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Health as a social movement

As the RSA and New Economics Foundation publish their report on their work with local communities to promote health and wellbeing, NHS England’s deputy director of personalised care reflects on the hallmarks of a successful social movement:

Big organisations and social movements – are they compatible?

Surely a social movement is, by its very nature, something that starts from an individual or localised issue, or from a perceived injustice.  So what can those of us who try to drive change through statutory organisations learn from social movements?

The RSA and the New Economics Foundation have just published a report: Health as a Social Movement, from theory to practice, which lays out the lessons learnt from a three year project commissioned by NHS England. The aim of the project was to discover what gives social movements their impetus and how we can mobilise some of that drive to improve people’s health and wellbeing.

The starting point was the well-documented challenges to people’s wellbeing and to the care system that aims to support them, alongside a recognition that seeds of solutions are already out there in our communities.

The project attempted to flesh out what it means to focus on the role of communities and individuals, which is fundamental to the strategic direction of the NHS outlined in the Five Year Forward View. It looked at what we can do to move away from the ‘factory’ model of care to build a sustainable future based on a more personalised approach.

It is an approach that recognises the aspirations and energy of individuals and shows the power that arises from people who are more connected with their wider communities.

The report makes clear that we cannot expect services to be solely responsible for the state of the nation’s health and acknowledges that it is counter-intuitive for institutions and systems to be leading social movements.

And yet, the results of this report demonstrate that large organisations can be a catalyst for change if they build on the strengths and energy that are already there in a community.

This project does not offer a new revelation. It is part of a long history of community development, citizen participation and person-centred health and care. Neither does it offer a one-size fits all solution. It recognises that different activities work in different places, and aims to identify the common features which can send change rippling out across communities.

The work builds on wider transformation taking place on the ground in six areas of England, and we are grateful to all who have participated in the work over the last three years: Airedale Social Movement; Wellbeing Erewash; Greater Manchester Cancer Vanguard Innovation; Better Care Together; The Royal Free London NHS Foundation Trust; and, Stockport, Tameside and Oldham.

Their work covers a range of settings, from care homes to schools, from hospitals to communities, from staff to service users.  And from their diverse situations, the report identifies eight signs of success:

  • Acting early: understand health holistically.
  • Bringing people together: connect and mobilise citizens to develop a shared purpose and take collective action.
  • Shifting control: enable people to have more access to, and more control over, the resources in their community that impact on health and wellbeing.
  • Collaborating widely: join forces with local anchor institutions, local CVS organisations and other public services.
  • Sharing power: form partnerships between citizens and professionals, pooling different kinds of knowledge and experience.
  • Changing culture: work to change culture and practice within state and civil society organisations.
  • Growing from local: make sure decisions and actions are rooted in local experience and build on the assets and experiences of the community.
  • Building momentum: learn as you go and use every opportunity to spread good practice.

So, yes, I do think that large organisations and social movements can be compatible.

The work reflected here stands as a testament to the energy of people both inside and outside the walls of our large organisations who are passionate about making life better for themselves, their families, their neighbours and communities.

Nicola Kay is NHS England’s Deputy Director for Personalised Care Policy and Strategy.

In her role, she develops and leads the approach to scaling up and mainstreaming personalised care, including embedding the relevant IT infrastructure, developing necessary skills across the NHS, identifying new legislative rights and strategic stakeholder engagement.

Nicola leads a team which work closely with local areas to embed new opportunities for personalised care in areas such as substance misuse and neuro-disability. Her team also includes a range of people who bring their own lived experience to the team’s work.

Prior to joining NHS England in 2016, Nicola worked for 10 years as a civil servant in a range of central government policy, strategy and finance roles. She led on health and social care spending at HM Treasury, including the commissioning reforms in the 2012 Health and Social Care Act, the Dilnot Commission and the 2010 Spending Review.

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One comment

  1. Lisa Beasley says:

    A really interesting blog Nicola, it resonated for me on many levels. I am a former Midwife who now works as an eating psychology coach- helping women with their relationship with food by learning to eat mindfully and working on their body image. I know that this holistic approach would benefit so many people and could be scaled up to offer an impactful alternative to current nhs practice. The question is, how to get the policy makers to listen to a model that focuses on a more social approach instead of just looking at symptoms.