Beyond the Five Year Forward View
The healthcare landscape is shifting. Whatever the motivation - whether economic considerations, a ‘more sustainable NHS’ or sheer desire to recognise the potential of measures beyond traditional ideas of medication - assumptions that had been firmly held are starting to fracture. Discussion around what can contribute to health and wellbeing and what it means to support society’s health and wellbeing is slowly but steadily spreading. Whilst the specifics may not have been finalised, the need to rethink the health service has been firmly established, and particular interest is being paid to the idea of ‘prevention.’
Prevention is one of the focal points of the Five Year Forward View (2014). Early on, the report positions itself in the context of previous failure: “twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.” Resistance previously to a prevent-based strategy is perhaps understandable. The implications of prevention must surely mean that a considerable restructure is needed. If we are genuinely talking about slowing illness, and even preventing it all together, then our usual go-tos as a society suddenly have limited power – after all, how can you medicate for something which does not yet exist?
The report notes that current care structures can be susceptible to “a ‘factory’ model of care and repair with limited engagement with the wider community, a short-sighted approach to partnerships and underdeveloped advocacy and action on the broader influencers of health and wellbeing.” Such susceptibility is hardly surprising when ‘care’ is understood as a product of a healthcare ‘industry’ and just like every other industry, a belief in the value of division of labour has been embraced. However, while such distinct roles might work in The Pin Factory, the boundaries between primary care, community services, and hospitals are detrimental to people’s health and need to be dissolved. For the authors behind the review - including NHS England, Monitor and Public Health England - this means taking “a more activist prevention and public health agenda,” which includes “greater support for patients, carers and community organisations.”
This redirection is clearly felt to be a bold step: “[a]s a nation we’ve just taken the unique step anywhere in the world of entrusting frontline clinicians with two thirds - £66 billion – of our health service funding” to help drive changes in local health systems. While the need to work through a model of partnership and collaboration has largely been agreed, what exactly this could and should look like remains to be decided. The report therefore emphasises the “vital’ role of research in providing evidence of possible transformations in services and outcomes.
Fortunately, when it comes to the role arts, creativity and community can play, the evidence is ample and the breadth of examples is captured well by the APPG for Arts, Health and Wellbeing in their inquiry published this year.
Since the publication of Creative Health: The Arts for Health and Wellbeing there has also been a Westminster Hall debate on ‘The role arts-based interventions can play in health and wellbeing.’ In summarising the debate, John Glen (Parliamentary Under-Secretary of State for Digital, Culture and Media and Sport) agreed that “[t]he arts can and must play a major role in helping us to meet the growing challenges we face in health and social care. As such we need to make a vital cultural shift to ensure that the arts are fully embedded in the health and social care system.”
However, as we approach the end of 2017, and three years on from the Five Year Forward View, the role of art and community in supporting people’s health - and especially with the aim of prevention in mind - has not been as embraced as is surely desirable. The debate itself being a case in point given the absence of any health ministers. MP Ed Vaizey, who secured the debate, commented “[i]t is a matter of some sadness to me that the last Health Minister to make a speech about the role of the arts in health was Alan Johnson.” In trying to ascertain how far along we are in this discussion, it is telling that one of the actions at the end of the debate was simply to call for a response from the Department of Health.
The debate made strong statements on arts in health and acknowledged the weight of the APPG report. However, rather than the value of art having been established, it was felt that “the evidence is growing, but more is needed.” This position will be met with mixed reactions. Ultimately, however, whether justified or not, if that is the demand it must be met.
And it will be, but support is needed to create opportunities for brilliant work to be done, and for it to be evaluated in terms of its health benefits. For now, the boundaries between the different sectors that needed to be ‘dissolved’ still largely stand. The call from the APPG to bring together “leaders from within the arts, health and social care sectors… to support good practice, promote collaboration, coordinate and disseminate research and inform policy and delivery” currently feels a long way off. Communication between arts, health and government struggles: too much is not communicated, too much is not heard. However, opportunities to work closer together are arising and by making the most of them each of us has the power to contribute to the cultural shift that is so desperately needed.
On Monday 4th December Flourishing Lives will hosting a workshop for organisations who want to enhance their understanding of Clinical Commissioning Groups and develop closer working relationships with CCGs. To attend please register via Eventbrite: closercommissioningworkshop.eventbrite.co.uk