Health Service Focus

09.02.18

Health creation is here to stay

Source: NHE Jan/Feb 18

NHE’s Sacha Rowlands speaks to Michael Macdonnell, NHS England’s national director for transforming health systems, about the value of health creation when designing strong sustainability and transformation parnerships (STPs).

Meeting NHS England’s Michael Macdonnell at New NHS Alliance’s bustling summit on 6 December, he is keen to tell me why he believes that STPs, accountable care systems and health creation are so important when addressing health inequalities.

“The whole point behind these is to build vehicles of collaboration for the NHS, for local government, for local groups, and for the third sector in order to try to get the best health for people in their patch,” he explained. The ultimate goal is partnership working and establishing how to get the best return on public pounds.

“Additionally, we’re trying to ask them to focus on population health, not just healthcare, which means really trying to understand the needs of the population – not just focusing on hospitals, but trying to redesign care in a way that prevents illness or prevents people from becoming acutely ill. That means drawing on the skills of some of these wider groups, but also getting upstream and getting to a more proactive way of doing healthcare.”

There are also technical fixes to be implemented, such as moving away from a hospital-based finance system that rewards activity and working towards a budget approach to try to get the best return on resources.

Health creation is an important part of STPs, but not the only part, Macdonnell told me: “We also need to improve healthcare services; we also have to deliver within the budget that we have. But as we ask people to collaborate and to think over the longer term, which is what these vehicles are about, we have to be asking: how can we reallocate some of our investment and some of our activity to try to prevent illness, not just deal with it when it comes?”

Council leadership in the DNA

That’s central for the mission. When STPs were first described in the Five Year Forward View, they were intended to deliver on three ‘gaps’: health and wellbeing, care and quality, and the funding and efficiency gap. The first is all about health inequalities and how to make an upgrade in prevention.

“Unfortunately we’ve had our preventative services cut in part, but we still have to get upstream and ask,” explained the national director.

“The best STPs are clearly ones that have local government at their heart – places like Milton Keynes, Bedford and Luton, Nottinghamshire, and Greater Manchester, which all have local government leadership baked right into their DNA. They’re making some of the strongest progress because they’re asking, ‘how can we bring housing, policing and fire services to the table in a way that solves health problems as well?’”

But the NHS England director claimed that is not being done well everywhere, with some areas finding it almost impossible to get local government and NHS organisations in the same room. “That’s the sort of thing we have to fix,” he argued.

Beyond ticking boxes

In too many parts of the NHS, health creation also is seen as a “tick box exercise,” and Macdonnell said that this is something they need to get much more forceful on. “It is about changing some of the incentives as well. If people want to do the right thing, we want to try and make it easy for them to do the right thing. And that means, for instance, changing how money flows; it means recognising some of those contributions as much as we do for A&E.”

But can NHS bodies really focus on health creation when they’re so intent on bringing down the deficit? “It’s easy to paint us into a corner where all we do is worry about money. We’d be in the wrong jobs if that was what we worried about all the time. We worry about trying to do the right thing,” he explained. “We don’t get to set the budget; it would be great if we could, but we don’t.”

When asked whether he thinks STPs will help facilitate long-term planning, the director argued that is “exactly what they’re for,” adding: “What we’re trying to do is create conditions in which local leaders ask serious questions about how they’re going to change things over a five-year period, for instance.”

If Macdonnell has one key message to give, it’s that every heath and care system across the country needs to engage with people to help prevent illness and put them in control of their own health – “not only because it’s the right thing to do, but because it will help them with their other jobs too.”

 

TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

HEE pledges greater support for doctors’ medical school transition

17/07/2019HEE pledges greater support for doctors’ medical school transition

Health Education England (HEE) has outlined its commitment to supporting doctors in the transition from medical school into training and working ... more >
NICE approves breast cancer drug combination on Cancer Drugs Fund

17/07/2019NICE approves breast cancer drug combination on Cancer Drugs Fund

The National Institute for Health and Care Excellence (NICE) has approved a new potentially life-extending drug combination for some people with ... more >
East Midlands Ambulance Service earns ‘Good’ rating from CQC

17/07/2019East Midlands Ambulance Service earns ‘Good’ rating from CQC

The Care Quality Commission (CQC) has awarded the East Midlands Ambulance Service NHS Trust a ‘Good’ rating, following an inspec... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

681 149x260 NHE Subscribe button

the scalpel's daily blog

Urology nurses are leading the way in adoption of prostate cancer biopsy technique

11/07/2019Urology nurses are leading the way in adoption of prostate cancer biopsy technique

Jonah Rusere, Advanced Nurse Practitioner for South East London Accountable Cancer Network, outlines an opportunity for urology nurses to make a difference to prostate cancer pathways. What is TRexit and why is it great news for prostate cancer patients all over the country? Let me explain. TRexit is the name given to a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies un... more >
read more blog posts from 'the scalpel' >

comment

Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >
Pay and reward in the NHS needs to be taken seriously

10/06/2019Pay and reward in the NHS needs to be taken seriously

Ben Gershlick, senior economics analyst at the Health Foundation, examines the new pay deal for NHS staff.  More than £50bn is sp... more >

interviews

How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >