The North West has made great strides in improving services but with complex problems persisting it will also take a process of social innovation to find creative solutions
The long term future for health in the North West presents an interesting dilemma. On the one hand, the NHS has had record levels of investment, is meeting and in some cases exceeding government targets and is managing its finances well. If central government targets have been the examination questions, healthcare in our region has passed with flying colours.
On the other hand, our region can also tell an unhappy tale of complex health problems, poor life expectancy and significant swathes of our population making unhealthy lifestyle choices and with very low expectations of having a healthy life.
This dilemma may well be telling us about the limitations of trying to apply yesterday’s solution to health and healthcare - central government’s push of uniform policy and process-driven responses to problems - in the face of tomorrow’s health challenges. Local health service organisations will be required to adopt a fundamentally different approach to delivering change in healthcare systems.
This re-engineering is unlikely to be enough in itself. The NHS must re-learn how to innovate socially and channel its social value.
Social innovation is particularly relevant to public services because the personal is now the political. In the last 10 years UK politics has become increasingly preoccupied with the collective impact of our personal choices. Social challenges such as smoking, obesity and changing patterns of disease are increasingly described by politicians as a collective enterprise, in which we are all called upon to play our part through changing our own personal behaviours.
Traditional ways of delivering change are not working. Public sector reform characterised by central targets and uniform solutions that rely heavily on structural and process-driven reforms is proving limited in its ability to tackle emerging complex social challenges.
And it is fair to say public services do not know enough about the context in which services are commissioned and delivered and how that context may be used more effectively. In the future, it will not be sufficient for public services just to understand provision. We must understand better how those services are used. Health services may be more effective in delivering the outcomes people expect if those designing them take into account cultural norms and expectations; broader lifestyle factors such as individual habits and behaviours and logistical factors such as timing, appearance and location.
NHS leaders would be wise to really understand the touch points people have with their services.
In health, social innovation is a way to redefine and reshape the relationship between people and the support they are offered, in pursuit of social goals. It might enable two things to happen - understanding local populations and redesigning what the NHS offers.
At a local level, the opportunities for primary care trusts to generate social innovation have never been greater. Social innovation enables commissioners to understand the needs and behaviours of their populations, while local involvement networks and community development will help strengthen the voice of local people.
Social innovation in health would help develop interventions and improvements to meet these needs. As the two broad types of intervention are community and behavioural, social innovation would help commissioners develop community interventions concerned with improving access and addressing health needs in a user based, culturally appropriate context.
This could be vital in meeting the needs of the many communities the NHS does not currently understand well - groups of patients with similar long term conditions and people from particular religious, ethnic or social backgrounds.
Behavioural interventions meanwhile focus on wider behavioural change issues. A PCT could become good at delivering both types of innovation, if it was representative and plugged in to its local population and experts in social marketing and behavioural change.
At a national level, social innovation is more likely to thrive in conditions where there is less central government push, enabling more local pull for improvement. NHS North West will regionally continue to make the case for social innovation but there is clearly a need to define it further.
The NHS was a social innovation. Now it could re-learn how to innovate socially and channel its social value in new ways.