I was asked last week to speak a conference which was looking at progress in addressing health inequalities since the influential Marmot review in 2010 which identified six ways to address inequalities:
My Christmas party season started in style at the weekend as I donned a posh frock and joined Newham Shared Lives scheme at a Glitter Ball at West Ham.
The NHS has many challenges – all of them big, many of them complex, some of them truly wicked. Or at least, seen as ‘wicked’, because they don’t respond to the things that services are currently good at. Of those challenges, perhaps the key one is how the health and care system can collaborate with the quarter of our population who have a long term condition, in order that people with long term conditions can live well. We need to achieve that because the NHS can (and does) do many wonderful things, some of them verging on the miraculous, but it can’t ‘fix’ a quarter of the population. And only people themselves can build good lives in good places; that’s something that services can support and enable, but not do for us.
All health and care interventions can be offered collaboratively, not just community-based interventions like Shared Lives, in which someone gets the support and care they need in an ordinary family home, but also acute and hospital-based services.
Collaborative leaders devolve money and power to enable personal tailoring of services, whilst helping those with personal budgets and Personal Health Budgets to work together to co-design new kinds of services. Conversely, commissioners will always fail the collaboration test when they organise services distantly, for large numbers of people. Professionals fail the collaboration test when they see people as customers and even family carers as just another set of clients with needs. Collaborative professionals have the humility to arrange their work around the capabilities and potential of citizens and carers. They share their knowledge, they make things simple and they are keen to accessible in an emergency.
This ability to collaborate with citizens, families and communities is perhaps the key voluntary sector offer to the NHS. But whilst the voluntary sector is far more capable of achieving that collaboration than the statutory sector, it’s important to admit that charities, social enterprises and community groups don’t always succeed in doing so. Many small community groups are embedded in the right relationships with communities, but lack the health and care expertise. Some large national charities have that expertise but have become unmoored from the communities which built them.
So there is a challenge for all sectors: to demonstrate that we have the insight, courage and humility to make hard, uncomfortable changes towards shared purpose, shared resources, shared knowledge and shared ownership. To recognise that we start to collaborate with citizens and their communities not when we deign to engage or consult with them, but when we return to them, with interest, the power, money and knowledge we have all borrowed.