and community-led, asset-based approaches across all sectors.

“It was also clear from the summit that professionals across sectors need to agree on Health Creation as a clear way forward, while enabling greater collaboration in the strategic use of assets to fight health inequalities”.

With health inequalities featured in the 10-year plan, now is the time to take action! The Partnership Summit was made possible by the support of Capsticks, NESTER, Power to Change, and a number of leading housing associations.

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