Shifting from a culture of encouraged dependency to informed responsibility

The recent King’s Fund analysis of the STP proposals, Delivering sustainability and transformation plans, from ambitious proposals to credible plans, highlights the need for leaders at all levels to engage with their communities and communicate why services are being transformed.

We face an enormous educative task.

In the 1970s, the educational psychologist Jerome Bruner contrasted education in developing and modern societies.

Whilst importing westernised education into developing countries had prepared young people for a life which didn’t yet exist, he warned that in a fast moving technological society (the 1970s!), the danger was that we were preparing young people for a life that would no longer exist.

Bruner was prescient. For those of us brought up in the twentieth century, our approach to a familiar world, which we thought we understood with confidence and maturity, now feels uncertain and even naïve.

The need for significant change is no more apparent than in the health and social care services.

Political parties can no longer build upon the roots from which they emerged; communications have developed beyond the grasp of many; and the expectation of early retirement is shattered by the prospect of a working life which seems to extend forever.

As Pope Francis said in relation to the environment, we are not so much living through an era of change but rather through a change of era.

The need for significant change is no more apparent than in the health and social care services. The 44 STPs provide a challenging platform for a change of era, which will demand foresight, ambition and collaboration.

But it will be different! The Kings Fund is right to insist that improvement in community provision, with the integration of properly funded health and adult social care, central to all the proposed STPs, is an essential precursor to full implementation of the plans.

But the ambition to provide world class acute provision across the country in a planned matrix reflecting the enormous medical advances of recent years is a quantum leap; it is right to close some of the district hospitals built to address the medical needs of an era which no longer exists.

We will need a new model of primary care, already developing in some areas: GPs working collegially and in partnership with a support workforce which includes health and social care professionals as colleagues. Partnerships with acute hospitals need to change too.

The 44 STPs provide a challenging platform for a change of era, which will demand foresight, ambition and collaboration.

Activity funding, which encourages sometimes unnecessary interventions and admissions to meet A&E targets, needs to be reappraised in the light of outcomes for patients; the emerging accountable care system approach will enable a more holistic view of costs within a population, as well as in response to individuals’ needs.

Transformations such as these affect not only what the health service does to the population, but also how the population responds by taking responsibility for its own health and well being; in Bruner’s terms, there is a huge educative task to move us from a culture of encouraged dependency to one of informed responsibility.

It will demand a national behaviour change akin to smoking cessation and the wearing of seat belts. It must be led by national government.

Such a coordinated significant change will only occur if we all respond critically and constructively to the STP proposals through the prism of future need; the alternative, which we cannot afford, is to plan for a future which will no longer exist.

John Guy is lay chair of Surrey Heath Clinical Commissioning Group.