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The NHS is 70. What should it be doing at 100?

Posted on 05 July 2018

It was family gathering time at the weekend, an 80th birthday, so a chance to check in with close relatives and re-acquaint with more distant ones. 

There was a no gift policy, instead an encouragement to donate to a good cause – heart disease prevention.  Conversation – as so often on these occasions – centred on ‘how people are keeping’, which meant accounts of ill-health being avoided, treated or managed.  In one small gathering on one afternoon this ranged from tales of creaking mental health provision and the disconnect between health and welfare support to inspiring accounts of life-saving treatments.

Our NHS and social care system is ten years younger and the whole nation is passing comment on ‘how it’s keeping’.  Gifts of additional budget are being made – albeit in the form of a post-Brexit IOU – while the usual voices are trying to burst the celebratory bubble by muttering about the need for lower tax takes and more private finance.  The NHS has become a bit like the weather – we all love to talk about it and have learned to take the rough with the smooth. When it’s good we rejoice while everyday frustrations are borne with a degree of fatalism, which means any politician promising to ‘fix it’ is immediately eyed with suspicion. It’s uniquely ours and we can’t imagine life without it.

Groundwork project officer teaching child to ride a bikeThe challenges facing the system are well documented and understood – an ageing population, unhealthier lifestyles and more complex treatments leading to constantly rising costs in the NHS coupled with a squeeze on local authority spending that is putting social care provision in a parlous state.  The answer is also well understood – managing demand by promoting behaviour change and personal responsibility and addressing the wider determinants of ill-health by ensuring more people have good work, better designed places to live in and stronger family bonds and community connections.  The helicopter view allows us to see the inter-connections and the direction of travel, but this clarity is lost when we’re down in the weeds battling over budgets and commissioning services.

Going beyond pills and prescriptions

For those of us on the outside of the 'health system' but who are engaged in work that aims to keep people well (as Groundwork has been doing for 36 years), there’s a temptation to rail against a profession which is wedded to a medical model and which demands ever more conclusive proof of what we all know is common sense.  This, however, does a disservice to the many people inside the NHS and the care system who are equally committed to the principles of prevention and health creation but who are challenged by how to turn the supertanker so that we’re investing as much in wellness as we are in sickness.

In our charged political atmosphere making this shift won’t be achieved by other cash-strapped organisations and sectors scrapping for a slice of the NHS funding cake.  Nor will it be achieved by commissioners within the health and care systems undergoing a Damascene conversion in terms of service priorities and evidence standards.  This has to be addressed by building a platform and infrastructure for better preventive action over time while maintaining our ability to meet urgent demand in the here and now.

Progress is slow, sometimes imperceptible, but as we mark the 70th anniversary of this radical social innovation, we should note the signs of optimism that, as a society, we’re getting to grips with what it means to prioritise wellbeing. 

Here are my five pulse points:

1. Parks and green spaces

Our national conversation about how we maintain parks and local green spaces is centred on an ever-increasing recognition that these natural assets are a vital component in engaging people of all ages and backgrounds in activities that keep them physically fit and mentally well, as illustrated by the brilliant data emerging from Birmingham’s Active Parks.

2. Social prescribing

NHS England is now taking up the baton on the concept of social prescribing by developing standardised outcome frameworks so that it will be easier to replicate the success of projects such as the Grow Blackpool network, managed by Groundwork, which uses outdoor volunteering as a means of helping people manage their conditions and make new social connections.

3. Tackling loneliness

Increased political attention on combatting loneliness is turning the spotlight on projects and services that help connect people with their neighbours and promote collective volunteering, helping us build the case for a stronger social infrastructure, as advocated by the A Better Way network in their latest series of insight essays.

4. Social value in procurement

The recently announced strengthening of the Social Value Act will force commissioners and providers to re-evaluate the outcomes targeted through procurement, including procurement by the NHS – a National Voices report last year found that only 13% of CCGs and 13% of NHS Sustainability and Transformation Plans make commitments to maximising social value.

5. Young people taking the lead

Young people are demanding – and leading – action to ensure the next generation of adults is better informed and more resilient to cope in a world which tends naturally to fragment communities, as evidenced by Groundwork’s youth ambassadors engaging their peers and community groups in a week of action under the banner of #InclusiveSpaces.

The NHS at 100?

When it’s my turn to be the recipient of best wishes for my 80th birthday, the NHS will be celebrating its centenary – assuming we both get there.  Wouldn’t it be nice if, by then, effective heart disease prevention wasn’t reliant on charitable giving but embedded in education from an early age, and if parks sat alongside Prozac in the treatments GPs could reach for in combating depression? The NHS grew from the post-war radicalism that brought us the notion of cradle to grave welfare and the goal of full employment. 

Maybe the time is right to recalibrate both by setting a new social and political goal of full wellness.


Post by Graham Duxbury,

CEO of Groundwork