Placing civic at the heart of neighbourhood health

Michael Wood, Head of Health Economic Partnerships at the NHS Confederation, discusses the UK government’s 10-year health plan, which builds on the 2019 Long Term Plan and outlines again, in black and white, the anchor role the NHS must play for neighbourhood health development – a vision, he argues, will only be achieved if all public services, as broad as they come, are integrated around local people.   

The 2019 Long Term Plan introduced to many in the NHS the concept of the health service, and the many institutions up and down the land that form its beating heart, as an ‘anchor’ around which local economies could be actively supported. While it should really be the words’ ‘long term’ that require emphasising in quotation marks in any national NHS document, it has been pleasing to see the activity and focus remain a mainstay of subsequent strategies.

Then and now

Fast forward six years (including several Prime Ministers, Secretaries of State and CEOs of NHS England) and, once again, we have the NHS as an anchor in black and white in the newly published 10-year health plan for England. Specifically, there is a renewed focus on NHS employment becoming a force for economic prosperity and social mobility (albeit at a time of significant restructuring which makes this a very tough proposition), an increasing expectation that hospitals make their contribution to research and life sciences a business-as-usual activity, not a ‘nice to have’, and, with a nod to the wider partnership aspect, we have the Leeds Anchor Network rightly praised as an exemplar of good local anchor practice. So, enough in there to reassure those that feared this concept would fall victim to NHS introspection.

However, the real size of the prize here is not just a couple of isolated references but what we have learned in the intervening period. Talk to the vast majority of NHS CEOs now and they will, largely unprompted, comment on the external world in which they operate and the power of local relationships. They will be particularly pleased to extol on the value of their own reach, their decisions and their services and how they impact the local population. This is the NHS as an active, intentional economic actor, not just a passive one. Thus, while many would argue belatedly, the real change we see emerging from the anchor work to date is that the NHS is now focusing locally on the ‘how’, not just the ‘what’. Better late than never!

Talking neighbourhoods

It is when the 10 year health plan for England talks about establishing a ‘neighbourhood health service’, that this concept really comes into its own. The government hopes this approach will help deliver a model of care that is preventative and better supports those most in need, including those with long-term conditions who regularly come into contact with different health and care services. It’s a high bar, but the hope is that successful neighbourhood health work puts an end to ‘hospital by default’ and provides more personalised and coordinated care, leading to better patient outcomes and more cost-effective delivery.

This way of working cannot be transactional and will require the gains from our anchor work to help leaders collectively support their shared communities. This may come in many forms, of which we can explore a few here.

Firstly, neighbourhood goes way beyond a particular GP boundary in the same way health is far greater than just the NHS.

To have any chance of succeeding in improving health and wellbeing, addressing growing demand, reducing health inequalities, and addressing wider socio-economic priorities, a fundamental change in how health and care services in England work with and for neighbourhoods and communities is required. This is about wider public service reform, with the NHS anchor role pushing it to share data, resources and estate with partners such as councils, VCSE and the private sector, helping identify those who, for example, most use crisis services or indeed fall between the cracks and miss out completely. Add in more focused use of social value and initiatives such as shifting health services to the high street, and you begin to build a compelling proposition for a more preventative, prosperous place where we would all want to live and work.

Secondly, the same principle applies to the coming focus on Integrated Health Organisations (IHOs).

For those not close to the policy, the ‘strongest existing NHS Foundation Trusts’ will be eligible to apply to become IHOs and given the significant responsibility of managing the entire healthcare budget for a designated local population. America and other parts of Europe have seen similar approaches to capitated models of healthcare, and there is logic in one institution holding both the responsibility and the risk. What it does mean is that the IHO will have to understand its local context, invest in prevention and innovation, and incentivise people not to go straight into the acute setting (the most expensive part of the health chain). We await the full details of the accreditation process, but in practice, the requirement for an IHO to be one of the ‘strongest existing FTs’ is actually far less relevant than proof of an inclusive approach to building a civic anchor role.

Comment: A nod to the future

Structural reform is often the first lever Ministers and other leaders try to pull when they want NHS change (or realise how little impact they themselves have) and there is enough of it going on. What matters now is that public services in their broadest sense integrate around local people, with a much richer understanding of and approach to engaging communities, the formal alignment of budgets and work programmes to best effect, and an improved delivery of services where they are proven most impactful. From the NHS’s perspective, it is its significant and lasting anchor role which will bring the curiosity required to keep it engaged in neighbourhood health development as the pressures mount.