CEO blog - Are we risking not grasping neighbourhood health working due to a lack of system leadership?

Are we risking not grasping neighbourhood health working due to a lack of system leadership?

Why do NHS decision makers at NHS England and ICBs  risk losing their way in funding and implementing neighbourhood health?

NHS decision makers may feel uncertain of what they want and how to achieve it and therefore they are investing in unknown territory. There is no roadmap to get to the new NHS they are being asked to create. The destination is clear - put the person at the centre, organise services around a defined population, improve outcomes, reduce inequalities, prevent people getting sick, and give people access to support as and when they need it. Sounds familiar but we have failed to achieve it in the past. Why?

Business cases are a good map for familiar ground: known problems, known costs, organisations we already know. Outcome commissioning sounds great, but most outcome data is built around hospital pathways, and new outcome data can take years to collect. So, the pathways to and from hospital are mapped in detail and the world beyond them is mostly blank.

Knowing a condition has say 2% prevalence in an ICB is very different from knowing which 30,000 of its 1.5m people actually have it. Knowing a populations data and managing it are very different things in practice. ‘Patient-centred’ and ‘joined up care’ have no agreed definition, so nearly anything can be called a proactive, preventative, holistic, person-centred intervention for a high-risk group. So many old services simply relabel themselves as the destination. For whoever holds the budget, that is a map where the places all have the same names. No wonder people navigate by the known routes of costs and hospital pressures. We stick to the main road to hospitals. Funding goes to frailty, care homes and end of life. All much needed, and the teams doing it work incredibly hard.

But it feels less about bringing health into the community and more moving the hospital door further away from the hospital. Population health maps show where they sit against a mythical average. They rarely show what those communities value or what is already working there. The people working on the front line are the guides, full of rich local knowledge. They know the paths. But they often speak a different language from the people they are guiding. So, we ask them to describe their territory in terms of places and language we already know, and the value of a place becomes how many hospital admissions it can avoid. And with ICBs becoming strategic commissioners, it is not always clear who is leading the expedition.

None of this is anyone’s fault. Nobody has given decision makers a way to go beyond the territory they already know. The paths to new places are narrow, but people are finding them. We need to map and widen them for others, because even with a new destination, if we stick to the same old roads we will inevitably end up back where we started.

William Greenwood

Chief Executive