Can community power help save our NHS?
Demand on the NHS is rising. To protect the future, the health service needs more than internal reform – it needs to reach outwards. As we open our call for evidence, Jessica Studdert and Luca Tiratelli introduce new work on community power and the NHS.
The NHS is our most dearly loved national institution. But health services as we know them are under threat.
As we emerge from the immediate crisis of the most recent pandemic response, the time is right to ask how we can ensure the NHS can be fit for purpose in the long term.
New Local is exploring how community power can protect the future of the NHS – and we’re seeking your views.
We have opened a call for evidence to gather insights from a wide range of perspectives, to inform a major report we will publish later this year.
The challenge of rising demand
For years the NHS has been grappling with the challenge of rising demand for health services. We are all living longer, and many more of us are doing so with long-term conditions.
The NHS was set up in an era of lower life expectancy and designed to treat people on a one-off basis, but more people these days need ongoing support.
Health experts such as The King’s Fund have demonstrated how this plays out most sharply at the acute end of services – with hospitals squeezed and waiting times increasing.
We’ve begun to expect ‘winter crises’ as normal. But the heroic way NHS workers have gone the extra mile during the pandemic means we cannot simply price this in for the future.
It isn’t fair to expect NHS workers to keep shouldering the consequences of a wider failure to shift the system to be more in line with actual population health needs.
Austerity over the last decade has certainly not helped the situation, with funding nowhere near keeping pace with demand. But let’s be clear: with or without austerity, the challenge of rising demand remains.
On its own, more investment isn’t a solution in the long term.
As our population ages, our working-age tax generating population becomes proportionately smaller.
And as public spend on the NHS grows, it risks crowding out spending in other areas that need investment.
If nothing about how the NHS works changes, we are going to see larger and larger amounts of money being swallowed up by acute care, simply to maintain the status quo.
This is unsustainable both from an economic and a staffing perspective.
The long-term future of the NHS as a free-at-the-point-of-use service depends on us finding new ways of working that resolve – rather than just meet – demand.
Why community power and the NHS?
At its heart, community power recognises that people themselves have the best insight into their own situation.
At New Local, we believe that this principle can be the foundation of new ways of working for public services. This means professionals working with people, rather than always just acting on their behalf.
We think the time is right to explore what sharing power directly with people could mean for the NHS.
Could it generate a rebalancing from a focus on overburdened crisis-led acute care towards more preventative approaches? This shift is widely regarded as necessary for the long-term sustainability of the service.
In recent years, the NHS has been focussed on reform within its structures. New “integrated care systems” are being set up in every area. This has involved the range of NHS services, from hospitals to GPs, working together and with wider partners in social care, on how they can better coordinate services in places.
This is welcome. But it is still a process based on internal coordination. How can we help the NHS instead reach outwards and work with people in new ways that enhance their health and wellbeing?
There have been calls for the NHS to move from focusing solely on treating illnesses to also creating wellness.
Meanwhile, in public services more generally, new practices focus on moving from ‘deficit’ approaches to ‘asset-based’ approaches. For the NHS, this would mean thinking of people as people, not just ‘patients’.
Such a shift wouldn’t stop the need for hospitals or clinical specialists. But it would ask questions about how health services can better work alongside people and support them to live independently and in good health for longer.
There are lots of areas where innovative new approaches of working with communities are taking hold. For example, the Healthier Fleetwood partnership which supports and connects people locally to take control of their health and wellbeing.
We would like to hear from you
In conducting new research on communities and the NHS, we hope to learn from the experiences of people already pioneering new ways of working.
We hope to set out what this might mean for how we can create a deeper shift in the system towards prevention and away from crisis-led action.
We would also like to explore what community power can do for health inequalities, which have persisted despite the existence of a national model of universal healthcare that is free at the point of use.
We would like to hear your stories, insights, innovations, and observations about the opportunities for, and barriers to, community power in the NHS.
Change is already afoot right across the public sector and deep within our communities. If we are committed to shaping a better future for our dearly loved NHS, there is no more time to waste.
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