The NHS Plan has a massive community-shaped hole at its core

January 8, 2019   By Adam Lent, Director, NLGN

This article first appeared on the Local Government Chronicle website on 7th January 2019.

It is generally accepted that doctors should avoid diagnosing their own illnesses and prescribing their own treatments. Evidence supporting this principle comes today with the publication of the NHS’s Ten-Year Plan. The rambling 136-page strategy reveals an organisation lacking a coherent grip on its own failings and able only to generate a mind-bogglingly complex list of unconnected solutions. Maybe they should have asked a friend to take a quick look first. They could have done worse than ask local government.

In many ways the NHS faces very similar problems to councils. Demand for services is rising rapidly and getting more complex. Citizens want more of a say. And resources are limited even if the constraints on the NHS are nowhere near as severe as for councils.

But compare how the most innovative councils are responding to these challenges and what the NHS now says it hopes to do and a vast conceptual chasm opens up.

Forward-thinking councils are recognising that the starting point for change must be the creation of a completely different relationship with the communities they serve. A collaborative mindset has to replace the hierarchical and transactional attitudes that have shaped local services for the last seventy years.

The reason is straightforward: if we are to make a wholesale move to prevention and away from acute care then communities need to do more for themselves. That means councils being willing to hand over power and communities being willing to take on responsibilities. Look to councils like Wigan, Cambridgeshire and Gateshead amongst others and you will find a radical redesign of services that has community engagement and empowerment at its heart.

This is a fundamental perspective that is completely absent from the NHS Long Term Plan. There is no sense of the need for a different and potentially difficult conversation between the health service and the population about communities taking on more responsibility. There is no self-analysis of the way the NHS’s hierarchical, status-obsessed culture militates against relationships with patients based on empowerment and collaboration rather than “doctor-knows-best”.

Instead, we have a document utterly infused with the belief the NHS is an organisation that can solve its own problems through structural, process and technological fixes. Indeed, the only time empowerment gets a look-in is in the chapter on technology where we are informed that new ‘digital tools’ like the inevitable NHS App will transform patients’ experience of the information they can access.

The lacuna is all the more baffling given that the New Care Model pilots launched five years ago by the NHS specifically aimed to trial handing more power and responsibility over to communities. It led to genuinely exciting initiatives in areas such as Morecambe Bay where community groups have taken on key healthcare roles. The Plan allows itself one paragraph to acknowledge the impact of these ‘vanguards’ but then fails to draw out any wider lessons.

The sad lesson from the Long Term Plan is that the NHS is far too important to be left to the NHS. The health service is incapable of developing a coherent, transformational strategy for itself. Nor does it understand that healthcare can no longer be ‘owned’ by healthcare professionals but has become, like all other aspects of public service, a matter for all of us.

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