Where are we on health?
21 March 2019
While we in the policy world sink deeper and deeper into the mire of Brexit and new political groupings, it is important to remember that most people continue to go about their lives entirely normally.
While we are worried about stockpiling and body bags, normal people are worried about normal things, and for most of us, this means our health. Health provision may have slipped down the list of the public’s key concerns, but it still dominates much of our lives.
What is happening in health? Some good things, but also a lot of Brexit-y confusion. To understand why, we have to turn to a time when the referendum was just a twinkle in a new Prime Minister’s eye, the heady days of 2010…
The early David Cameron years saw an attempt to drive competition through the system, especially with the creation of clinical commissioning groups. As author and journalist Nick Timmins said in a recent article on Cameron’s public services legacy for news outlet, Tortoise: ‘The result [was] fragmentation, both nationally and locally’.
This perhaps predictable outcome was particularly unfortunate when – as Mr Timmins identifies – the big challenge then and now seemed to be ‘how better to integrate care for the growing numbers with long-term conditions’.
While not explicitly removed, and without changes in legislation, most of the features designed to encourage competition brought in by the Cameron Government have now been dismantled.
In more recent years, the talk has been more of attempts to bring things together in collaboration, as seen with the creation of sustainability and transformation partnerships – themselves now morphing into integrated care systems. Most recently, we had the NHS Long Term Plan, and some significant extra money to help deliver it.
The plan won plaudits, as it picked up on a number of problems and set targets to reduce the suffering they create. For instance, that by 2028 the proportion of cancers diagnosed early will go from a half to three-quarters and maternity-related deaths will be halved by 2025.
The plan also included a nod to those interested in the less acute side of what the NHS and the state can do, a cause further buoyed by secretary of state, Matthew Hancock, promising a Green Paper on prevention.
All this feels positive but should we take it with a pinch of salt? Some feel much of the preventative and ‘social determinants of health’ material in the Long Term Plan and the ministers’ pronouncements is only paying lip service to the ideas. So, will much change?
It is easy to argue that money is the most important thing, as the moving of public health back to local government a few years ago illustrates. This was a good move, as it gave health prevention powers to the body that has most say over the general factors that contribute to good health in a locality. But, undermined by the massive cuts to local government funding, the value of that switch is now being questioned.
While funding is vital, it is not everything. One big shift in the Long Term Plan, even if not generously funded, is the full-on embracing of social prescribing. This is a very different approach to dealing with the factors which keep people healthy through their lives and the social responses which help people maintain and manage their mental and physical health.
A new approach, and a radically different one, it is however true that there is not yet much hard evidence to support social prescribing. It is argued that it helps people in the longer-term and reduces the stress on clinical services, but there is some scepticism in the medical world.
To make it a success we will need civil society and local public services to play a big role. And of course, it is not just a cheap option. Link workers or navigators are needed to guide people to the right local sources of support and a healthy and effective civil society, decently funded, is needed to provide them.
For all the churn in the health service, social prescribing has the potential to have a big impact on people’s health.
Being prescribed some work in a garden, or some mentoring, or the chance to take up art, might not seem a big deal with things like Brexit looming, but for those who receive it, and for our overstretched health service, it could be the start of something very important.
For more of NPC’s work on health, see here.
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