Jeremy Hunt and Simon Steven’s recent announcement to ‘turbo-boost’ Sustainability and Transformation Partnerships (note, they are Partnerships now, not just Plans) provides a welcome shot-in-the-arm for those across the system who are working hard to transform our health service into one that truly focuses on people’s health, and not just their illnesses.
In a united front, they announced capital funding (to the tune of £325m) and increased autonomy and flexibility is being offered to the 15 best-developing STPs in a bid to create a peloton of front-runners paving the way for others to develop. Primary care hubs will receive some new investment and a new forum for national and frontline leaders to ‘have more conversations’ will also be established.
But the lack of zeal for revolutionising ‘partnerships’ which are, after all, what a shift to place-based, population-based health system is all about, was laid bare.
When challenged by David Orr of the National Housing Federation about why it is that hospitals are making a case for funds to build homes – rather than working in partnership with housing associations which are much better equipped to do this – the question was side-stepped, or not understood. Jeremy Hunt instead focused on the need to join up organisations within the NHS before being able to integrate with those outside it adding “I’d love to see a time when the health budget will pay for sorting out the damp in someone’s home … in perhaps 5 years time” … Simon Steven’s immediately adding wryly, “ … with our growing health budget”.
This is old-thinking. In places like Liverpool and Derby, CCGs monies have been funding ‘healthy homes programmes’ for some time and the NICE guidance on ‘Excess winter deaths and illness, and the health risks associated with cold homes’ makes a clear evidence-based case for spending to make vulnerable people’s homes warm as a route to improving their health (and avoiding deaths). Housing organisations are building affordable key workers homes for the health workforce and repurposing sheltered housing for step-down to alleviate the DToCs crisis. They are being commissioned by CCGs to do all sorts of things to modernise our health system, to deliver outcomes for patients and to take the burden off primary and secondary care, public health and mental health.
This has been happening for some time. If we are serious about improving health outcomes, we must get serious about money following people, about drawing the expertise from wherever it exists and stop putting cross-sector spend into the ‘too difficult’ box because it challenges us conceptually.
The P in STPs also needs to extend to seeing people and communities as partners because an equal partnership between people and services is how health creation happens(see Health Creation Alliance Manifesto for Health Creation): https://www.thehealthcreationalliance.org/wp-content/uploads/2016/07/A-Manifesto-For-Health-Creation.pdf. This new National Forum for national/local conversations must include local residentswho know how to create health in their communities. If it is limited to professionals (whether national, managerial or frontline) then a huge opportunity to transform our health systems into ones that truly deliver for people will be missed.
It is time our leaders – at national, STP and local level – understood that bringing partners in from outside the NHS is not just ‘nice to have’ but is the route to successful transformation and actively support it. The NHS can’t heal itself, it’s tried enough times already. It’s time to let others have a go!
Merron Simpson, Chief Executive Health Creation Alliance
