When the NHS was founded 70 years ago it was focused on treating sick people. The instruments of delivery were hospitals, GPs and nurses—things that still dominate the public consciousness when we talk about health.
So effective has the NHS been at keeping people alive, it now has more patients than its first proponents could have ever imagined. Nor could early architects have predicted the sophistication and expense of the life-prolonging treatments, which now present a continual dilemma of resource allocation. The NHS still demonstrates great talent for delivering acute medical care, but is stretched to breaking point by ever-increasing demand.
So, to survive in a time of tight public finances, health services leaders, politicians and stakeholders all have recognised it needs to change. It must adapt to an increased prevalence of long-term, complex conditions and to try to prevent ill-health from arising in the first place. It needs to stem the tide of ever-increasing demand, through prevention and self-management strategies, while convincing the public that doing this is a valuable role, and some of its old roles may need to evolve.
This will not be easy, and the NHS will need all the help it can get. NPC sees charities as being well-placed to help shoulder this burden in several ways:
People’s wellness/wellbeing is rooted in their social circumstances—work, housing, relationships, childhood, education, community, environment and play. The prevention of ill-health relies heavily on these ‘social determinants of health’—as Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity calls them. He concludes that not only does poor housing, lack of work and all the other factors contribute to our mortality, the very experience of being disadvantaged in an affluent society will affect people’s health.
Charities cannot solve all of society’s ills. However, NPC sees charities working on housing, work, community, education, environment all playing a role in helping to shape the health of society. This work, the evidence tells us, will help to prevent disease.
Charities are better placed than the statutory health system to explore new models for the following reasons;
- They may be able to reach and support people in marginalised communities that don’t engage well with the health system
- They can be flexible and agile, and can take risks/adapt more easily than state super-structures
- Local or specialist focus allows charities to adapt and tailor support to individual needs
They are also superbly placed to help in the management of chronic conditions and ill-health. They have experience supporting people to manage their own conditions by providing information in every format. Many charities, such as Asthma UK, are developing digital aids. Others, such as the federation of Mind charities, have developed successful peer networks. Charities can be a conduit for the co-production of care and treatment solutions, closely involving the very people affected by frailty or health conditions. Thus charities are able to innovate and collect the evidence to determine what seems to work.
An example of where this works in collaboration with the NHS is the Bromley-by-Bow Centre’s social prescribing work. Social prescribing is a means of enabling doctors, nurses and other health professionals to offer local non-clinical services (often delivered by charities) that would help people’s social circumstances and thereby improve health and well-being. Examples include walking clubs, ‘men in sheds’, gardening societies and healthy eating projects. In Bromley-by-Bow, 95% of local GPs reported improvements in their patients’ health and well-being. Self-reported scores by people attending support this.
Among all these positives, the main disadvantage is charity sector patchiness. Only a handful of big national health charities aim to reach every person affected by a condition. Most charities accept that the services they can only offer services in the places where someone is willing to pay for them. The ‘postcode lottery’ of care railed against by many, including charities, is mirrored by the sector’s own ability to meet only some needs in some places.
Which brings us to the central challenge. Who pays for these services? and whether the state health system—Department of Health, NHS, Public Health England—can be persuaded to reallocate resources? Charities currently do not have the scale to cover all people, all needs, everywhere. They are being encouraged to team up to offer solutions to the NHS, but there is no one model for who approaches who, and where responsibility lies.
The Somerset voluntary sector have got together to offer joined up services to the NHS, in itself a feat of hard work, and they are having conversations with the NHS about how a social prescribing scheme might work, and get resourced. Waltham Forest local authority and Clinical Commissioning Groups meanwhile have taken a proactive approach with the voluntary sector, and allocated funding to be distributed to the many local organisations offering social prescribing. This process has a dedicated senior officer at the local authority who knows everyone.
Much depends on local leadership on both sides—charities and health sector. When people start to really see the benefits, and please—let’s collect evidence as we go, then we hope others will copy the pioneers and use charities more widely to deliver health benefits.
This blog is part of a series, in the month of the 70th anniversary of the founding of the NHS, exploring the relationship between the health service and the voluntary sector.