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

Traffic light system could reduce hospital waiting times

24/04/2018Traffic light system could reduce hospital waiting times

A pilot system is making it easier for GPs to understand the hospital waiting times experienced by their patients. The e-traffic light system co... more >
Ambulance workers threatened with weapons and sexual violence

23/04/2018Ambulance workers threatened with weapons and sexual violence

Sexual assaults on ambulance workers have almost trebled in five years, a Freedom of Information (FoI) by union GMB has revealed. Since 2012 the... more >
RCN seeks views on three-year pay deal

23/04/2018RCN seeks views on three-year pay deal

The Royal College of Nursing (RCN) has opened its vote for its members to have their say on a three-year pay deal. If approved, the deal would s... 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

NHS long-term funding: what’s in store?

10/04/2018NHS long-term funding: what’s in store?

Anita Charlesworth, director of research and economics at the Health Foundation, discusses Theresa May’s recent announcements on long-term NHS funding and considers the options available. The prime minister’s appearance in front of the Liaison Committee of the House of Commons last month has caused quite a stir in the health world and no doubt a fair amount of angst in the Treasury. This is not the first time a prime ministe... more >
read more blog posts from 'the scalpel' >

comment

Building a solid evidence base

18/04/2018Building a solid evidence base

Danielle Doyle of THIS Institute, co-created by the University of Cambridge and the Health Foundation, says the new organisation will dare to try... more >
Forensics v fraud

18/04/2018Forensics v fraud

Gareth Ballance, technical lead of the Forensic Computing Unit (FCU), gives a snapshot of a day in the life working for the NHS Counter Fraud Aut... more >
A personal view of NAPP’s future strategy

18/04/2018A personal view of NAPP’s future strategy

Dr Patricia Wilkie, president of the National Association for Patient Participation (N.A.P.P.), outlines her personal ambitions for the coming ye... more >
It’s all about quality data

18/04/2018It’s all about quality data

Steve Graham, eProcurement/Scan4Safety lead at the Department of Health and Social Care (DHSC), and Gillian Fox, head of the eProcurement Program... more >
Setting the reform agenda

18/04/2018Setting the reform agenda

In 2017, the National Audit Office (NAO) said the government needs to take a stronger and more integrated approach to rein in the cost of clinica... more >

interviews

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 >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >
Simon Stevens: A hunger for innovation

25/09/2017Simon Stevens: A hunger for innovation

Simon Stevens, chief executive of NHS England, knows that the health service is already a world leader when it comes to medical advances – ... more >