There are a lot of problems in the NHS right now. And there are a lot of articles and blogs listing them one by one in all their glory. I’ve even written some of them. But this isn’t one of those blogs.
I’ve spent the last couple of months running workshops with our partner organisations in Realising the Value, trying to ascertain the system level levers and barriers they work under. Essentially, we have identified some of the leading organisations working with person- and community-centred approaches for health and wellbeing and tried to establish what helps them and what hinders them.
And if you want to hear about the problems they face you won’t be surprised to hear that they are many and varied and will be listed in full in the programme’s final report in due course: the system that commissions them often completely undermines them, the NHS has an allergy to the risks of innovation, and (newsflash) resources are tight right now.
But the NHS should also find a message of hope from organisations like these, working differently, and working brilliantly.
Right from the start of the workshops I experienced alternative, and better, ways of working, even at a very basic level. Such as the director who simply started a meeting by telling us to put down our pens and phones, be quiet and spend 30 seconds being in the room and thinking about what we were here for. It’s not rocket science but why don’t we all do this? Why do we think that we are more effective in meetings scrolling through emails or tweeting our thoughts? Why is the latter experience so much more common than the former?
All of the organisations also talked about the importance of partnerships and community. So far, so obvious. But they also lived these values. Workshops involved everybody, from NHS chief execs and commissioners to local authorities and councillors, to doctors and academics, to local artists and even, heavens above,… patients. Except these really weren’t patients. They were people.
They had not endured health care being done to them as patients do. They were people with their own story and their own experiences who had seen at first hand the benefits of truly person-centred approaches. And indeed so much so that many of these organisations are now in part run by people that have first benefitted from them: mentors, peers and organisers who were once subject to the system themselves but discovered these organisations treating people as people.
I came away feeling that a cancer diagnosis would be a less scary thing, not because of breakthrough drugs or the genius of doctors but because of the existence of organisations like Penny Brohn UK. Equally, that a welcome, renewed political focus on mental health in the last couple of years must not be met by lobbies of psychiatrists and pharmaceuticals but by the expansion of groups like Creative Minds.
Which brings us back to the workshops and the system levers that enable and grow these groups. Systems can make change in a variety of ways. In the Health Foundation’s Constructive Comfort report the authors identify a difference between 'prodding' organisations (where providers are nudged into line by targets and performance management) and 'proactive support' (enabling providers through support).
The second approach depends on supporting the existing strengths and assets of providers. The local organisations that Realising the Value is partnered with are doing this already – they are recognising the stories and strengths that people have and are building on them to develop their care.
The NHS should treat these organisations the same way – realise they are great assets that can be built on to support the health system. The question is how to do this – how can we enable the organisational assets we have? Over the next few months we will be testing the findings from the local partner sites with a wider range of organisations and communities. We’ll then be taking our story to the representatives in the national bodies who can make change happen. We hope some of the answers will become clearer as we publish the full findings of our research later this year.