Lord Andrew Mawson has used his own extensive experience, and that of his clients, to help inform the debate on the Health & Social Care Bill in the House of Lords (11-26 January 2022).
Addressing the Bill as the opportunity to take an innovative and entrepreneurial approach to delivering NHS and social care services, Lord Mawson drew on his 37 years of helping people, places and communities to thrive.
“It is clear that the Government now have before them an opportunity to transform not only the NHS, its culture and its ways of working but the public sector, much of which is not fit for purpose in this century,” he said.
A member of the Olympic Park Legacy Company board for 19 years, Lord Mawson emphasised that starting by bringing together the right people for the project was fundamental to its success. The same principle should apply to creating a sustainable NHS and social care structure.
“Empowering the chairman to choose the right team with the right skill set is absolutely crucial if we are to transform the NHS and make it fit for purpose in this century,” said Lord Mawson.
He also reflected on how an entrepreneurial approach at the Olympic Park had embraced east London’s large artistic and creative community in health, jobs and skills, education. The innovation agenda is now driving a £1.2 billion development at the Olympic park, bringing together University College London, the London College of Fashion, Sadler’s Wells, the V&A, the BBC orchestra and other organisations.
“We need the systems of the state and the public sector to learn from this entrepreneurial behaviour, which is happening on the ground, in real places and now to scale, and to understand the detail of what it means for the macro systems of the NHS,” added Lord Mawson.
He urged fellow Peers to become intensely interested in the NHS and in all the systems of government assessing practicality and the procurement machinery, which he suggested is not working. For example, major centralised technology programmes often fail because they are imposed rather than co-created around the real needs and opportunities that are presenting themselves.
“It is all about the relationship between people and technology and a learning-by-doing entrepreneurial environment. In my experience, technology was simply a tool – an enabler – to facilitate a marketplace that we needed to build between us.”
Lord Mawson also cited the need to work closely with the voluntary, social enterprise and faith sectors already active in communities, learn from their achievements and change the model for procuring local health and wellbeing services. He tabled an amendment calling for delegation of resources and the authority to allocate them in a way which will achieve the intended and agreed objectives.
“Place systems may choose to pool delegated resources in order to commission collaborative services at scale, where they jointly agree that they are not best placed to provide such services, and such discussions are already taking place in mature systems,” he explained.
“For example, in north-west Surrey we have agreed to jointly commission dermatology services across two place systems. The point is that delegation to place does not work against the development of services at a wider scale where that is appropriate, but the recognition of this needs to come from the place level.
“True transformation – true to the spirit of the Bill and the NHS long-term plan and to achieving the intended benefits of integration – cannot be achieved without the freedom to invest those resources in a way which can unlock long-term benefits.”
Lord Mawson also suggested an amendment to deliver a more joined-up approach between public services and other sectors: “In general, NHS bodies do not currently make best use of their local voluntary community, social enterprise and faith sectors when procuring services to achieve key health outcomes, especially in prevention and early intervention services.
“We need to make leaps in how health services are now delivered through integrated services and offers to populations, by thinking radically about who can support people best, and in what way, to keep them healthy, look after them at home where possible and provide services which understand people as individuals and meet their needs holistically.
“Traditional models are not working for the groups which can offer most value. Local charities and social enterprises tend to be funded on a hand-to-mouth basis using grants, so most cannot permanently invest in their services.”
Finally, Lord Mawson urged systems such as NHS England to become learning organisations and to embrace an environment that is about innovation and more entrepreneurial activity.
He concluded: “This debate is being watched around the country, and I am aware of a very interesting dialogue going on with people both inside and outside the system. We should all be encouraged by that and should build on it.”