The health community remains doubtful of Cameron’s big idea
Does the “big society” have any relevance to the future of the NHS?
Health secretary Andrew Lansley has expressed his desire to make the NHS an exemplar in the development of social enterprises, and the British Medical Association has made public involvement a key test of its support for the proposed commissioning reforms. But does this add up to anything more than a motherly serving of reassuring apple pie in unsettling times?
‘Community groups believe “fashionable” diseases such as cancer will hog whatever resources are available’
The big society - or something very like it - is already active in health. This week’s Resource Centre highlights some examples that fit neatly with the prime minister’s idea of enhanced civic responsibility. Research has shown that health is already the busiest sector for social enterprise.
However, the most powerful evidence of the prevalence of community groups in health comes via Patient View’s survey of the sector which is exclusively revealed in HSJ. The survey collected the views of nearly 900 organisations with more than a million members.
This is a significant number - politically, as well as socially - and the government’s desire to appeal to the community minded among the electorate is very understandable in this context.
The context also makes the results of Patient View’s survey doubly worrying for the government. There appears little enthusiasm for the coalition’s NHS plans. At the heart of the concerns lies the belief that, despite government claims to the contrary, frontline NHS services will be cut.
Community groups also believe “fashionable” diseases such as cancer will hog whatever resources are available and that this problem will be accentuated by a weakening of national standards, meaning rarer conditions will slip out of local plans.
At the heart of this schism lies a different view of what community groups should do. For the government, an ideal big society venture is a direct service provider tackling a need that was or would have been previously addressed by a public sector body. Yet that only describes around one quarter of community organisations. The great majority are driven by campaigning activists - set up to disseminate information and to argue for political, financial and organisational change that would benefit those they represent.
The last administration’s unprecedented boost to NHS funding created or re-energised community led projects across the nation. But the way the money flowed to third sector providers also often created a culture of dependency in some direct service providers.
Not only does this mean many community schemes are now facing oblivion as the NHS purse clicks shut, it also tended to stifle the creative thinking and occasional iconoclasm that defines the best schemes. Understandably, if you get the majority of your funding from one source, you tend to bend over backwards to keep that source happy.
In summary, we have a third sector in health with capacity and experience, but often with the wrong mindset to take on the more central and independent role that the government would like to see it adopt.
It is also the case that third sector organisations often find it very difficult to do business with the NHS. In this week’s opinion slot (page 12), Professor Philip Sugarman highlights the continuing complaint that charities are at a competitive disadvantage when trying to unseat existing NHS providers. Smaller organisations also struggle with the bureaucratic burden placed on them by public bodies intent on ensuring good value for public funds and that volunteers have required standards of training or that patient confidentiality is protected.
A true big society revolution could have a significant impact on the future of the NHS - for example, by using third sector expertise in self-management to deliver more effective services for those patients with complex needs.
However, we appear to be a long way from agreeing exactly what that future might look like.
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Readers' comments (6)
Anonymous | 2-Sep-2010 9:16 am
If Social Enterprise is seen as such a big part of the "Big Idea" in the NHS, why is the 'Right to Request' being stopped from 30th September?
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Justin Dix | 3-Sep-2010 11:43 am
Whatever the future holds, this article does at least highlight the fact that the NHS is a big and complex business. Can good principles that are broadly supported be turned into workable and fair means of delivering healthcare? We need systems of governance that balance flexibility with accountability and that will be a key test going forward. "Big Society" needs to be balanced against the traditional NHS theory that no-one gets left behind. In reality they do; will the new NHS address the equity issues or make them worse? Will very local GP based commissioners be able to make the brace decisions and take the budgetary hits required by larger populations and the minority groups within them?
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Anonymous | 3-Sep-2010 1:34 pm
Campaigning charities are at fault here as well, particularly in mental health. For example the major mental health charities led by Rethink are currently running a 'Fair Treatment' campaign calling for mental health provision to be given parity with services for physical conditions and yet the same charities had an overly close relationship to the Blair and Brown administrations and seemed to have waited for Labour to leave office to demand of the Coalition Government fairness and reforms mental health service users had been demanding of Government and them for years! Right now mental health patients are protesting the lack of availability of various talking therapies , particularly around personality disorder as isolated individual service users are being told there are no resources or that these therapies are not available locally. This is an area where the mental health charities could take practical steps to help resolve the demand and supply problem not by simply demanding that Trusts provide these therapies , the current situation, but by collecting data on who wants what talking therapy , where they live and contacting independent suppliers/providers to look for creative solutions , economies of scale and discounts as the bureaucratic Trusts are too stuck in catchment area mode to think outside that box and aggregate demand of the clusters of isolated individual patients across various Trust going without treatment as I'm pretty sure most patients would be happy to travel to neighbouring areas for treatments rather than going without or being stuck on a waiting list for years. Patient Choice resolves this problem in physical health services but mental health services are excluded from the Patient Choice agenda so there's no mechanism to free up/clear talking therapy waiting lists or bus ppl to group patient demand even though there are supposed to be budgets available for treatment and care. The mix is wrong here. We need a more sensible split, more charities providing practical services operating independently of those doing the campaigning as we have a glut of wealthy mental health charities duplicating indignant campaigns for NHS reform and high profile anti stigma iniatives but few willing to act to practically help solve problems .
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Sunita Berry | 3-Sep-2010 3:48 pm
Am I missing the point here with regards to mental health. If Programme Budgeting data is to be believed, we already spend 14.5% of the total NHS budget on mental health. Anyone care to explain why we should spend more; and do people even know what the spend is when they ask for more?
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Anonymous | 7-Sep-2010 1:28 pm
Sunita you are correct!
The PCT's are spending large amounts of money with secondary care mental health providers with little or no evidence around outcomes for service users. Only a small amount of money is spent on prevention within public health or social care.
The new funding if mental health gets if any should go on prevention and well being and not more of same or divert money away from sceondary care mental health.
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Anonymous | 11-Sep-2010 2:18 am
No small cic or similar would be able to establish the neccessary governance framework that would satisfy the cqc. particularly following an enivitable incident or death.
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