Time for action: how NHS England is embedding the learning from Realising the Value

Anu Singh is Director of Patient & Public Voice and Insight at NHS England. She tells us why NHS England funded the Realising the Value programme, how it is helping to implement the vision behind the Five Year Forward View, and what NHS England now plans to do with the tools and learning developed during the programme.

Why did NHS England decide to fund the Realising the Value programme?

Our health system is still run on a very traditional biomedical model of health care that doesn’t fully meet people’s needs. For example, up to a quarter of people attending general practice don't have a primary medical need. In many cases more social models of health care based on person- and community-centred service models would be better placed to meet the needs of today’s populations.

But our health system is stuck in a self-fulfilling cycle. We commission services that we know about, and generally keep to pathways we’re familiar with.  And as a result, outcomes of care aren’t improving at the pace we’d like. We want to move towards a much more responsive model, formed through co-production with communities and patients. But that means making some fundamental changes.

Until now we’ve not really been sure what that new relationship with communities should look like or how things should work on the ground. What conversations do we need to be having and who with? What different payment mechanisms do we need? How can we translate what the evidence says into practice and culture change? We couldn’t answer those questions just by continuing to talk among ourselves, we needed to hear from other voices: individuals, carers and communities, researchers and think tanks. That’s why we invested in Realising the Value. As an independent consortium they’ve been able to pull those different voices together and make some really valuable recommendations.

How can person- and community-centred approaches help reshape our health system?

In the past we’ve looked at the problem in the wrong way. We’ve thought about restructuring services, rather than building on ‘assets’ that are already out there in the community. Now we’re asking better questions about what people and communities need to become stronger and happier, and to be able to support themselves better. And that might mean looking at housing, employment, or something else that’s not traditionally in the domain of health care.

Social prescribing is a good example of how this works. One GP told me that in the past when somebody came to him with depression, he used to prescribe Prozac. Now within the new social prescribing system that’s been set up in his practice, he can help them find a job.

Just think about that shift. Some people might think it’s not his role to do that, why is health getting involved in things that are primarily social? But if the actual diagnosis is social not clinical, we need to be helping people where they are. Otherwise their problem will exacerbate into a clinical need.

What’s stopping these sorts of approaches developing organically at a local level?

It’s a big commissioning change. You might know you want to support people with diabetes or COPD in a different way, by focusing on peer support and self-management education for example, but actually a lot of your commissioning is already tied up in other services. So it is having that time and space to understand what it means for your local population and to be able to translate that into commissioning and delivery.

How does Realising the Value support wider work to reform the health service?

It absolutely feeds into work the vanguards are doing to develop new models of care, and of course the Sustainability and Transformation Plans being worked out at the moment. Prior to Realising the Value it wasn’t clear which interventions to back. Now we can give clear guidance to communities and providers on what works in developing asset-based health.

In particular, Realising the Value has helped us define five interventions that will form part of all of the frameworks we’re developing in two of the new vanguard groups – MCPs and PACS (Multi-speciality Community Providers and Primary and Acute Systems).

What do you think are the most valuable outputs from the Realising the Value programme?

We’ve been working on an economic tool that supports commissioners to model local populations. It’s a really practical resource that helps local systems decide what to do. Along with the five core interventions these are probably the most useful bits for commissioners.

Getting deep insight from the work of the Realising the Value partner sites has been invaluable. The first phase of Realising the Value brought together the international evidence and helped us understand it, but it was only in the second phase through the intensive work we’ve done with the partner sites that we’ve really been able to translate that knowledge into delivery.

How else is NHS England planning to take this work forward?

Realising the Value has formed the blueprint for NHS England’s new Supported Self Care  programme, a national initiative I’m leading that will help every clinical commissioning group (CCG) across the country translate our new knowledge about person- and community-centred approaches into something their population will be able to benefit from. The programme has already started and will help to deliver the Five Year Forward View so runs until 2021.

We have to put all of our time, energy and focus into delivery now. And that’s why Realising the Value has come at such an opportune time, it means we can go out to the system and help make the change happen.