The head of NHS England gets his blood pressure tested. Photo: Getty
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How people-powered personalisation could lead the NHS to recovery

The NHS needs a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities.

It’s been an important month for personalisation in the NHS. For the first time, around 60,000 adults eligible for Continuing Health Care now have the legal right to a personal health budget. Health and social care leaders have been finalising applications to participate in the potentially ground breaking Integrated Personal Commissioning Project seeking to blend social health and social care funding for individuals and allow them to direct how it is used. And publication of the NHS’s Five Year View set a course for the organisation that commits the organisation to enabling patients to have far more control over their care, including but not only through greater control over shared budgets.

Encouragingly, these moves towards personalisation appear to be based on a deep understanding of why producer-led forms of provision have had their day. The Five Year View makes a strong defence of the values and professionalism of today’s NHS, but makes no bones about where it has fallen short, operating as if health and wellbeing can be delivered to people, rather than achieved in partnership with them. 

It warns that the NHS has been prone to "operating" a "factory model of care and repair" instead of harnessing what it calls the "renewable energy represented by its patients and communities". At a point when 70 per cent of today’s health spend is on long term conditions, rather than isolated health problems that might respond to one-off "repair", agreeing forms of support that fit with people’s own lives and aspirations, and plug into their own resources, could hardly be more important. 

So, as health prepares to speed up its journey to personalisation, it makes sense to look at what can be learned from the experience of other sectors, particularly the sector in which personalisation was born – social care. Much of that learning is very encouraging. We now have detailed evidence of the impact of personal budgets, for example, on the lives of those who use them. 

This month saw the publication of the Third National Personal Care Survey. In line with previous research it shows that the overwhelming majority of budget users believe that their lives have improved in terms of independence, dignity and family and paid relationships. As Alex Fox has noted in a new report for the RSA, people who make long term use of social care have repeatedly demonstrated over the past two decades that they are often better than highly trained professionals at making effective use of public resources. 

Yet personalisation remains highly controversial as a philosophy and as a set of practices. Critics worry about colluding with neo-liberal models of individual choice and control, about the de-professionalisation and fragmentation of the workforce, about creeping inequities, and about abnegating proper risk management. Even some of those who are well-disposed towards its aims are concerned that personal budgets in particular have become expensive bureaucratic thicket in which rationing and provider-interest continue to thrive.

For Alex Fox, the way of resolving these problems is to go back to the roots of personalisation and recognise the true challenge it presents, which is not one of administrative adjustment but of profound culture change. Far from being founded on an individualised view of wellbeing, personalisation rests on a deep understanding and respect for how we thrive or falter as people who are embedded in families and communities. So personalisation must go wider than budgets and individual choices, as clearly recognised back in 2007 in the government’s Putting People First concordat. For personalisation to succeed it needs to be part of a shift towards prevention and the development of inclusive and supportive communities.

The RSA’s own research and practice supports this approach. Our work on social isolation and drug and alcohol recovery, for example, is based on building trust in the capability of individuals, families and communities to forge solutions that are right for them, with the support of services that are re-shaped to respect and support the support ecosystems – formal and informal – of the places they serve. 

For example, the RSA’s Whole Person Recovery Team in West Kent is testing, at scale, a service delivery model that fosters community networks in order to support sustainable, long-term recovery from drug and alcohol abuse. The service attempts to build people’s "recovery capital" by connecting them with the people, groups and places who can become their support ecosystem.  It is a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities. 

Ironically, given the aspirations of the NHS Four Year View, Whole Person Recovery explicitly rejects a medicalised model of addiction and recovery – a reminder, if one were needed, of the  and scale of the task ahead if the health service truly wants to embrace personalisation. For social care, the culture change challenge has been huge. For health, it is likely to be even greater.

Paul Buddery is director of RSA 2020 Public Services

How Jim Murphy's mistake cost Labour - and helped make Ruth Davidson

Scottish Labour's former leader's great mistake was to run away from Labour's Scottish referendum, not on it.

The strange revival of Conservative Scotland? Another poll from north of the border, this time from the Times and YouGov, shows the Tories experiencing a revival in Scotland, up to 28 per cent of the vote, enough to net seven extra seats from the SNP.

Adding to the Nationalists’ misery, according to the same poll, they would lose East Dunbartonshire to the Liberal Democrats, reducing their strength in the Commons to a still-formidable 47 seats.

It could be worse than the polls suggest, however. In the elections to the Scottish Parliament last year, parties which backed a No vote in the referendum did better in the first-past-the-post seats than the polls would have suggested – thanks to tactical voting by No voters, who backed whichever party had the best chance of beating the SNP.

The strategic insight of Ruth Davidson, the Conservative leader in Scotland, was to to recast her party as the loudest defender of the Union between Scotland and the rest of the United Kingdom. She has absorbed large chunks of that vote from the Liberal Democrats and Labour, but, paradoxically, at the Holyrood elections at least, the “Unionist coalition” she assembled helped those parties even though it cost the vote share.

The big thing to watch is not just where the parties of the Union make gains, but where they successfully form strong second-places against whoever the strongest pro-Union party is.

Davidson’s popularity and eye for a good photo opportunity – which came first is an interesting question – mean that the natural benefactor in most places will likely be the Tories.

But it could have been very different. The first politician to hit successfully upon the “last defender of the Union” routine was Ian Murray, the last Labour MP in Scotland, who squeezed both the  Liberal Democrat and Conservative vote in his seat of Edinburgh South.

His then-leader in Scotland, Jim Murphy, had a different idea. He fought the election in 2015 to the SNP’s left, with the slogan of “Whether you’re Yes, or No, the Tories have got to go”.  There were a couple of problems with that approach, as one  former staffer put it: “Firstly, the SNP weren’t going to put the Tories in, and everyone knew it. Secondly, no-one but us wanted to move on [from the referendum]”.

Then again under different leadership, this time under Kezia Dugdale, Scottish Labour once again fought a campaign explicitly to the left of the SNP, promising to increase taxation to blunt cuts devolved from Westminster, and an agnostic position on the referendum. Dugdale said she’d be open to voting to leave the United Kingdom if Britain left the European Union. Senior Scottish Labour figures flirted with the idea that the party might be neutral in a forthcoming election. Once again, the party tried to move on – but no-one else wanted to move on.

How different things might be if instead of running away from their referendum campaign, Jim Murphy had run towards it in 2015. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.

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