White Paper Reconciliation 2 and where the Big Society can help

Another Monday, another big announcement. Yesterday’s speech by David Cameron on the Big Society was, like much ideas in the Health White Paper the Monday before, trailed during the General Election but received little publicity in the wake of the leadership debates.

Our third essential that I wrote about , but which we knew the White Paper wouldn’t address directly, was addressing the rise of untenable demand on the NHS. Untenable demand has arisen as the NHS has expanded to unquestioningly subsidise every societal and cultural choice. I have outlined before (pg 42) what I see these demand ‘giants’ as or arising from: neglect (ignorance and loss in the cachet of caring); risk (displacement, waste and fear); drift (disease mongering); commodification (blurring of the line between therapy and enhancement) and conflict (the simplistic rejection of partnership).

However the emphasis that was placed on public-patient involvement in “Equity and Excellence” is definitely a step in the right direction. The more the public are aware of the pressures on the NHS, decision- making, budgets etc. the more likely they (we!) are to realise both that there are unsustainable demands that are being made and that the way we live is a significant driver of them. Patient information needs to work two ways – so not only do we know more about what we should be offered – but we also know more about how to use services appropriately. If GPs are holding the purse strings then this in itself will incentivise them to ensure they are consulted on genuine patient need and then deal with issues in the most efficient way. Added to this if the Big Society vision of voluntary sector is going to be welcomed in delivering more health services, they also will want to ensure their time is used wisely.

There are two HUGE challenges here. One is seeing the voluntary sector as mainstream, their contribution from services such as welfare-to-work as a health ‘outcome’ and having a longer-term view on the value they deliver. The other is ensuring the weak – particularly the frail elderly – are not forgotten. If ever there were patient-reported-outcomes worth gathering, it’s the experiences of those with the weakest voice that we should be listening too.

Our fourth essential with which the White Paper concurs, the best has to trump the good and alternatives cannot co-exist because ‘that’s what we have always done’. There can be no excuse for not adopting best practice; but the perennial challenge is spreading the knowledge – and we’ll come on to accountability next…

What Big Society and Equity and Excellence have in common is that their visions require strong, determined leadership, effective funding linked to outcomes and mature partnerships between commissioners, providers and with local government. Here’s hoping.


About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
This entry was posted in Andrew Lansley, Demand Reduction, Inequality, White Paper and tagged , , , . Bookmark the permalink.

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