It’s often said that the greatest gift you can possess in life is good health. Many of us take our health for granted, that is until something creeps up on us or worse, hits us out of the blue. It might not be our own health that is affected but someone close to us and in some cases, it can have a life-changing effect. Many people are left feeling isolated, unable to find the right help, advice or support for them or their families, when or where they need it.
My experience of working in the community sector has shown how often people in this situation – people like you and me, too – take the initiative to create their own ‘service’ to fill this gap. It can be quite informal, such as a self-help group where people with a common problem come together to provide mutual support. Or it can be, or become, something more formal with wider impact, such as the Nilaari project, set up in 2000 to provide support for black and Asian residents with substance, mental health and offending issues in one area of Bristol. It clearly filled a vacuum as the project now extends across the city.
If you look closely, these locally based, non-clinical approaches to health and social care can be found in any community and it was no different when I was asked to identify and review activity in a large shire in the Midlands. My work focused on the priority health issues in both its urban and rural areas. The aim was to identify neighbourhood and community responses that could sit alongside clinical responses which would be submitted to NHS England as one of the 44 areas required to produce a Sustainability and Transformation Plan (STP). These plans set out how an area proposes to reconfigure its services and resources to adapt to changing and future demands in health and social care – considering the whole of the health ‘eco-system’ will be central to their success.
My review identified that there was an extraordinary amount of local public and voluntary sector activity taking place, with strong involvement and knowledge of this in local authority community teams, but that it had little visibility at a clinical/acute/secondary care level. With an STP board comprising wholly statutory providers – clinicians and commissioners – it was not surprising that the work was going unnoticed and was little understood. And to be fair, if you or I have a health or care need, we place our faith in the responses of these specialists without needing to understand the complexity of how they operate, or the pyramid of skills that our unique situation will require.
I drew together a narrative with many examples across the area and included development proposals and examples of innovative practice from elsewhere. My aim was to describe the breadth of volunteer, community and third sector led approaches and how encompassing them could help both reduce demand for and support from primary and secondary care. I hoped it would help make the shift in provision look less daunting.
I was pleased to find that the area’s final STP submission had neighbourhood models of care woven throughout it. Shifting the weight of demand from clinical to community care and responsibility from clinicians to citizens is imperative; only together can we sustainably give the gift of good health. It will be interesting to see whether a behemoth such as a NHS Trust can really grasp the nettle and implement new models of partnership working with communities. Whilst it’s a tall order, it is likely that only the STP areas that clearly understand their wider market, are able to create adaptive and integrated delivery models and distribute money differently, will be able to withstand the growing pressures on our health and social care services.