What the system can do: The role of national bodies in realising the value of people and communities in health and care
It is welcome that national policies, including the NHS Five Year Forward View, increasingly recognise that to improve health and the quality of care, people and communities should be active in co-creating health and wellbeing with the formal services and the staff who support them, not passive recipients of care or services. Evidence is growing that more person- and community-centred approaches to promoting health and providing care will lead to improved health and wellbeing for individuals, as well as stronger and more resilient communities and social networks. In time the hope is that these approaches may also contribute to reducing demand on formal services.
In England, a wide range of person- and community-centred approaches for health and wellbeing are already in full operation or being tested, spanning health, social care, wider public services and communities. NHS England has also been developing a self-care programme ensuring that person- and community-centred approaches are embedded in key national programmes. If the policy direction is clear, the key question addressed in this report is how can we achieve faster progress?
Learning from Realising the Value (RtV) and other programmes, such as Integrated Care and Support Pioneers, highlights that most of the factors associated with successful implementation of personand community-centred approaches for health and wellbeing are to do with local context. This could involve passionate individuals leading change, local partnerships growing strong on the back of successful pilots, supportive local leadership, or time spent building and sustaining relationships across organisations and with communities. Clearly, the local context is the primary responsibility of local organisations and communities.
However, local context is influenced by the policies designed by national bodies, such as NHS England, Health Education England (HEE), NHS Improvement, the Care Quality Commission (CQC) and the National Institute for Health and Care Excellence (NICE). And while national policies can help progress, they can also unintentionally hinder. Commonly cited obstacles include: contracting arrangements, commissioning structures, competition, information governance, and competing national directives. National bodies have a crucially important role in identifying and reducing or removing these avoidable barriers.
Some of these barriers have arisen because they may serve other policy goals, rather than encouraging person- or community-centred approaches. And there are a great number of policy priorities and initiatives at present. The most obvious is work to ensure that the NHS in England lives within its growth-constrained budget, while still achieving the goals set out in the NHS Constitution and the changes set out in the NHS Five Year Forward View. In the 18 months since the RtV programme was commissioned, the New Care Models and Integrated Personal Commissioning programmes have started; the second wave of Integrated
Care and Support Pioneers was announced (and the early evaluation of the first wave was published); there have been several ‘devolution deals’ in health care; and Sustainability and Transformation Plans (STPs) were announced.
This report – produced as part of the RtV programme – focuses on how national bodies can best remove barriers to progressing person- and community-centred approaches for health and wellbeing. It reviews the range of mechanisms (often called system levers) national bodies use to influence health and care services to achieve policy objectives, and the impact these have on person- and communitycentred approaches for health and wellbeing. It suggests what national bodies might best do to help implement and spread these approaches, including the five approaches that the RtV programme focused on: self-management education; peer support; health coaching; group activities; and community assetbased approaches.
Local action will continue to be the main driver of change towards more person- and community-centred approaches, particularly in the current complex, pressurised and dynamic context. However, this report identifies six key findings relevant for policymakers and national system leaders, and a range of specific actions that could be taken in areas such as education and training, regulation and commissioning to help create an environment conducive to these approaches flourishing.