The sound of no hands clapping

I met with the Secretary of State for Health and Social Care, Sajid Javid, last week. Well, when I say I met with him, it was actually a Zoom meeting. And there were 141 other people on the call. The meeting was facilitated by those great folk at NHS Providers, and was for Chairs and CEOs of NHS Trusts across England. As it turned out, Sajid Javid’s appearance was a bit of a rushed event. The Cabinet meeting he had been in just before he was due to join us overran apparently. But nevertheless, there he was ready to tell us all how the NHS was faring and what was on his ‘must do’ list. He started with an almost shy quip – ‘Yes here I am, and it all started with a camera in the ceiling’* which was slightly amusing. Everything went downhill from there. The meeting was loosely predicated on Chatham House rules, so I can’t spill all the beans, but he wasn’t great for sure. He noted that there was no more money for the NHS, and that he was serious when he said at the NHS Confederation Conference the week before that the NHS was like Blockbusters and needed to be more like Netflix.

I thought this was a peculiar analogy. Blockbusters went out of business in 2014 and according to last week’s Wall Street Journal, Netflix currently has debts of just under £15 billion. He assured the audience that there weren’t higher than normal numbers of people attending emergency departments, it was just that we couldn’t move medically fit people out of hospital that was causing problems. If it is possible for a collective Zoom meeting audience to gasp en masse, then this was that moment. It is true that there are high numbers of people in hospital beds who don’t need to be there. In the main its because there is insufficient social and domiciliary care for them to be safely discharged. It is also true that emergency departments continue to see record high numbers of people attending each and every day. This has been the case for most acute hospitals since earlier this year. Anyway 15 minutes after these pearls of wisdom had been handed down, the Secretary of State was gone, and like many others I’m sure, I was left wondering why he bothered to turn up at all There was no applause.

Now I missed that particular NHS Confederation Conference this year. I think I was busy supporting colleagues who were busy looking after patients in our allegedly ‘not so busy’ emergency departments. It was a shame as there actually were a number of really good speakers with something interesting and challenging to say. One of these was Hilary Cottam. 

If you haven’t come across her work before you can find her website here. It is worth visiting. Hilary is, without doubt, an internationally recognised author, innovator and change maker. Read her biography and you will see just what a difference she has made to so many people in so many different places across the world. She is simply phenomenal.

Her paper at the conference was called Radical Health (although she originally wanted to call it ‘Marooned on a toenail’). It is a wonderful account that brings together some of her life’s work in finding different ways to help those many folk who need the help of others. You can find the full paper here. My computer asked me for verification before opening up the link, but you can safely skip that. Partly the paper draws upon her ideas from her book, Radical Help, published in 2018. Hilary provocatively argues that the British welfare state is beyond reform. She suggests that there are new ways of thinking about how to help both young and old in their time of need, and how we might better care for those who live with a physical or mental health problem. At the heart of this approach is the notion of human connection.    

Her paper provides case study insights into how this can be achieved. I have to admit to being in awe of the programme she started many years ago called Wellogram. It’s an approach that builds on listening to others, building relationships, forging connections, boosting confidence and a sense of self that is worthy and valued. In a phrase that I love, Hilary describes the approach as ‘weaving people together – at the right moment – to support continued good habits and to combat the social isolation that underpins so many problems’.

Hilary provides us with three reasons why we cannot continue to just tinker with the NHS. (1) the nature of the problem has changed – our health care system still foregrounds cure, and is a service provided through the use of vertical systems of command and control. Even during the pandemic, such an approach didn’t always produce the desired outcomes. (2) Care – as the current Secretary of State noted, providing care-based services is still a major problem for our society. The Health and Social Care tax is likely to be spent on trying to provide more of what we currently have, and which has been failing people since the 1960’s. (3) Poverty – the pandemic clearly revealed that poor health is rooted in poverty and inequality. The new Health and Care Act explicitly has addressing inequalities as a new statutory duty for NHS service providers. All three reasons resonate with me as I’m sure they will with many readers of this blog.

What to do about this situation – well please read Hilary’s paper. The answers she suggests I believe can only be taken forward through effective place-based services. We need to harness the expertise found in communities, in localities, in schools, with faith leaders, voluntary services and of course in the work of our public health colleagues. Hilary’s paper lifted my spirits. This is the 14th year of writing this blog. I have not missed a single Sunday throughout that time. Recently I have been thinking I should stop. I wondered if my words and thoughts made any difference at all. Reading Hilary’s work made me reflect – I concluded that if my blog makes just one person pause and think and then act differently, it will have been worth it. So, loyal reader, in the words of Arnold, ‘I’ll be back’.  

* I also read last week the terrifying news that the disgraced former Secretary of State for Health and Social Care is poised to re-enter the Prime Minister’s Cabinet.