Last week, I wrote about the NHS Long Term Plan, and the changes it outlines for the way that the NHS works with communities and community organisations, which have the potential to be important, if they are followed through.
There is a separate Chapter in the Plan about “Putting the NHS back onto a sustainable financial path”. The actions it outlines will no doubt be prioritised and looking at them gives a good sense of the challenge facing those of us who will be trying to keep a focus on building a more community-embedded, holistic and personalised health system. The five sustainability tests cover balancing NHS budgets, “productivity growth”, reducing “growth in demand” and “variation”, “improving providers’ financial and operational performance” and making better use of “capital investment and its existing assets”. Prevention and integration are cross-referenced, but the missing insight here for me is that even the most efficient use of the NHS’s own resources won’t deliver sustainability: we need to place equal value on using and building the resources brought by individuals (their capacity to self-care and to care for each other), communities (are they lonely or inclusive? places it’s safe to walk and cycle?), and community organisations (which could contribute so much more health care and health-creation).
Because we see efficient use of NHS resources and transforming the use of community resources as completely separate issues (one short-term, measurable and urgent; the other long-term, intangible and aspirational), we stymie both: short-term efficiency drives are insignificant next to the impact of collapsing social care and fracturing communities; cheap and cost-effective community programmes, including even flagship social prescribing programmes, can be axed in pursuit of a balanced budget.
So I would add another test to the five sustainability tests in this chapter. For real NHS sustainability, every local health system will need a clear picture of all of its local health-creation assets, on which it must base a Long Term Plan for investing in its communities.
Escaping the invisible asylum 