Powerful people: Reinforcing the power of citizens and communities in health and care

‘In a world where most healthcare demand comes from patients with long-term conditions, the focus must shift to creating health rather than responding to ill health. That means giving people the information, power and control to stay healthy, manage their conditions and choose their treatments.’

Foreword, Alan Milburn and Stephen Dorrell

The NHS faces a challenge over the next decade of meeting growing and more complex demand within tight financial constraints. There are already many examples of doctors, nurses, managers, community workers and patients trying out innovative models of care that show how this challenge can be met. The task for policymakers is to ensure that we have a healthcare system that supports these empowering models and enables them to spread.

Attempts to empower patients so far have focused on making acute services like hospitals more responsive, but we now need to give people greater control over their own health in their homes and communities, long before acute care is required, or in recovery after hospitalisation.

This report reviews many of the promising, empowering models of care that are already being tried out all around the UK, such as:

• social prescribing models, which address people’s social, emotional and practical, as well as medical needs
• brokerage and integration models, which mean that services are joined up around the person rather than people having to navigate fragmented services
• peer support models, which mobilise the knowledge, skills and empathy of people with similar conditions
• asset-based community development models, which focus on strengthening people’s capabilities so they are less dependent on services and can lead independent lives
• technology-enabled care plans, which provide people with the tools and data needed to better manage their condition themselves.

Nevertheless these models are at the margins of the system. What can we do to help them spread? We argue that five steps need to be taken:

1. We need to change the way money flows around the NHS. We recommend that £4 billion of the new money the government will invest in the NHS over this parliament goes into a transformation fund to invest in new models of care and drive change in the healthcare model provided throughout the country. We recommend that money is put directly in people’s hands by accelerating the spread of personal health budgets, which should be an entitlement for all those with long-term conditions by 2020. More widely, local commissioners should provide funding for integrated healthcare providers based on capitated and outcomes-based funding.
2. The government should embrace and take further the ‘devo-health’ agenda. Power needs to be devolved down to local areas and to frontline professionals so that they are better able to redesign services around people’s needs.
3. This agenda requires a profound change in clinical and healthcare cultures and mindsets. We need to equip the healthcare workforce with the roles and skills required to provide these new models of care, as well as moving to a coproductive culture in which decision-making is genuinely shared between patients and healthcare professionals.
4. Technology is key to putting more power, especially data, in citizen’s hands, which will enable them to know more about their own health and act more effectively themselves to stay healthy and well. But the NHS is very poor at adopting and diffusing new technologies. We call for a better adoption and diffusion mechanism for technologies, such that it is easier to sell products into the NHS and such that the NHS itself is demanding innovation.
5. Empowerment is not just something that is given by the system: citizens themselves also need to play a role. While the government, employers and communities have a duty to act upon the social determinants of ill health, we all have a responsibility to live healthily. This should be incentivised in the tax system, such as by increasing taxes on some high-strength alcoholic drinks. A more active role for citizens should be promoted by helping them to be more involved in and prepared for care planning; by actively seeking to achieve the goals agreed; by sharing their health data with professionals from different service organisations; by getting involved in the community and by helping others; and by purchasing and utilising new technologies.