On social models of health

We often hear about the strain on the NHS: rising demand with limited finances. The NHS has a five year plan for change, and one of the main changes planned is for greater patient involvement and greater public participation. This is where the RSA’s work, bringing together leaders from across healthcare to realise what a participative, empowering and social model for health could look like is key to helping to achieving the highest quality healthcare system, and one that is adaptive to the changing world where longevity is the norm and networks are how collective priorities get made. 

Simon Stevens, the NHS England Chief Executive, has called this endeavour ‘health as a social movement’. The RSA, along with Nesta and the New Economics Foundation, are helping NHS England and 50 ‘vanguard’ areas share their learning and insights as they work to make this a reality.

Helen Bevan, The Chief Transformation Officer in NHS England’s Horizons Team, who opened last week’s event at the RSA, said the NHS is torn between ‘the old world of hierarchy and the new world of networks’. The NHS is not just asking citizens and communities to play a greater role. Realising the enormous potential of social movements means the NHS changing itself, too. One of the world’s largest bureaucracies needs to shift from a culture of cure to prevention.

At our event, we looked hopefully to models like Buurtzorg, which utilises the humanity of medical professionals by allowing them to become not only experts of medical practice but community organisers.

What we heard time and time again were that the root issues, generating needs that materialise at a primary care level are not medical, they are social and structural.

We saw Alan Higgins, Director of Public Health in Oldham talking about his experience seeing how art can be used to heal, and with the right funding formula, bring real tangible benefits for the public health and public finances.

And in Halton, new social enterprises range from trading ukulele lessons to a community litter cleaning business are being created by people who would otherwise be treated in formal health settings. Speakers confirmed first hand the restorative potential of the Power to Create – the health benefits associated with greater opportunities for people to be authors within their own lives.

Stepping back, we also realised, however, that our entrenched assumptions about where responsibilities for health lie can only be challenged if space is made for a constructive debate. Talk of shifting the boundaries between the role of individuals, families, community groups and public services evokes powerful emotions. There is a risk that social movements are seen as a means of off-loading services and to the voluntary sector to save public money. But transformation to a people-powered health system is possible alongside a tax-funded publically owned health service. It would be desirable to maximise the power of social movements for health whether the NHS was under the pull of austerity or not.

As former RSA staff member Nathalie Spencer argues in our audio recorded for the RSA Student Design Award Animation Brief: 

“We’re not saying ‘oh we all need to take more responsibility for our own health just so that no-one else has to care’.  What we are saying is that we also have the power to support each other to live well”.

If ‘it takes a village to raise a child’, it goes that a social movement for health cannot be creating by individuals acting in isolation. My main takeaway from the event was that we can’t view social movements as the products of great leaders and individuals; they are collective endeavours and so we need to understand the dynamics if we are going to better support their impact on the NHS and on our health and well-being. Listen to Helen on RSA Replay and she’ll tell you, we’ve got enough lone wolves. 

Looking beyond our event, we are now focused on discovering what needs to change to make this a reality. Kathryn Perera, Head of Transformation within NHS England’s Horizon Team last week offered tips on overcoming the uncertainty that can block us all from pursuing progress with social movements.

In a social movement, people inspire one another to act. This is radically different from the professional model of prepare, plan and deliver. In the daily NHS reality of life and death medical interventions, hierarchical models will endure. But in our wider communities, living well and avoiding ill health will rely on the strength of networks, locally and nationally. What we can learn collectively from each other adds up to more than the sum of what we know individually. Our role at the RSA is to strengthen the networks that realise this value.

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