While there’s a lot of truth in that statement, it’s not helpful. The NHS clearly is struggling with very tight budgets, and more money would definitely help… but it’s not the answer. The NHS is capable of absorbing more money, and then coming back for even more. This was the story of the first decade of this century, when NHS funding increased by more than 50% in real terms (a staggering, unprecedented and unrepeatable deal), but it wasn’t enough.
No, the answer has to be a radical re-think about how the NHS does its job. First, this means re-designing the way we do things now – doing things better. For example, patients should not be kept in hospital for days and even weeks after their medical care is completed – euphemistically called ‘delayed transfers of care’ in the sanitised NHS jargon. We need to adjust each of the component parts of the care system – everything from supporting frail people better in the community, through in- and out-of-hours GP services, A&E and hospital wards, through to more and better options for supporting people with failing independence in their own home – to get the right balance for each community. Imagine a control panel with a series of dials for each component – we need to calibrate each bit properly if we are to get rid of those inhumane blockages which can ruin people’s chances of good quality life and independence.
Second, it means working differently – doing better things. And this is where co-production really comes in. It means helping people maintain what matters to them most in life, by focusing on their outcomes, and delivering support in a way which maximises their contribution, not minimises and infantilises what they can do. People know what a ‘good life’ means to them, and it’s the job of the NHS and its partners to deliver that, by getting alongside people and offering them whatever support they need. There are hundreds of ways in which the statutory services can bolster people’s independence, rather than unwittingly undermining it by thinking of what people can’t do, rather than what they can. It’s about providing information, practical support, training in coping skills, links to people in a similar situation… as well as more specialised provision.
The great thing is that people usually want very little intervention, if you can wrap that support around them soon enough, while they still have coping skills. ‘Minimal intervention’ really is what most people would choose, if they had the choice. In simple terms, we need a three-way partnership. We need systems designed to support and empower citizens and staff; professionals who know how to listen and respond; and service users and carers who know how to get the best out of the service on offer, and expect to be in control.
The trouble is, that’s much harder to bring about than bunging another few millions at the problem!
Marcus Longley is Professor of Applied Health Policy at the University of South Wales, and Director of the Welsh Institute for Health and Social Care.