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STPs a ‘step on the road’ to fixing public overreliance on the NHS

Sustainability and transformation partnerships (STPs), accountable care systems (ACSs), accountable care organisations (ACOs) and other service-related acronyms are merely a step on the journey to recognising that inspiring good health is about focusing on people and place, rather than treatment, diagnosis, illness and conditions, the boss of Public Health England (PHE) has argued.

Speaking exclusively to NHE, Duncan Selbie, who first joined the NHS when he was 17 and worked his way up to chief executive at a handful of health providers, said these system transformation plans are “about the NHS getting out a bit more and recognising that in order for it to thrive, it needs to be more engaged in the community.

“It needs to be more engaged in what we call, in today’s jargon, ‘population health’ – which is what’s driving ill health and what’s driving poor health,” he explained.

“It goes back to the [Derek] Wanless Report in 2004: if we want a sustainable NHS, then we need to invest in the public’s health and be concerned with these wider issues: housing, economic growth, jobs, how to help the education system to support young people getting into work. And the NHS depends on that.

“STPs are, if you’d like, an advanced form of planning for the NHS, but it’s only a step on the journey to recognising that it’s people and place, rather than treatment and diagnosis of illness and conditions, that matter.”

A crucial component of focusing on ‘people and place,’ and ultimately on inspiring health creation, lies in realising that wellbeing stretches far beyond the ability to access a hospital or see a GP.

“The whole thing is about how to help people in their home and in their community. And the best way to help the NHS is to use it smartly and not to be using it where there are genuine alternatives,” added Selbie. “That is at the heart of a health-creating community.

“Prevention, in the sense of the days gone by, would’ve meant how to help people quit smoking or drinking, focus on what they’re eating, that sort of thing – or it might’ve been thought of as how to help people get out of hospital faster or avoid admissions. But it’s much more than that.

“It’s about how to help people stay well for longer. The way I frame it is, it’s not so much about what the matter is with people, but what matters to them.”

This could be anything from staying in work and having money in your pocket to simply having a meaningful reason to get out of bed every day or a friend to turn to.

“We know that there’s as much or more science underpinning people remaining well by having a job or a friend than there is anything we do in healthcare,” continued Selbie.

“That isn’t to say healthcare doesn’t matter; it’s just not all that matters. For years, politicians, the media and the public have conflated good health with what the NHS can do. The NHS can do a lot, but it can’t help people to stay well. That’s not what its function is.

“If we’re going to improve the health of the people, we need to improve the housing, we need to improve the education, we need to get more jobs. You can’t have an overreliance on the NHS.”

Our full interview with Selbie will be available in the upcoming edition of NHE (Jan/Feb). To receive your free copy, subscribe here.