The Changing NHS

The NHS remains overwhelmingly a treat and care system, despite its’ long held espoused intent to shift significantly toward a prevent and promote system. Partly this lack of progress might be because national and local politicians exert pressure for a focus on issues that are most familiar / of most concern to the electorate (largely treat and care related issues). It also might be partly because NHS managers don’t feel terribly confident about the efficacy of the actions that can be taken regarding prevention and especially promotion. It's all a bit like trying to get this tractor to the top of the sandhill. But for me, there’s also something else here – something to do with the NHS’s inability to really believe in what its’ espousing.

What would be different if the NHS became really serious about becoming a prevent and promote system?

Well, for starters, local leaders, especially in PCTs, would clearly and effectively communicate (and re-state on a daily basis), the need for managers and clinicians to pay much more attention to preventing ill health and promoting positive health and – here’s the difficult bit - to consequently pay much less attention therefore to treatment and care. This is ground zero. Without this re-occurring message, clearly stated, and a significant reallocation of time and mental energy, the NHS has no chance at all of escaping the ‘stickiness’ of the status quo.

It also needs local leaders to be able to translate this strategic intent (to become more focused on prevention and promotion activities) into concrete, practical and measureable actions that make sense to staff. Examples might be:

• Measured over the course of one year, the executive team will spend at least 35% of its regular weekly meeting time discussing, sanctioning and reviewing prevention and promotion related activity
• We will spend 2% more of our revenue budget, year on year, for the next 5 years on activities that are genuinely classified, by researchers in the local university, as prevention and health promotion activities
• We will, in partnership with the local authority, successfully introduce a single health information system that’s focused on recording the health and social care needs of the 500 families agreed, by both parties, to be ‘most in need’ within our local geography
• We will help local councillors and senior local authority officers to better understand the relationship between improving health and local policy making. To this end, within 2 years, local councillors as a group will self-report ‘the health agenda’ as something that is absolutely central to their own organisation’s purpose and something that is amenable to significant impact as a result of more health conscious local policy making.

In addition to these largely process related measures, an NHS that really is serious about focusing on prevention and promotion will have successfully shifted its own culture in two important respects. First, at a local level, we’d have an NHS that was full of people positively enthusiastic about seeking out people with poor health, addressing both the causes as well as the affects and learning lessons for the future. Second, at a national level, we’d have an NHS that was confident enough to collectively seek to exert (or encourage others to exert) significant and concerted pressure on Governments to address the most important health issues in a serious, connected and sustained way.

Too often at the moment the NHS seems largely content to only deal with whatever is put in front of it. But maybe that’s largely what you’d expect from a treat and care system?

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