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Some further reflections on whether ‘community is the best medicine’

In October 2018 MutualGain had the opportunity to meet a range of health and social practitioners from across the country when exhibiting at the King’s Fund conference, Community is the best medicine: making a reality of community-based health.  Although there were examples of some fantastic practice it was hard not to be left with the impression that engaging with their communities is still not as much ‘business as usual’ as it could be.  This came to mind again following the launch of the new NHS Long Term Plan.[1]

Reminding people that the country has just been celebrating its 70th birthday, on 7th January Simon Stevens, the Chief Executive of NHS England, launched the Plan by declaring it would take us up to its 80th celebrations.  Drawing on the experiences of staff and patients, the Plan is designed to keep what is great and relieve pressure on a service that provides care to one million people everyday.

Developing the Plan has involved patient groups representing 3.5 million people.  Some of its key messages include a clearer emphasis on ‘place-based population health’, prevention and health inequalities with an expectation that Integrated Care Systems (to buld on those already in place and cover the whole country) really understands the needs of their communities.  Key responsibilites will fall to primary care networks covering populations of 30-50,00 with local clinicians and patient groups having greater control. Citizens themselves will also be expected to play their part in taking responsiibility for their own health.

Apparently Simon Stevens has battled hard with politicans to secure funding for the Plan, including a clever reminder of that controversial claim made during the referendum campaign in 2016.  The resulting security of resources is very different from other parts of the public sector.  One projection is that by 2025 the NHS will have 39 per cent of all public spending (up from 23 per cent in 2000) meaning the UK will have a ‘health service with a state’.[2]  This may seem like good news for an organisation that is a ‘national religion’ but, at the same time, highlights a challenge.

Successful delivery of the Plan is dependent on parts of the state other than ‘health’, not least social care (and remember that local government has had its funding cut by almost 50 per cent overall since 2010).  Alex Clark captured some of the dilemmas in The Guardian recently[3]  when describing the experiences of her elderly father. While describing the Plan as ‘great stuff’ she would first ‘be keen to hear a little bit more about the #NHSShortTermPlan’.

In its initial analysis the King’s Fund concludes[4] thatthe Plan is ‘ambitious’ and ‘reveals a clear pragmatism’ but ‘while many of the remaining uncertainties (the Spending Review, Brexit, social care) are beyond the remit of NHS leaders, it is perhaps the sheer length and detail of this plan that may prove a hostage to fortune in the coming months and years.’  It seems vital therefore that there should some sense of how engagement with communities will play a role in delivery.

Despite the Plan being 120 pages long, it is too early to expect all the detail to be worked out.  Nevertheless it was interesting to explore the document to see if there is any mention of some things that feel crucial to addressing the challenge that the King’s Fund identifies.  Taking four key elements I discovered:

  • Patient engagement = no results
  • Involving service users = one mention
  • Coproduction = no results
  • Local communities = four mentions

Simon Stevens ended his launch presentation by reminding the audience that there will be over one million more people retiring in the next five years and that one in three girls born today will live to be over 100.  My initial analysis is obviously far from scientific, but am I wrong to think that there is still a lot to do to find the right dose of community medicine to meet their needs?

Michael Keating

4 February 2019