NHS will betray founding principles unless it turns to community-led prevention

The NHS could cease to be fair and free at point of use, unless it shifts focus to building health in the community, new research has found.

Think tank New Local argues that the way the NHS operates is fuelling its demand crisis. The original 1940s vision for a healthcare system cannot cope with challenges of the 21st century in which people are living longer with more complex conditions.

To avoid collapse, the NHS must fundamentally change its way of working, focusing attention and resources on preventing illness out in communities. New Integrated Care Systems (ICSs) – which became statutory this month – should divert some of their budget from acute care to preventative community-based approaches.

Giving people more power over their own health will help people manage and prevent illness before they need professional medical help, finds the report. This will in turn ease the burden on GPs and hospitals.

The report contains dozens of examples of where health practitioners are already adopting a community-powered approach, with tangible results. Including:

Fleetwood, Lancashire, where a local GP has shifted from surgery work to community-facing initiatives, helping to set up dozens of resident-led social groups. A&E admissions in the town have fallen and overall health has improved.

Pimlico, London, where the UK’s first Community Health Workers are working alongside a local GP to look after the health of their neighbours, visiting homes regularly and referring to services. Demand on the GP is already decreasing.

Greater Manchester, where a local HIV organisation works with people living complex lives helping them to access NHS services. They have seen 79% reach an undetectable viral load.

The report recommends that central government commit to a 10-year ban on health-care reforms to give new ICSs – partnerships between the NHS, local government and others – the space to establish positive ways of working.

It also calls for each Whitehall department to come up with its own strategy to reduce health inequalities, which are increasing in the UK.

New Local recommends that ICSs build community voice into decision making, equip staff to work with patients or residents as equals and moves away from the traditional, hierarchal culture that has dominated the NHS.

Jessica Studdert, Deputy Chief Executive, New Local, says:

“Our traditional healthcare model, where people arrive in surgeries and hospitals to be ‘fixed’ and then return for their next medical episode, is not designed to tackle the complex, long-term conditions our ageing society is living with.

“To ensure a free and fair healthcare system for the future we need a fundamental shift to an approach that tackles the roots of ill-health and uses the strength of people in communities to create healthy lives.”

Prof Donna Hall, Chair, New Local and Bolton NHS Trust, says:

“The causes of ill-health are woven into people’s lives, relating to where they live and how they live. It stands to reason that health inequalities will never be bridged in medical settings alone.

“If ICSs determine their role as management of status quo we will have failed. We need the same fresh thinking, energy and imagination as when the NHS was created 74 years ago to shake up the boundaries between mental and physical health, GPs, acute and community services.”