Getting well together
Source: NHE Nov/Dec 16
Eight months on from the Place-Based Health Commission’s final report, Lord Victor Adebowale talks to NHE about the impact of STPs on bespoke health and the leftover challenges in achieving integrated care.
Back in March, the Place-Based Health Commission, chaired by Lord Victor Adebowale and co-hosted by independent CIC Collaborate and the New Local Government Network, launched the much-anticipated ‘Get Well Soon’ report.
The document, which addressed the need for integration between the NHS and councils, made its case for place-based health through a simple scenario: if you were to ask someone what health services they wanted, their answer might be clinical, or perhaps focused on efficiency; if you asked what would help them enjoy life more, their answer would likely focus on everyday lived experiences.
Place-based care means the health and wellbeing system must focus on answering the latter question first, the report said. This would require the NHS to build stronger bridges to people, primarily by drafting the expertise of local government, community pharmacy, housing providers and the voluntary and community sector.
Speaking to NHE almost eight months after the report launch, Lord Adebowale emphasised that the key to ensuring these organisations play an equal part in establishing place-based health is orientating all parts of the system to the situation at hand, as well as “to what they are there for, what the current status of the health and social care system is and the impacts on the population it serves”.
“The NHS can take a lead in pulling together that data alongside the local authorities, because, in a sense, they’re on the frontline,” he said. “But they’re not the only people that contribute to health and social care – so the question is: how do you design intervention that brings all the players together to agree to orientate themselves around the challenge that’s facing them?
“Once people are orientated to that, it’s very difficult for them to say ‘it’s not to do with me’. You’re either leading, following, or you need to get out of the way – and once you’ve done that, you can then set objectives collectively that are actually meaningful to all the players in the room.”
Learning from all STPs
The report identified three major challenges that are holding back today’s system from rolling out reform. The first was the ‘evidence paradox’, which argued that operational and financial pressures mean NHS organisations are often reluctant to invest in prevention because there isn’t enough evidence that it will save money in the long term.
The other challenges included poorly aligned incentives – the fact that health providers and councils work to different sets of incentives which often drive them to work in isolation – and excessively heavy and inflexible forms of national regulation, which restrain “too many parts” of the public sector.
The emerging STP programme could act as a springboard to overcome some of these challenges and achieve more effective collaboration, Lord Adebowale argued, and is the right way forward – but it is not a panacea.
“I see them [STPs] as part of a systems leadership intervention,” he added. “We need to learn from them, we need to reiterate their importance, invest in the learning and the leadership, and press on.
“I think some will fail, some will be challenged by the sheer speed at which we’re going – some would say necessarily so – and, of course, not having time to form the relationships necessary to set credible objectives means that the strategy is weakened.
“But that doesn’t mean to say that we can’t learn from every one of the STPs, and use that learning to strengthen the relationships and develop the plans.”
As well as committing to learning from the triumphs and downfalls of STPs – which are now being published by a handful of footprints – Lord Adebowale also stressed the importance of honesty.
“It’s dishonest to say that with one leap we’ll be there,” he continued. “This is a complex system in a highly complex political and financial context, and it’s going to need us all to show some humility to the need for us all to learn.
“In other words, let’s try and understand what a big investment STPs are in the future of NHS and social care, and not make the mistake of doing what we usually do – which is layering another intervention on them because they haven’t worked instantly, so we don’t learn anything from them.”
Relationships trump objectives
Expanding on the current level of collaboration happening across the NHS and councils, the commission’s chair explained that it’s happening, but just not fast enough: “There are some notable exceptions where it’s happening, but I think these exceptions are always there, regardless of STPs, because they have the relationships in place.”
He later emphasised the importance of these relationships, arguing that “at the end of the day, relationships trump objectives every time – if you don’t have the right relationships, then you’re done”.
Lord Adebowale, who also recently helped write the FYFV for Mental Health as part of his role in the mental health taskforce, acknowledged that the overall planning process of orientating all players and building strong relationships does take time – particularly in the current financial climate. “But it’s worth doing,” he added.
Fifteen years into the future
One of the headline recommendations in the Place-Based Health Commission’s report was the need to engage in long-term health planning; specifically, this means creating a Fifteen Year Forward View rather than the current five-year plan. Lord Adebowale and his team wrote that this approach would “galvanise everyone within the system to work towards the same goals”, acting as a blueprint to create an agreed vision on place-based health – whilst also building on the FYFV, the STPs and the emerging devolution framework.
In terms of parliamentary planning, Lord Adebowale noted that “there is nothing wrong” with a 15-year view that has five-year break clauses. “Actually, if you do it in that way, you can measure more clearly the impact that government policy – not just in health and social care, but government policy generally – is having on health and social care,” he added.
“My personal view is that any policy in any government, local or national, that doesn’t contribute to the health and wellbeing of the population is taking us backwards as a nation, and is costing us more in terms of the narrow expenditure, which people perceive as the NHS. We need to be thinking about a 15-year view: I think that’s perfectly appropriate, and I think it’s perfectly appropriate to do that in a way that’s politically acceptable.”
Asked whether it’s possible to have a 15-year plan while still adapting to unexpected issues along the way, the commission chair pointed to the fact that some companies, like BMW, already have 100-year plans in place – because strategic plans and visions are merely that, “and not predictions of the future that are bound to always come true”.
“What they provide you with is a path; they provide you with guidance. It’s like setting sail in a ship: to use the analogy, there’s never a direct route between point A and point B, but you know where you’re going. And giving the public that sense of ‘this is where we are going’ is quite important,” he said.
“If you give that to the public in a very clear way, then it gives them the sense that you have a vision for health and social care which is inclusive, and looks not just at the needs now, but the needs in the future. And I think the public deserve that. They got it when the NHS was established, and I think they deserve it now.”
The ‘Get Well Soon’ report can be viewed at:
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