This series of three short articles highlight projects I’ve worked on that help describe the future direction of the NHS, supporting the government’s 10-year plan, and the ambitions of our wider health and social service systems in response.
NHS Futures 1 of 3: Population Health & Systemic Shifts
NHS Futures 2 of 3: Better Technology, More Humanity
Context and Why This Matters
For most of us, what affects our health happens overwhelmingly outside of hospitals and clinical contexts: What we learn about our health and how to look after it, the support and advocacy we get from family members, the options available to us locally to exercise, eat healthy food and breathe clean air, how our jobs and care duties affect our sleep and stress levels all impact our current and long term health.
Our health system can quantify reactive care relatively easily – from people presenting in A&E, to operations completed, hospital beds occupied and people successfully discharged. In proactive care, we can still put numbers on immunisation levels, population health trends and the value of early medical interventions. When we then progress into the more quali-quant and open-ended world of preventative care, there are so many factors at play in our daily lives that it is harder to quantify. It is therefore more challenging to create business cases for how social prescribing physical activity such as parkrun across a region may prevent 100 heart attacks in thirty or forty years’ time, or how funding inter-generational volunteering and befriending services such as GoodGym can prolong the independence and good physical and mental health of older people by so many months or years.
Further slicing preventative budgets between different service offers across the health, social care and voluntary sectors becomes even more complex when trying to quantify their individual and complimentary impacts.
The Project
The Octopus is an organic, relational network of services that holds a key principle at its centre: That sharing knowledge and resources strengthens the whole system. It affirms that collaborating is more productive than competing for budgets, which can create transactionality; referring residents from one service to another to account for resourcing. The Octopus is a thriving partnership between its three ‘hearts’ of the health, Local Authority and voluntary and community sectors with the ‘brain’ of academia which helps to document interventions and population health; producing case studies and health analytics. As part of the initiative a universal index for health and wellbeing has been developed to be more meaningful to residents and staff, and helps to further coalesce teams. It represents the major shift in the NHS towards localising health and working with people outside of clinical settings.
At the heart of this is the Neighbourhood Teams initiative and the amazing work of the Community Health and Wellbeing Workers (CHWWs or “Chewys”). CHWWs are modelled on an originally Brazilian primary care approach of knocking on doors in more socio-economically deprived areas to help residents connect with the local health system, and also problem-solve with a broad remit. This includes support and connections to housing, employment, safeguarding, education and navigating the admin that often accompanies these.
Image credits: CHWWs at Churchill Gardens, Healthcare Central London + CHWW, Cornwall NHS Federation
Most recent HCL data shows that although CHWWs are primarily health-oriented, the most common support provided is with housing, then adminiustrative support for navigating services, with referrals to a GP in third. The full list of interventions is long and diverse.
CHWWs are local to their area, understanding the nuances and changes among its residents and places. They provide the health and other services with keen eyes and ears amongst neighbourhoods, families and individuals. They are able to reach people who may have not contacted services in a while, but could benefit from their support.
The evidence base and CHWW practitioners continue to grow in number, from 4 to 25 over the past few years, aided by research led by Dr. Matthew Harris at Imperial who regularly speaks at the Octopus events. More details can be found in the Kensington & Chelsea and Westminster Bi-Borough Health and Wellbeing Strategy (pages 25-28), and NHS reviews of other pilot schemes around the UK.
Image credits: Healthcare Central London + my own
Culture Eats Strategy for Breakfast
The most striking thing I feel at the quarterly summits, where different services present their approaches, challenges and successes, is how eager everyone is to help one another. A small forest of hands will raise after every presentation to offer resources, connections, data and business case support. This is the opposite of protecting remit, budgets and ‘territories’ of more transactional systems.
The boundaries between professions and sectors are dissolved, and the focus is on the potential of connections, as shown in this chord diagram below, and the pains with which one of the Octopus founders, Dr. Saul Kaufman wanted me to accurately represent the exact number of connections measured between each node. You can also notice that there are usual and unusual suspects mapped onto here, who all have roles to play.
If we are to shift meaningfully from a predominantly reactive care service to a preventative health and wellbeing system, the Octopus demonstrates how opportunities of open collaboration, culture building, resource sharing and collective impact can be realised.
The logic case is simple – the more we do this good thing early on, the more we see these benefits later on. Prevention is better than cure from a human experience and economic point of view. But when funding for preventative is competing with the very immediate need to shorten waiting lists for people who are already unwell, it is a much harder sell; particularly as election cycles of five years demand quick results. But for our health and social care system to thrive in the future, we must shift our weight from the back foot to the front foot, and develop cultures of collaboration rather than competition.