New models of care must be built on new approaches to prevention | Rob Webster

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Rob Webster

Unless we take serious action on prevention, invest in new care models and sustain social care services, we will fail to see the fruits of our hard work come to life, says NHS Confederation chief Rob Webster.

I first heard Sir Michael Marmot speak in 2010, after the publication of Fair society, healthy lives. His report landed during a period where the NHS had been set an unprecedented financial challenge and had to deliver this through transforming care. This was the world of quality, innovation, productivity and prevention (QIPP), often referred to as the ‘Nicholson Challenge’, to save £21bn over five years. 

If that sounds familiar, then so does the refrain that social care is under pressure. And in tough times, public health budgets are the first to be cut, as we let the urgent issues of dealing with NHS pressures squeeze out the important task of affecting future demand. 

At the NHS Confederation, we believe that any tenable solution to the issues faced by the NHS must embrace the public’s health and the importance of community and social care. 

Next week, health and local government leaders will come together to discuss the relationship between new models of care and prevention. The event (on 7 March) is co-hosted by the NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association, as part of our joint work to help spread the learning from the vanguard programme across the health and care sector. 

We are fortunate to have Sir Michael Marmot as a keynote speaker. With a career dedicated to analysing the social determinants of health, Sir Michael commands the attention of governments and policymakers worldwide on the best approach to effective preventive healthcare.  

It’s been six years since Fair society, healthy lives was published. The message in that report was clear: tackling health inequalities has huge societal and economic benefits; taking action reduces illness and lessens other knock-on impacts, such as productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.

One of the striking points he made when he spoke in 2010 was that if you take a three-year-old child who is cuddled by their parents, talked to and read to daily, they have better life chances. As a CEO responsible for health visiting and children’s services at the time, that made me think very carefully about our interventions, and paved the way for integrated care in Leeds.

More recently, Sir Michael has looked at the differences in health within countries and between countries, in his book The health gap.  He found that traditional approaches to prevention and public health only go so far. To have a real impact on reducing health inequalities and improve prevention, we must create the conditions for people to lead flourishing lives, and empower individuals and communities. 

Sir Michael clearly believes that reducing health inequalities is a matter of fairness and social justice. This approach carries a responsibility to provide a sustainable, responsive service. It reflects a move to a care system which recognises the benefits achieved from care services, and the people who use them. It includes wellbeing, health, inclusion and employment. 

Achieving this vision will require a change from one which sees communities and people as having problems, to one which starts with their assets – this is one of the four obsessions of the NHS Confederation.  It will require the wider care service to recognise the fact that investing in health, like in education, will reap rewards for the country and its communities. There are some excellent examples from the integrated care pioneers programme where this is the case, and now the vanguards are getting there too.

Connecting Care is a partnership of health, local government and voluntary organisations based across Wakefield, and is one of the many new models of care we will be showcasing next week to highlight how we can make a real difference by rebalancing the relationship between the individual and professional, and putting people in control of their own health. 

The initiative aims to provide people in care homes with more proactive, connected and rounded assessment and care planning. It involves groups of GP practices working as a network with a team of community nurses, social care staff, therapists and voluntary organisations, to organise services around the needs of those people registered with their practices. 

The teams provide a joined-up service for people who are most at risk of becoming ill, such as those with long-term conditions, complex health needs and people who have been in hospital following an emergency or operation.

While it is perhaps too early to measure the impact the partnership will have on the community in the long term, it is clear that the change to planning the way care is provided is already having a positive impact on the people receiving care – and the people planning and providing it.

It is nearly a year to the day since the original 29 vanguards were announced by the national bodies. Their launch represented a notable shift in our approach to the design of health and care services in England, by backing clinicians, local leaders and communities who want to take the principal role of transforming services in their areas. 

If the vanguards, of which there are now 50, are to succeed, they must always focus on new ways of improving outcomes for patients and communities, beyond the traditional changing of organisational structures and models. And the national bodies must change gear, to deliver support, capacity and critical challenge.

The primary message from the Five Year Forward View, from which the vanguards were born, is that the future health of our population, the sustainability of the NHS, and the economic prosperity of Britain, all now depend on a radical upgrade in prevention and public health. 

Unless we take serious action on prevention, invest in new care models and sustain social care services, we will fail to see the fruits of our hard work come to life. It is these wider system improvements, coupled with a close eye on the way we invest in our care services, that will create viable options for sustaining and improving the NHS over the longer term.

Rob Webster is chief executive of the NHS Confederation. Follow him and the organisation on Twitter @nhsconfed @NHSConfed_RobW

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