How will the NHS adapt? Will its response to challenge be dominated by financial, organisational and political interests, bypassing what really matters to ordinary people? It would not be the first time. Or will the NHS seize the opportunity to genuinely ‘put patients first’?
The 2015 Challenge Declaration helps frame that discussion. Recently co-produced by the NHS Confederation and seven partners – including my organisation, National Voices – it sets out seven challenges that must be tackled for a sustainable NHS. But what does a truly people-centred response to these challenges look like?
The declaration starts with the need challenge. The NHS is inclined to worry more about rising demand than about meeting need. A people-centred response puts health inequalities centre stage, targeting resources on those with the greatest burden of ill health. It has urgency and is cross-governmental in scope, tackling not only unhealthy behaviours, but their underlying causes.
The culture challenge is to create an open, transparent, bottom-up and participative NHS. The declaration sets out the goal of building confidence in the health service. The corollary is that the NHS should also be building its confidence in the people, trusting more to the capacities that patients and communities can bring to the business of health and care, and learning to let go. Now that really would be culture change.
The design challenge is not just about creating a different pattern of services. It requires a radically different approach to the process of design. It means building services around people, not around institutional and professional silos. It means organising for outcomes that matter to people, such as wellbeing, independence and control. It is about recognising and nurturing informal networks of support. And crucially, it is about designing with – not for – people. A ‘no decision about me, without me’ approach at all levels, from an individual’s care plan to board-level decisions at the Department of Health.
However constrained the public finances, health spending remains a matter of political and societal choices, not economic inevitability. A people-centred response to the finance challenge demands that the NHS has funding sufficient to maintain the essential principle of a comprehensive service, based on need – not ability to pay. It demands greater funding to allow social care to fulfil its function of promoting wellbeing and independence, rather than acting as a barely adequate crisis intervention service. And of course, all additional funding must be tied to reform.
Whatever the funding, great leadership can make the decisive difference in determining the quality of care. A people-centred response to the leadership challenge takes a broad view of leadership. It is about creating the conditions in which all staff have the means, capacities and character to do the right things. It is also about nurturing and embracing the potential of patient and citizen leaders. They are partners in making better decisions about the design and delivery of services. They are not just ‘patient reps’ with a fancier job title.
Differently designed services create a huge workforce challenge. A people-centred response recognises that the workforce of the future needs values, attitudes and incentives conducive to partnership working. And it considers the informal workforce: patients, family members, neighbours, friends, volunteers and the voluntary sector. How to engage, support and mobilise that much bigger resource is a central part of the challenge.
The seventh challenge is technology. A people-centred response ensures that the NHS catches up with other sectors of society in making best use of modern technology, since it is still so woefully behind. And it ensures that people are the masters – not the slaves – of the technology.
A people-centred response to the 21st century challenges of healthcare is itself highly challenging of the status quo. It thinks beyond the boundaries of the NHS and statutory agencies; it challenges professional orthodoxy. It deconstructs familiar ideas of the ‘the patient’. It moves us away from a medical to a more social model of health. It demands a radical sharing of power with ordinary people. Are you up for it?
Jeremy Taylor is chief executive of National Voices. Follow both on Twitter: @NVTweeting @JeremyTaylorNV