Policy is just a bunch of words until practice makes it happen.

Partly because we are coming up to a General Election, and partly because it’s something that people like to talk about, we are living in a time when people expect multiple policy documents to be written. Different think tanks eagerly await each other’s reformulation of policy for the NHS and social care and parse them for differences very closely.

The next stage of this process is to try and persuade political parties to pick up on each of the resulting policy ideas and sell it into their own policy making process – the holy grail being to achieve a sentence in the manifesto.

(I know, I know I spend hours doing this too – but given my biography it’s not easy to give up on it).

The manifesto is the policymaker’s holy grail because it’s the electorate that transforms (to mix my mediaeval metaphors) the base metal of a policy document into the gold of reality. (Except it isn’t).

But, to repeat yesterday’s theme, what people generally don’t talk about is the important fact that most policy documents remain what they are – words on a page – and what matters – the practice of turning the base metal of ideas into reality – doesn’t really get talked about.

All my adult life has been bound up with social policy. I studied it at the LSE for my first degree and then taught it for 13 years at both University and Polytechnic. Then I was involved in writing local government policy and occasionally ran policy departments. Then, for 7 years, I joined Whitehall working on health reform for New Labour with Secretaries of State and Tony Blair. I was called a policy special adviser (aka a ‘Spad’). Altogether that accounts for about 40 years of my life.

But all these activities contained a number of contradictions. The social policy intellectuals that taught me, were teaching me about social policy as a practice. They were training us to do things, not just to write them. They wanted me to do this as an activity not to study it as a set of papers. My teachers had truly built the practice of post-war welfarism. How did employers and employee’s contributions in National Insurance really work to bind people into a social contract? How would comprehensive schools actually teach people from very different backgrounds?  They made sure we would spend a term working through how a new town was created with different aspects of the work.

In July 2001, when I went to work for Alan Milburn as his policy Spad, I remember saying to him that I didn’t know much about health policy. He told me that he thought we had had quite enough of that and what we needed to do now was to implement some. He handed me the NHS Plan and asked for 20 practical themes to enact.

Then, in 2007, I became Director of Strategy for NHS London. The good news for the city was that Ara Darzi had been working on a strategy plan and three days after I started the job it was published and I had my themes to implement again.

So now, at this stage of my life, I want to know how to make things happen rather than writing statements of intent. And that’s the policy issue I’ll be raising in this blog.

Many organisations are arguing for a policy on prevention. When this happens it will be a vital pivot for the NHS – and for all of our society. However, in 2023 as a policy, it’s not new.

Let’s look at two really excellent NHSE policy documents from the last decade. The Five Year Forward View (2014) and the Long -Term Plan (2019).

These really did interpret the world in a very different way from what went on before.

“The first argument in the forward view is that is that the sustainability of the NHS depends upon a radical upgrade in public health.

Second, when patients need health services patients will gain greater control of their own health care. the NHS will become a better partner for voluntary organisations and local communities.

Third, the NHS will take decisive steps to break down the way in which the NHS is provided between family doctors and hospitals between physical and mental health and between health and social care.

The foundation of the NHS will remain list based primary care Given the pressure they are under there will be a new deal for GPs Over the next five years the NHS will invest more in primary care.

To support these changes, the NHS leadership will have to act coherently together and provide meaningful local flexibility in the way hat payment rule, regulatory requirements and other mechanisms are applied”.[1]

To make the obvious point. This didn’t happen. But that didn’t stop another policy document five years later interpreting the world in a similar way.

Chapter one sets out how the NHS will move to a new service model in which patients get more options better support and properly joined up care at the right time in the optimal setting.

The long-standing aim has been to prevent as much illness as possible. Then illness that cannot be prevented should be treated where possible in the community and in primary care.

1 We will boost out of hospital care and finally dissolve the divide between primary and community services.

2 The NHS will reduce pressure on emergency hospital services. 

3 People will get more control over their own health and more personalised care when they need it.

4 Digitally enable primary and outpatient care will go mainstream across the NHS.

5 Local NHS organisations will increasingly focus on integrated health moving to integrated health systems everywhere)”.[2]

These are excellent aspirations. We really need these changes to happen. My point is that 10 years and two very good policy documents on – they still haven’t happened. If, in 5 years’ time, we have yet another policy suggesting prevention as a new idea, and in the meantime have not brought about real change we will have put the NHS at grave risk.

Time to do it rather than write a policy on what a good idea it is.

[1] Five years forward view October 2014.. Executive summary

[2] NHS Long term plan January 2019