Health Service Focus

Health creation is here to stay

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.”

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