Back in February, NHS England announced funding for a three year programme “....to support social movements in health and care”.
Social action for health gain has, of course, been around for a very long time bringing together the twin disciplines of community health and community development. But that was in happier times.
The present proposal springs from NHS boss Simon Stevens’ 2014 ‘Five Year Forward View for the NHS in England’, a carefully crafted document which majors on good-sounding intentions like “health as a social movement”, without committing to sufficient numbers of trained staff (though it talks a lot about “new options” for health-care volunteering, a greater reliance on “self-care” and using more of the “renewable energy” of unpaid carers).
Is ‘health as a social movement’, therefore, just another rendition of the Big Society? In other words, don’t expect good public services; if you’ve got any kind of health or other problem, sort it out amongst yourselves and don’t bother the authorities?
Those who’ve read sacked mental health Tsar’s Natasha Devon’s new account of her dealings with government over child mental health – particularly ministers’ single-minded fixation with unpaid peer to peer support to replace funded services – might share my suspicion.
But perhaps I shouldn’t be too cynical?
As someone who has been involved in community development in health for many years, I decided to put my prejudices on one side and find out more.
And that’s as far as I got.
I couldn’t find anyone who would give me any information beyond the press release and a couple of spin-filled blogs that followed it.
First I tried NHS England. The project has its own email address, England.email@example.com. Several messages later, no response.
So then I tried their “three national partners” – ‘innovation charity’ NESTA, the Royal Society of Arts (RSA), and the New Economics Foundation (nef).
All communications with NESTA disappeared into a black hole, as did those with the RSA - even when I had a contact name and an email address for the latter (Tom Harrison, in case he’s reading this).
With nef I got a little further, but along the lines of ‘well the project hasn’t started yet so there’s not much to say’. I replied that I was interested in what they were planning to do, not what they’d done, and asked for a project plan. That was at the beginning of March. Several reminders later nef’s Daniel Button confirmed that such a plan did exist and said he would send it to me straightaway. Well now we’re into May and still no sign of the plan.
This complete lack of interest in talking to the outside world about a project that is supposedly all about ‘engagement’, ‘co-production’, ‘empowerment’, and ‘greater solidarity’, does nothing to allay my cynicism.
And means the spin is all I have to go on...
According to NHS England the project will apparently involve the three national partners working with six ‘care model vanguards’ to “develop, test and spread effective ways of mobilising people in social movements that improve health and care outcomes and show a positive return on investment” .
Nef’s advert for its involvement bangs on about the NHS needing to be “... not just ‘of the people’ and ‘for the people’ but ‘by the people’ too”. Power must be shared and collective action taken to solve shared problems in order to “... transform local health systems so that people, not clinical interventions, become the driving force.”
According the RSA’s account, they are busy “... reimagining approaches to health and well being” and that with their “national learning partners” they are “... driving support for health beyond the healthcare system”. Their ambition is to “... see a step change in prevention, a shift in power to people and their social networks, and engagement with communities in taking action.”
NESTA, judging by their website and the fact that no-one there seems to know anything about the project, is keeping quiet. Given the hyperbole from the other partners, this is perhaps a sensible strategy.
The six vanguard areas are similarly coy about their involvement. I could find no reference to this work on any of their websites. Clearly they were happy with the NHS England rendition of their involvement. For example, the Royal Free in London is going to “kick-start a social movement towards workplace health and well-being” (maybe start with the junior doctors?), whilst Wellbeing Erewash’s communities are going to have “... sustainable self support systems... which will empower them to make healthy and sometimes life changing choices”. Meanwhile people in Morecombe can look forward to being “... mobilised at scale for health and wellbeing, and integrated into the local leadership structure” – for ‘Better Care Together’ is going to get everyone to move “... from ‘patient to citizen’ and ‘organisation to system’”.
I don’t know about you, but to me – having spent my life working in community development – this just sounds like meaningless drivel. I have no idea what they plan to do with the hapless communities that will be on the receiving end of their ministrations.
This would be laughable were it not funded by a sizable chunk of public money and likely to give authentic and useful community health initiatives a bad name. If any of these ‘partners’ happen to come across this article maybe they can enlighten us all (in plain English please)?