The health system can work differently with communities to improve health

Every week in the news there is a story about how our nation’s health is getting worse and the NHS is struggling. There is an urgent need for change in our health system. At the same time, there is a growing understanding that the NHS cannot make the changes we need all by itself. The NHS can operate to remove an appendix, provide vaccinations, set broken legs, prescribe medication. But recent research by the Health Foundation has found that access to health care is only responsible for 10% of the nations health. Other factors such as money and resources, housing, education and skills, good work, transport, the quality of our surroundings and the food we eat all have a significant influence on our health. By itself it can’t create friends and support networks for people living with long term conditions, or provide hobbies and things to do for people living in social isolation, or improve our environment.

In partnership with NHS England, six vanguard sites across England, and the RSA, we’ve been working on a programme which aimed to see how the NHS can enable and support this kind of health-promoting activity outside of its traditional remit. The six places all tried something different, from creating a movement of cancer champions in Manchester, to bringing communities into care homes in Airedale – but all aimed to create a new relationship between health services and local people.

The NHS cannot work alone to improve our health

The NHS is needs-based and target-driven. It is conditioned to respond to people once they have health problems. It is a national sickness service.

With a target-driven system, some people will not meet thresholds and will fall through the cracks. Young people who don’t yet have a diagnosable mental health condition are not receiving the support they need to stop things worsening. Elderly people living alone are not receiving the support they need to get out of the house and stay healthier for longer – around one in five elderly people are in contact with friends or family less than once a week. People all over the country are not being supported to flourish and live their healthiest lives. And it is not up to the NHS to do this alone.

All communities contain assets and resources that the NHS can be blind to when only looking at needs – particularly the connections, skills, talents and energy of its residents. Often there are community and voluntary organisations working locally who are already well aware of these and nurturing them. The NHS can connect into these but it needs to work alongside communities to identify and support these assets.

The health and care system can amplify local community action to improve health

We know that when communities take action on what matters to them, their health improves and health inequalities tend to decrease. We are working on several different programmes already (with the Big Lottery and DCMS, and the People’s Health Trust) that support communities to undertake social action.

The additional value of this programme is that it was backed by the NHS. When the health and care system supports this type of community action it can be catalysed and amplified. And the support provided doesn’t just have to be financial. We saw all sorts of examples of this throughout the programme:

• Training already being provided for NHS staff was opened up to local voluntary sector leaders to build local capacity
• NHS buildings were provided as meeting spaces for local groups reducing the cost barriers that could otherwise prevent people getting together
• Care home staff had time (a couple of hours a month) to support residents of a care home to pursue their own interests
• A local CCG partnered with public health and the education department to fund a school wellbeing project, meaning their money went further

It’s not what happens, it’s the way that it happens

Commissioners are increasingly recognising the need to work with communities to promote health. We heard from people we talked to that it feels like there is a bewildering menu of different things they could do, from social prescribing to time banking to asset based community development.

What we learnt from this programme was that there is no one right thing to do. There is no silver bullet. Some things work better in some community contexts, but the important thing is to work with communities in partnership to empower them and support them to do what works for them. Through talking to project leads and participants in the six Vanguards, we identified eight principles for working with people in communities to take action on their health:

1. Act early. Understanding health holistically, addressing the wider determinants of health and tapping in to citizens’ concerns about health and care.
2. Shift control. Enabling people to have more access to and more control over the resources in their community that impact on health and wellbeing (including funding decisions, public buildings, local health and wellbeing strategies).
3. Bring people together. Connecting and mobilising citizens to build knowledge, help each other, develop a shared purpose and then take collective action in their communities to help each other stay well.
4. Collaborate widely. Joining forces with local anchor institutions, local CVS organisations and other public services; gaining encouragement and full support from the NHS.
5. Change culture. Working to change culture and practice within state and civil society organisations, so that they can provide effective and continuing support to citizens.
6. Grow from the local. Making sure decisions and actions are rooted in local experience; address local needs and value; and build on the assets and experiences of the community.
7. Build momentum.  Learning as you go and using every opportunity to spread good practice and make it sustainable.
8. Share power. Forming partnerships between citizens and professionals, pooling different kinds of knowledge and experience to guide local action, taking a person-centred approach and co-producing action to enable people to act on their own health and wellbeing.

What next?

The programme has now ended, but the lessons learnt for commissioners, professionals in the health and care system, and community leaders will only become increasingly relevant as we continue to shape the future of our health system that we urgently need.

If Simon Stevens is serious in his intent for the NHS to move from a needs based sickness service to a sustainable, genuinely caring and health promoting service then it is essential to continue to find ways for professionals in the health and care system to work alongside citizens and communities in this way.

To find out more, take a look at the report

To read the RSA’s piece on the programme, click here