Playing a role in the Prime Minister’s strategy to reduce loneliness.
Back in May, when I re-started this blog, I wanted to emphasise that in order to succeed in meeting its new healthcare goals the NHS would need much more than public money. Now, as the main outcomes of the long-term plan are becoming clear, the full range of partnerships that the NHS will need are becoming clearer.
Today, nearly all improved healthcare outcomes will require society, outside of the NHS, to play a full role in their delivery. Whilst the long-term plan is, hopefully, going to explain how these outcomes will be delivered, I am worried that the plans will only concern those parts of the delivery chain that involve the NHS. If it thinks only about the importance of the NHS some parts of the plan will fail, and all of them will be suboptimal.
To take an example. Our society is quite rightly concerned about improving cancer survival rates. The NHS has an important part in that process and all improvements in cancer treatments will have an impact. But the main obstacle to improving cancer survival rates is their late presentation to the NHS. Late presentation is essentially a cultural issue concerning how people view their health, fear their death and worry about overburdening a very busy NHS. On its own the NHS can only have a small impact on late presentation.
So, since the long-term plan will want to improve cancer survival rates, to really achieve that it will need assistance from a very wide range of other parts of our society. It will be interesting to see if it recognises such a set of dependencies.
If they are included it would be a great breakthrough because throughout its 70 year history the NHS has not developed very good relationships in asking for, and receiving, help from civil society. Given its size and importance the NHS has rarely felt the need to reach out beyond its state activity to the wider voluntary sector.
This lack of organisational relationship has been compounded by the way in which knowledge is understood and used within the its main activity – medicine. Medical knowledge is developed and applied by professionals with little recognition of any role that patients and the wider society can play in the process of healthcare.
In the last few years coping with the increased demand from an ageing population with multiple long-term conditions has meant that small but significant sections of the NHS have recognised both the non-medical aspects of healthcare and the role of organisations outside of the NHS in helping to improve it. So nearly every STP recognises that civil society will play a big role in meeting new healthcare outputs. But in contrast to the wish, virtually none of the STPs include civil society organisations in the same way as they do – for example – hospitals.
Whilst this is a growing realisation, it is still a minority recognition.
We are some weeks off of the publication of the long-term plan – but given some of the leaks that have come from the Prime Minster and the Chancellor, we have a clear idea of two areas that will feature and I want to deal with these today and tomorrow. Today I want to deal with the pledge the Prime Minister made about social prescribing.
On 15 October the Prime Minister announced that as a part of the general strategy about loneliness (and the appointment of a loneliness minister) she was going to boost social prescribing. Civil society organisations already play one of the major roles in combatting loneliness. They have been doing so since before the NHS was created.
The Prime Minister was however linking successfully combatting loneliness with the role primary care can play in the development of social prescribing. For the Prime Minister and the NHS long-term plan, it is social prescribing that is the new initiative here.
The Chair of the Royal College of GPs said at the time,
“Today’s announcement is a great result for GPs and for patients. The College has been at the forefront of campaigning to highlight the adverse health implications of loneliness and this shows how much impact we have had in a short space of time.
GPs across the country are seeing an increase in the number of patients, across all generations, who are not ‘medically ill’ but whose problems stem from social isolation, so it is very encouraging to see the Government taking action on this.
Our community action plan called for access to a ‘social prescriber’ in every practice and the ‘connector’ schemes outlined today will be a major step forward to achieving this.
We look forward to more detail about how the proposals will be funded and how they will work in practice. We must ensure that we have a society-wide approach to this challenge and that responsibility for the success of the strategy does not fall disproportionately on GPs and their teams.”
The RCGP is placing social prescribing at the core of primary care but of course this does not mean that all GPs are passionate about including it. Many GPs still do not see its point.
The RCGP’s argument – that responsibility for this should not fall disproportionality on GPs – means that civil society is going to have to play a big role here.
Which means that for social prescribing to work civil society organisations must play a role in becoming a part of the social prescribing service. Without civil society organisations there will be no ‘social’ to which to prescribe.
At the moment, across the country, it is civil society that is providing the placements to which patients are prescribed. And for this to work they will have to be paid for by the NHS.
The analogy of prescribing is an interesting one. When doctors prescribe drugs, the NHS recognises that a part of its budget needs to pay for the drugs it prescribes. When the NHS prescribes a placement in a civil society organisation it will have to do the same.