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.