“The NHS can learn about community power from local gov” – An interview with Sir Chris Ham
New Local is proud to welcome Sir Chris Ham to our Board. Sir Chris is a health policy academic who started life as a political scientist. He was chief executive of the King’s Fund from 2010 to 2018, and was professor of health policy and management at University of Birmingham’s health services management centre from 1992 to 2010. We spoke to him about community power in the NHS, why he’s continuing to challenge the government’s test and trace approach, and why he decided to join New Local’s Board.
You’ve have had a hugely varied career. Has there been a common thread?
I began work as an academic, but I never wanted just to write for other academics in learned journals. I’ve always had an affinity with people in public policy roles and I’ve been struck by the gap there can be between them and academics or researchers. I’ve been interested in how to make connections between two worlds that don’t come together very comfortably. I’ve been a sort of broker – making research more comprehensive for the people who make decisions.
What has been the point you’ve felt you’ve made the biggest difference?
It was particularly interesting to work at the Department of Health between 2000 and 2004. I was head of a newly created strategy unit that advised on the direction the NHS was taking. It was around the time of massive investment under the NHS Plan 2000 and we needed to demonstrate how were going to use the money on things patients would actually see and value.
That was my most influential time, simply because of my proximity to the decisions being made. The experience of working in government is invaluable to anyone interested in policy – however much you think you know, there are some things you only find out by being in the room.
You’re now using your platform now to speak out about test and trace for Covid – what do you hope to achieve?
In the early stages it was about calling the government out on its approach, and highlighting the mistakes made in setting up this privatised, centralised, fragmented system of test and trace. I’m now working with the national team developing test and trace, supporting them to change direction and put local authorities and public heath teams into more of a leadership role. I believe that government should be honest about its mistakes in failing to recognise the role of local government early enough. It now needs to give resources and support to councils so they can succeed in their testing and tracing role.
Why did you decide to join the New Local Board?
I’ve always been interested not just in the NHS but in the relationship between the NHS, local government and the VCS (Voluntary Community Sector).
From 1977 to 1986 and I worked at the School for Advanced Urban Studies at the University of Bristol, which was formative in my understanding of the role of local government and the need for partnership working with the NHS
At the Kings Fund I became particularly interested in the work done in by Wigan Council and got to know [New Local Chair] Donna Hall. I was impressed with the approach they’d taken under austerity and with the radical strategy they’d developed through the Wigan Deal. I thought – if it can happen here, why not everywhere?
Reading the work of New Local, particularly The Community Paradigm, resonated with me further. I share its fundamental belief in the value of public services and intervention, but also an awareness that intervention must be different in the future. It is important to be a critical friend of the welfare state who is not merely critical but who has constructive ideas of what ‘better’ looks like.
We need to recognise that public services don’t have all the answers – that communities and the third sector have valuable assets and ideas – and they should function much more as partners.
Where does the NHS stand now in terms of involving and empowering patients?
I don’t think the NHS is as far ahead in its thinking and actions as local government. There’s lots of things happening in small pockets, like the Bromley by Bow Centre that for many years has been a forerunner in integrating a community hub with a health centre and taking a more patient-led approach.
But there’s nothing on the scale of the Wigan Deal in the NHS – and that’s one reason the NHS can learn from working with local government.
Why is community power needed in health care?
Fundamentally it’s about moving away from a paternalistic approach to health care – a ‘pill for every ill’ and ‘doctor knows best’ – to a partnership model.
It’s about recognising the contribution that all of us could bring to healthcare. For example, people with chronic long-term conditions are experts in their health and wellbeing. It’s what they do every day – in terms of diet, exercise, whether they take medication, how social they are. We know that these life choices make a bigger difference to health outcomes than doctors do. We need to value and recognise that.
It is not just helping people to live with conditions, it’s about them not getting ill. How do we help them take up opportunities to stay well, exercise, diet, and maintain social connections? You see this in the growth of social prescribing. There is a recognition that there are non-conventional things that could help people with health issues – often more than conventional medicine.
Should local government have a greater role in health provision?
It seems to me obvious that the health care system of the future needs to be much more joined-up and integrated. I think local government should be working in greater partnership with the NHS. One benefit of Covid-19 has been the work done by Local Resilience Forums – with councils, health care, emergency services and the third sector working together with great success. I hope we can hang on to these gains and create health and care system that really works for everyone. Integrated health systems across England are another way of doing this.