Looking back on my time as Chair of the Co-operative Party’s Chair of Policy we carried out a well-informed and wide-ranging debate process on healthcare, which led to the formulation of seven major policy statements.
Statement One: Empowering Patient Voices
Statement Two: Addressing Health InequalitiesStatement Three: Collaborative Solutions for Healthcare Challenges
Statements four and five discuss a new settlement for NHS staff and achieving parity of esteem for mental health services.
Statement 6: Improving preventive care.
Statement 7 focusses on securing the NHS’s future through education.
Each of these policy statements addressed how we want to restore our NHS’s status as one of the great institutions in our country’s recent history. The previous debate on social care also had a lot to say about the importance of health and care services in British culture and life. I would also add there is a much needed debate we musy have about the fundamental role that the renewal of the NHS Estate might play in any transformation of the NHS
More recently I’ve been reflecting on the history of our National Health Service and the modern Welfare State, and it appears that at various stages of the development of health and care services, we tried two of three potential paradigms for providing these services. We have used the state and market paradigms to address current difficulties, but we may not yet have given the third paradigm, the community or social paradigm, sufficient thought.
Cooperatives and the values of common ownership have yet to be fully explored elsewhere other than at the local level, where some great examples exist. However, I believe that the Third Age of health and care giving can be found in those examples and values.
The state and market paradigms that have dominated our models of health and care provision since 1948 were created to address the very distinct health concerns of the period.
Perhaps the state paradigm’s emphasis on uniformity and professional control was (at the time) a logical response to the immense problems of establishing a groundbreaking universal healthcare system. However, there have long been obvious indications that this drive to provide consistent provision in all places has resulted in falling marginal gains as health inequalities appear and grow.
It is also plainly obvious that there are broader social, economic, cultural, environmental, and other variables that influence health outcomes for individuals and communities in considerably more substantial ways than the provision of health and care services alone.
We then switched to the market paradigm, which emphasises production and patient choice. Again, perhaps an apparently rational reaction to increased demand, rising prices, and the introduction of concepts like the postcode lottery of service provision.
Unfortunately, this paradigm appears to be ill-equipped to deal with the intricacies of the interconnected health and social concerns that so many people and communities face.
It appears that neither the state nor the market paradigm has the resilience or responsiveness to respond to the demands of an ageing population, as well as the issues that arise from normal ageing and the complexities of life in an increasingly fragmented society where past norms may no longer hold true (if they ever did).
Our existing provision models appear to be capable of just increasing activitiy levels in response to rising demand. This is not financially viable nor necessarily in the best interests of the people involved. More activity does not inevitably lead to better outcomes for patients. Perhaps the focus should instead be on keeping people happy and healthier in their communities for longer periods of time.
This must surely entail rethinking the relationship between our health-care systems and our communities. A Third Age for Health and Care Systems, focussing on community capacity, assets, and networks.
We must move away from viewing individuals as passive recipients of care. We must transition to a system that respects people’s understanding of their own needs and collaborates with them to co-produce their own health and well-being. It may also bring them together in a localised cooperative effort to satisfy the needs of individuals and communities. We saw some of this in the communal responses to the effects of the Covid 19 outbreak.
There is a lot of data to support the notion that this leads to better experiences and results for individuals and their carers, as well as a direct influence on reduced demand for services.
Many of the challenges we currently confront in health and care, in a system that many believe is dysfunctional, derive from the way we have done things. Returning to business as usual is no longer an option. If our health-care system is to meet the challenges of the future, we may need to discover a new path, a third path.
Will the 10 Year Plan give us this new path? Or might it be seen as necessary but not sufficient to transform the NHS? I remain optimistic that we can find a way.
Chris Bain 