Let’s turn the NHS ‘manic monologue’ into a creative conversation and develop a more innovative, entrepreneurial approach to health and wellbeing, says Lord Mawson
The annual heated debate about the challenges facing the NHS is here again, reminding me of Denis
Healey’s famous comment about a “manic monologue, which sheds as much light on the situation as an electric drill”. We know that demand outstrips NHS resources, but instead of the media, clinicians and politicians repeating the same old arguments, we need to change the narrative and go back to basics.
Eminent researchers such as Sir Michael Marmot and others have demonstrated that a significant proportion of the problems that bring people to A&E or GP surgeries are not biomedical – they are social and economic. Anecdotal evidence from east London and the north of England indicates that over 50% of people presenting are actually seeking treatment because of poor housing, unemployment or loneliness.
So if we want to reduce demand on primary and acute care, we must tackle the underlying causes of poor physical and mental health, not just react to their outward manifestation. Good health and mental wellbeing is not about employing an army of expensive health professionals – it is about rebuilding our communities.
Lord Crisp, former NHS chief executive, and other peers including Victor Adebowale, John Bird, Jane Campbell and myself, began a conversation. We contributed to an article in The Lancet in October 2016
outlining a new manifesto for the NHS.
A key action we suggested was that: “The transformation of the health and care system Lord Andrew Mawson is a crossbench peer, executive chairman of Well North, and a director of the London Legacy Development Corporation from a hospital-centred and illness-based system to a person-centred and health-based approach needs to be accelerated and funded.”
Fundamental to this is a joined-up conversation across government departments – health does not sit in an NHS box. How, in practical terms, can we achieve this? The answers lie not in blue-sky
thinking, but firmly on the ground, in communities where local people are taking innovative, entrepreneurial approaches to improving their health and wellbeing.
As executive chairman of Well North, a social movement which is tackling health inequalities in 10 places across the north of England, I’m hugely impressed by what people can achieve when they take a collaborative approach and overcome the old silo mentality. Good health is everyone’s responsibility – individuals and families, NHS services, local authorities, businesses and employers, the voluntary and
social enterprise sectors.For example, in the Girlington district of Bradford, the NHS
teaching hospital, local authority and business community are collaborating to create a new health, education and enterprise campus to tackle issues such as unemployment, isolation and an overwhelmed A&E, all of which have a major impact on health.
Well Doncaster, which began in the former mining community of Denaby, has been the catalyst for significant health improvement. The Bumping Space drop-in group, by taking small practical steps, has
supported people with mental health issues, reduced social isolation and also provided practical help around dealing with debt or applying for jobs. Community allotments are encouraging social connection alongside exercise and healthy eating. Over three years, the changes have been remarkable and Well
Doncaster is now extending its work to three other sites across the metropolitan borough.
Business has a key part to play in creating healthy communities, as we have seen in Well Sheffield and Well Rotherham.
Dransfield Properties and its partners are leading on the development of two new town centres in Stocksbridge and Waverley, with good housing, amenities, health services and jobs for local people.
With the steel manufacturing and mining that employed hundreds in these places now long gone, an innovative approach to health and wellbeing is putting the heart back into these communities.
These are all great examples of the public, enterprise and voluntary sectors creating joined-up solutions, in contexts where people recognise that health is everyone’s business.
So how do we replicate these exciting new approaches to health and use them to change the national narrative?
During my 35 years of working with the Bromley by Bow Centre in east London – and more recently
with the Olympic Park legacy team – I’ve seen the importance of perspective.
We need to start with small practical actions, think radically, join the dots and take a 20-year view. Money is useful to pump-prime projects, but success and sustainability depend on bringing people from different disciplines together and engaging them in a new conversation – within communities but also across
government. We need to create a ‘learning by doing’ culture which empowers people and encourages them to work together.