The main theme of this blog is how other parts of society can help the NHS thrive in its mission. Because, in the modern world money is not enough. The needs of a 75 year old with two long term conditions (increasingly the median patient for the NHS) exceed those that medicine can meet. For most people the problems of diabetes and dementia from which they suffer will not be ‘solved’ by medical staff and drugs. They do have strong medical needs that must be met, but those needs are also social, environmental and psychological. Some, but not all, of those psychological needs may be met by the NHS. Companionship, having someone to regularly pop in, or help you pop out, probably won’t be.
For older people with a couple of long term conditions to live better lives they will need a wide range of institutions to work with than the doctors and nurses of the NHS. Nearly everyone with a long term condition will manage a better life if they take regular exercise. Better still if that involves getting out a bit. Even better if it involves getting out a bit with others. Nearly everyone with a long term condition will learn how to manage it better if they have the possibility of meeting and discussing their illness with others who have been managing their condition for a little longer.
Most clinicians now recognise the limitations of a purely medical approach to helping people to better manage their long term conditions. But the NHS has not proved dextrous at creating relationships with other organisations in society to provide that assistance.
Across the country there are thousands of small examples of voluntary organisations working with patients in alliance with NHS clinicians to improve the patient’s capacity to manage. The Richmond Group of Charities wanted to achieve something at a greater scale A report published by the Richmond Group and the NPC ‘Untapped Potential ’, outlines a much bigger approach to this issue. For 18 months the Richmond Group worked with Somerset’s Sustainability and Transformation Programme to develop a much closer relationship between the Somerset branches of these Richmond Group organisations and their local NHS. (In the interests of full disclosure I have been an unpaid member of the steering group for this project).
The Richmond Group funded and recruited two programme managers to work part time for six months – one in Somerset and one nationally. The local programme manager met with people across the county to learn about the area, its people and its health and care system and to introduce the collaboration.
Anyone reading this who spent any time in 2016/7 trying to create new partnerships will recognise that this is a far from easy task. Across the country GPs are beginning to work differently with hospital doctors; community nurses with hospital discharge nurses; and paramedics with primary care staff. There is a lot happening. But whilst most people recognise how important this is for the more coordinated experience of patients, they also recognise how hard it is.
Add in the different cultures of local government social care services and it gets even harder. Add in the passion of the voluntary sector for specific causes, and creating relationships becomes more difficult still.
And like most analyses of the process of creating new partnerships the one obvious issue was that it takes time and effort to develop them. You can’t expect to have “Developing better relationships with the voluntary sector” as item 13 on a 17 item agenda to work. If developing and maintaining partnerships is only an agenda item – it’s just not going to. Think about your own life. If our personal relationships depended on items on an agenda rather than the real business of getting on with each other – we would all end up being very lonely. Getting to know and respect different cultures takes time and energy.
As these partnerships get going across the country there are clear practical things to achieve. In the Somerset collaboration public bodies, Richmond Group charities and the wider third sector agreed to focus on scaling social prescribing. A similar collaboration in another area may decide to focus on something completely different.
Classically ‘social prescribing’ by the NHS aims to link people with practical and emotional support from the third sector, via their GP, with patients who need that support. They are working well, but are only available in a few parts of Somerset. It feels sensible to work together to improve access across the county.
Please have a read of Untapped Potential. I think it outlines a new and productive kind of leadership in health and care – one that is not centralised, that is pragmatic and consultative. It’s not easy but given the nature of the needs of the public in the NHS’s 70th year its pretty important.
The Richmond Group represents some big organisations and whilst they don’t have a lot of money they do have – in the relationships with the public and their local groups – very considerable assets.
Without strong partnerships, including investment in these assets, the NHS will not thrive.