Welcome to the first in a series of blogs by Merron Simpson that will dig deeper into the insights gained by The Health Creation Alliance over the last seven years through our work to support system wide transformation and shore up long-term NHS sustainability by advancing a health creating approach to addressing health inequalities.
The NHS’s 75th birthday celebrations are hotting up. Communities across the country are invited to participate in a range of activities: enter a national photo competition, invite an NHS ambassador to give a school talk, give blood, walk 1000 miles. At the same time, the NHS is showing signs of serious illness that might be expected if its lifespan matched that of the human race. It is ‘stuck’ in a problem that has been exacerbated by the COVID-19 pandemic, financial and wider challenges and that is compounded by a failure, over decades, to address health inequalities. These are acting as a vicious cycle and the more the NHS focusses on addressing the problem without a fundamental re-think, the more it could worsen the situation.
Thankfully, senior NHS leaders now acknowledge that the current model is not working. It is within this context that the NHS Assembly is asking some fundamental questions: Where has the NHS come from? Where is the NHS now? How does the NHS best serve us into the future? Going back to first principles is a good idea, because the NHS has been such a success story for much of its life, there’s every chance of finding the ‘elixir of youth’ in its beginnings.
While working on The Health Creation Alliance’s Submission to NHS Assembly, NHS@75, my attention was drawn to the NHS Constitution and its seven principles (last updated in July 2021). I was astonished to find Health Creation writ large throughout, leading me to ask the question: ‘…so why is Health Creation not already business as usual?´
I learned that ´The NHS belongs to the people´ … ´It is there to improve our health and wellbeing, supporting us to keep mentally and physically well´ … ´The NHS is accountable to the public, communities and patients that it serves´ … And ´The NHS works across organisational boundaries´” (including explicitly local authority services, other public sector organisations and a wide range of private and voluntary sector organisations) … Really?!
Speaking on behalf of The Health Creation Alliance’s (THCA) very diverse membership, I feel confident to say that the reality is falling a long way short of the stated ambition on all these matters.
An NHS that really worked in this way would recognise Health Creation as equally important in addressing health inequalities as the treatment of illness and prevention of ill-health. This is not our experience, although it is our ambition; our Call to Action in our latest event series, Coming of Age is for all Integrated Care Systems (ICSs) to do just that and to adopt and embed Health Creation as a way of working making it business as usual across the whole system.
Health Creation requires adoption of a relationship-based approach. Only through sharing power with communities and other local partners is it possible to work together to create the conditions for new solutions to better health to emerge and to be sustained over a long period. Fostering meaningful and constructive connections leads to increased confidence and this leads to greater control (the 3Cs of Health Creation). Being in control of our lives and environments enhances our health and wellbeing.
- For the NHS workforce this means equipping clinicians and the wider workforce with skills in Health Creation and ‘asset-based’ tools they can employ to work with communities and other local partners to open up new solutions and pathways that better address the wider determinants of health for their patients. This is highly energising for professionals whose default setting is a ‘deficit based’ clinical and treatment focus which can be demoralising. As one of our members recently explained: “Deficit language creates barriers and deficit behaviours; but shifting from a deficit to asset model opens up a whole new range of possibility”.
- For communities (who are patients ‘en masse’) this means recognising, valuing and working with existing community networks as power-houses of positive change for communities, as well as investing in community strengthening to increase community connections and social capital where these are lacking. The aim should be communities taking the lead wherever possible – because being in control enhances health – participating as equal partners in a coordinated way with formal services and for the system to become accountable to local communities (as per the NHS Constitution).
The Health Creation Alliance has been working to raise awareness of Health Creation and developing approaches to support system implementation, for over seven years. Many caught a glimpse of the possibility for a new order to emerge through the COVID months and there is now greater appetite to challenge the status quo and loosen the ‘system rigidity’ that has thus far prevented the required shift to enable health to be created through a system approach.
While the NHS is currently grappling with serious issues and pressures on many fronts, our members’ experience is that change is possible and desirable. The willingness of NHS England to contemplate reworking the current NHS model, coupled with greater autonomy of and devolution through ICSs plus some new potential drivers for change through the Fuller Stocktake and Hewitt Review offers a huge opportunity to make the NHS fit for purpose again.
The top-down nature of the imminent celebrations do feel like a desperate attempt to support an ailing centrally-driven NHS limp along for a few more years. But it is within the gift of ICSs to do things differently; not waiting for top-down permissions but to reinvent their systems and lead upwards. The Health Creation Alliance is helping to create the context and conditions – and supporting ICSs at the community, neighbourhood, place, system and national level – to make this become possible.
According to the ONS Life Expectancy Calculator, the NHS at 75 has a life expectancy of 89 (if it is female, 87 if it is male). Unless, that is, we are prepared to rediscover and strengthen what the 1890s Tredegar miners who established the forerunner to the NHS knew all along; that community ownership and leadership is the real route to better health and wellbeing. It could well be the secret to eternal life for the NHS too.
If you would like to discuss how The Health Creation Alliance might support your system to make this transition, please contact firstname.lastname@example.org