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

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Our union backed Brexit, but that doesn't mean scrapping freedom of movement

We can only improve the lives of our members, like those planning stike action at McDonalds, through solidarity.

The campaign to defend and extend free movement – highlighted by the launch of the Labour Campaign for Free Movement this month – is being seen in some circles as a back door strategy to re-run the EU referendum. If that was truly the case, then I don't think Unions like mine (the BFAWU) would be involved, especially as we campaigned to leave the EU ourselves.

In stark contrast to the rhetoric used by many sections of the Leave campaign, our argument wasn’t driven by fear and paranoia about migrant workers. A good number of the BFAWU’s membership is made up of workers not just from the EU, but from all corners of the world. They make a positive contribution to the industry that we represent. These people make a far larger and important contribution to our society and our communities than the wealthy Brexiteers, who sought to do nothing other than de-humanise them, cheered along by a rabid, right-wing press. 

Those who are calling for end to freedom of movement fail to realise that it’s people, rather than land and borders that makes the world we live in. Division works only in the interest of those that want to hold power, control, influence and wealth. Unfortunately, despite a rich history in terms of where division leads us, a good chunk of the UK population still falls for it. We believe that those who live and work here or in other countries should have their skills recognised and enjoy the same rights as those born in that country, including the democratic right to vote. 

Workers born outside of the UK contribute more than £328 million to the UK economy every day. Our NHS depends on their labour in order to keep it running; the leisure and hospitality industries depend on them in order to function; the food industry (including farming to a degree) is often propped up by their work.

The real architects of our misery and hardship reside in Westminster. It is they who introduced legislation designed to allow bosses to act with impunity and pay poverty wages. The only way we can really improve our lives is not as some would have you believe, by blaming other poor workers from other countries, it is through standing together in solidarity. By organising and combining that we become stronger as our fabulous members are showing through their decision to ballot for strike action in McDonalds.

Our members in McDonalds are both born in the UK and outside the UK, and where the bosses have separated groups of workers by pitting certain nationalities against each other, the workers organised have stood together and fought to win change for all, even organising themed social events to welcome each other in the face of the bosses ‘attempts to create divisions in the workplace.

Our union has held the long term view that we should have a planned economy with an ability to own and control the means of production. Our members saw the EU as a gravy train, working in the interests of wealthy elites and industrial scale tax avoidance. They felt that leaving the EU would give the UK the best opportunity to renationalise our key industries and begin a programme of manufacturing on a scale that would allow us to be self-sufficient and independent while enjoying solid trading relationships with other countries. Obviously, a key component in terms of facilitating this is continued freedom of movement.

Many of our members come from communities that voted to leave the EU. They are a reflection of real life that the movers and shakers in both the Leave and Remain campaigns took for granted. We weren’t surprised by the outcome of the EU referendum; after decades of politicians heaping blame on the EU for everything from the shape of fruit to personal hardship, what else could we possibly expect? However, we cannot allow migrant labour to remain as a political football to give succour to the prejudices of the uninformed. Given the same rights and freedoms as UK citizens, foreign workers have the ability to ensure that the UK actually makes a success of Brexit, one that benefits the many, rather than the few.

Ian Hodon is President of the Bakers and Allied Food Workers Union and founding signatory of the Labour Campaign for Free Movement.