The art of the possible: The role of the NHS in improving health

What a difference a year makes. Exactly one year ago I wrote my blog about the role of the NHS in improving health and a lot has happened in the policy world since then. 

It started last summer when the newly appointed Secretary of State for Health set out prevention as one of three priorities for the health and social care system. This was followed in the autumn by the release of the Department of Health and Social Care policy document, Prevention is better than cure, followed closely by the Chief Medical Officer’s annual report for England on Better health within reach just before Christmas. The hotly anticipated NHS England Long Term Plan was published a few weeks later, with an entire chapter dedicated to prevention and health inequalities. We also await the Prevention Green Paper due before the Comprehensive Spending Review later this year. 

While many of the messages aren’t new to some people, what feels different is the level of interest and commitment to doing things differently. There’s never been a riper time to be focusing on the role of the NHS in improving health. 

But while these statements all help set a conducive context, how do we now turn this into a reality? There have been criticisms that the various plans and documents are light on what’s needed for implementation. Prevention, population health, integration, social determinants and inequalities are huge areas. Where does one begin? And at what levels should we be addressing this?

The different roles the NHS can play in improving health

We have identified four ways in which we think the NHS can make a positive difference on health and wellbeing: as a direct provider of health care, as an employer, as an anchor in the community, and as a system leader and partner.

1.    As a direct provider of health care, building prevention and action on social determinants into services and pathways. 

This includes prevention of major risk factors like smoking and alcohol, and using screening to make earlier diagnoses. The NHS can also help to tackle more complex issues like multi-morbidity,  and be part of interventions  that address people’s social context and underlying causes of ill health (eg poor housing, unemployment or poor working conditions). 
In her blog, Suzanne Wood delves further into this and describes examples of work we have funded in these areas, alongside our work with the Faculty of Public Health to better understand the role of the NHS in prevention. 

2.    By acting as a role model employer providing good quality, stable employment and prioritising the health and wellbeing of its workforce, creating healthy and environmentally sustainable environments for both patients and staff. 

Our NHS staff are our populations and our communities. As an employer of over 1.6 million people in the UK, the NHS has both the opportunity - and responsibility - to better support staff and improve their health and wellbeing. In this interview, our Clinical Fellow, Anya Gopfert, reflects on the results of latest NHS Staff survey and the impacts felt by staff in the NHS. She describes an example of an initiative we are funding to understand how access to green spaces can impact on the health and wellbeing of NHS staff.

3.    By intentionally acting as an anchor in its community, leveraging its resources and activities through procurement, creating good employment and the use of its land and assets to maximise social value and contribute to wider economic and social wealth in a place. 

The Health Foundation’s forthcoming research with CLES and The Democracy Collaborative is exploring the role of the NHS as an anchor institution further. In an interview with one of the participants of this research, James Goodyear from Leeds Teaching Hospitals NHS Trust describes practical examples of how his organisation is acting purposefully as an anchor institution to tackle some of the adverse social, economic and environmental factors that widen inequalities and contribute to poor health. These include creating opportunities for local people from deprived or excluded communities to have  a career in health. We are also pleased to be working with NHS England to build on the aims set in the Long Term Plan to help maximise the role of the NHS as an anchor in its local communities.

4.    As a system leader and partner working to improve population health through their local health and care system. 

There has been a lot of focus on Integrated Care Systems and Sustainability Transformation Partnerships as vehicles to deliver place-based care and improve population health. There are limits to what the NHS can achieve alone, and working collaboratively with other parts of the public and third sector - as well as with patients and local people - is crucial to ensuring approaches to improving population health and wellbeing are joined up throughout the health and care system. The Long Term Plan acknowledges this and focus is now needed on how to make place-based care a reality. We already know that building relationships, focusing on shared outcomes, and building system capabilities are important and underpin several of the other roles of the NHS in improving health as an anchor and through prevention. We will be exploring these issues, among others, in the coming months. 

The art of the possible

There is already lots of good practice going on across the UK but to truly achieve the vision set by recent policy direction will take a lot more. 

Improving population health requires not just different types of activity but a different mindset and cultural shift – from the NHS as a sickness service to one that promotes health, values health as an asset and rewards activities and outcomes that focus on improving health. We need to be better at engaging people, developing capability around improving health and delivering change across boundaries, and at sharing and spreading good practice.

None of this is easy in the face of the immediate pressures on the health services up and down the country. However, the recent stark reports of stalling life expectancy and increasing health inequalities mean this must become more than an optional ‘added extra’ for our health services. 

I remain optimistic when I see the headway being made by NHS teams and organisations, including some the Health Foundation has funded. For example, Pathway, whose model of health care for homeless people has spread from a small pilot to being recommended in the Long Term Plan. 

This and many other projects show great examples of the art of the possible. 

Dominique Allwood (@DrDominiqueAllw) is Assistant Director of Improvement at the Health Foundation, and a Consultant in Public Health Medicine and Associate Medical Director working in a large teaching hospital in London. 

This blog originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.