“We have a democratic deficit in healthcare” Raj Jain on rethinking the NHS

June 8, 2021   By Raj Jain

Raj Jain joined New Local as a member of our Board in May 2021. He is the Chief Executive of the Northern Care Alliance, one of the largest organisations in the NHS providing specialist, acute and community services in North West England.

I work in what is referred to as the health service. Many would prefer it to be called what it is – an ill-health service. 

People want good care when they fall ill or when the condition they are living with flares up. 

But many people also know that if they had help in different ways, then they may not fall ill or their long-term condition might not cause so many problems. Why aren’t we listening to their voices? 

“We’ve got to support our communities to have a louder voice.”

Is an Emergency Department more important than investing in community assets that support people before they fall? Could the NHS make better decisions if it heard the voices of communities in a clearer way?

We have a democratic deficit in the healthcare sector. We are behind some parts of the public sector. If you’re dissatisfied with care or health decisions, who do you go to? You might wait until the next general election, or contact your local MP, but most people just think ‘That’s the NHS – that’s what it’s like’.

It’s very odd considering how much taxpayers’ money goes into the NHS, and how important healthcare provision is to people.

It’s part of the NHS’s psyche to be parental and scientific. But people are more than biology – an arm or some skin. They’re a whole human being and can think for themselves.

We’ve got to support our communities to have a louder voice. They are far better than us at understanding what is important to them. We will make better decisions if we co-produce services with communities and do what is important to them.

Even as an acute chief executive, I believe the solutions to our healthcare sector’s issues lie in our communities.

Community-led health is happening, but it’s on the fringes. The NHS will do occasional consultation exercises, but it’s in a sporadic and clinician-led way; on change we’ve already decided needs to happen.

Moving toward community-led health means redirecting some of our budgets; even shrinking hospitals to invest in anticipatory, community services. I believe this will lead to less pressure on acute services in the long term, allowing them to concentrate on what only they can do.  

For example, why have we not properly rolled out surveillance services for people with heart failure? These are tried and tested. They stop preventable exacerbations, saving the patient a traumatic journey through emergency service and saving the NHS many £000s from avoidable admissions. 

“We need to address how the public can be better informed, not give up.”

About 2% of the population has heart failure – ask them and their families whether or not they would want new investment in an emergency department or in community services. We do ask on occasion, but it is often as an adjunct to our decision making. We could do so much better if we worked to have democratic accountability.

In discussing the idea of democratic accountability in the NHS, I have heard people argue it is of little use as the ‘public’ are not informed enough to make sensible decisions i.e. medicine is complex and multi-faceted. I believe there is truth to this, but we need to address how the public can be better informed, not give up.

At the Northern Care Alliance we’re unusual in seeing most of our growth arise from community services. This is significant, we are a £1.3bn per annum organisation.

This growth has come from partners who want us to co-lead the delivery of services. Partners appreciate that we are trying to make a difference on the causes of ill health, not just treat the symptoms.

We are working with local authorities to create 1,000 jobs per year in health and care for some of most disadvantaged people. That is us helping to lift people out of poverty. This could have a more significant and longer impact on health than most of what we do in the hospital.

Without doubt my cultural background and experience have influenced my outlook as a chief executive. My parents came over from India. My dad was an ice cream man. I went to a big comprehensive school in Liverpool. I saw lots of poverty and what poverty does to individuals.

I am passionately committed to tackling inequalities. The facts are that if you’re from a richer place, you get more money spent on your healthcare than if you’re from a poor place. This isn’t right.

I believe New Local is going to make a difference, spreading knowledge and insights and helping join up the NHS, local authorities, and our communities, and really spread the message about the power of communities in the health service and beyond. I’m very proud to join New Local’s Board.

New Local is running a Call for Evidence on how our health service can be improved, and become more community powered. Join it here until 9 July 2021.

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