Following our chief executive Helen’s piece on Integrated Care Systems (ICS) and thinking of our excellent product the Confident Leader, my mind turned to what is needed to more than meet the aspirations of Simon Stevens’ bequests to us. Simon has been for me an excellent NHS CEO and thus difficult to replace. My fear is the NHS will revert to a hospital focussed CEO who favours ‘big beasts’ with only the traditional lip service to primary care, localness and the community’s health. I would be more than happy to be disabused.
We have been bequeathed the Primary Care Network (PCN) and now ICS both of which potentially encompasses and indeed should embrace beyond only healthcare. It must be about health of which a health service important though it is, only contributes. I would like readers to proffer their ideas of what health is and encourage them to look and seek beyond an absence of disease. My definition of being healthy is feeling good about yourself including having more control over your life events and of course the benefits endowed by health behaviours. Health is a positive and active state of being and population health is about communities and the individuals living within.
As a medical doctor I chose general practice as I wished to be a doctor to an individual rather than a specialist in ‘body parts’, a generalist not a partialist. During my 36 years as a GP, I was for 13 years a local councillor and many of my patients were my constituents. For the first time having worked in a nationalised industry the NHS, I sought something from them- their votes. It changed my perspective as a doctor. I was indeed much more of the community and how can you have population health without the community? So what has all this to do with you. Very little I hear yourself think and you could well be right but hopefully there are some useful outputs from my experience. We need to reset the relationship between the NHS and its community of citizens.
A fundamental issue is NHS patients need to be regarded as both customers and citizens. Younger generations are increasingly less likely to tolerate the ‘take it or leave it’ attitude so prevalent in nationalised industry. The concept that a want is less important than a need is a professionally engendered judgment. How is a patient meant to know the difference without recourse to a professional carer or at least accessible information when the need arises? And yet the judgement prevails in our NHS fuelling a too judgemental attitude by many NHS staff? Patients of course made errors but so do clinical staff. Are there better systems than a nationalised model for healthcare apart from a private model? Yes in our near European neighbours who have generally better satisfaction, certainly better healthcare outcomes and are better funded! The NHS plan of 2000 reinforced the view that a nationalised NHS is best but I think that view needs to be imperatively reviewed!
To come to my point, the policies we have inherited from our outgoing NHS chief executive of PCNs and more latterly ICSs allowed us several benefits. A potential bringing together of the health service, the care services and public health service to focus on prevention, cure, care and the health of the population. New Zealand’s inspirational Prime Minister has it when she described her country as a team of 5 million. That’s the mindset we need in our NHS and the PCN and ICS are excellent ways of achieving such an aspiration. And yet my years of experience suggests it will be mostly led by NHS leaders with a traditional ‘top down’ compartmentalised mind set which will negate the broader vision.
Can we influence that change presupposing that we desire it, or should it be the ‘same old’ leadership? We cannot however ignore the facts Many more people died in the UK from Covid than most other countries for two reasons, the high levels of the infection and because our nation was so unhealthy before Covid-19 struck. UK has the worst population health in Europe. Health inequalities have been widening over the past decades although reversed during the Blair government. People who live in the most deprived places now spend more years with disability and get ill years earlier than in the least deprived ones. This degrades lives and reduces the contribution people can make economically and socially. BAME communities (although that glib acronym is likely to be changed to a description that reflects humanity) have even worse health.
For a more community as well as customer focussed NHS that enabled beyond healthcare, we need a new type of leader. We will explore the topic in a subsequent article.