Adam Lent gives his views on the NHS long-term plan

It is generally accepted that doctors should avoid diagnosing their own illnesses and prescribing their own treatments. Evidence supporting this principle comes today with the publication of the NHS’s 10-year plan.

The rambling 136-page strategy reveals an organisation lacking a coherent grip on its own failings and able only to generate a mind-bogglingly complex list of unconnected solutions. Maybe they should have asked a friend to take a quick look first. They could have done worse than ask local government.

In many ways the NHS faces very similar problems to councils. Demand for services is rising rapidly and getting more complex. Citizens want more of a say. And resources are limited even if the constraints on the NHS are nowhere near as severe as for councils.

But compare how the most innovative councils are responding to these challenges and what the NHS now says it hopes to do and a vast conceptual chasm opens up.

Forward-thinking councils are recognising that the starting point for change must be the creation of a completely different relationship with the communities they serve. A collaborative mindset has to replace the hierarchical and transactional attitudes that have shaped local services for the last 70 years.

The reason is straightforward: if we are to make a wholesale move to prevention and away from acute care then communities need to do more for themselves. That means councils being willing to hand over power and communities being willing to take on responsibilities. Look to councils like Wigan and Gateshead MBCs, and Cambridgeshire CC amongst others and you will find a radical redesign of services that has community engagement and empowerment at its heart.

This is a fundamental perspective that is completely absent from the NHS long-term plan. There is no sense of the need for a different and potentially difficult conversation between the health service and the population about communities taking on more responsibility. There is no self-analysis of the way the NHS’s hierarchical, status-obsessed culture militates against relationships with patients based on empowerment and collaboration rather than “doctor-knows-best”.

Instead, we have a document utterly infused with the belief the NHS is an organisation that can solve its own problems through structural, process and technological fixes. Indeed, the only time empowerment gets a look-in is in the chapter on technology where we are informed that new “digital tools” like the inevitable NHS app will transform patients’ experience of the information they can access.

 

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