From new models to new cultures of care

The New Care Models Zone was one of four feature zones at this year’s Health and Care Innovation Expo. The zone explored the progress made by the 50 vanguards developing and testing new models of care that can be replicated across different health economies. Jeremy Taylor, Chief Executive of National Voices, also chaired an expert panel discussion on the ‘Future NHS Stage’ at Expo – ‘From new models of care to new cultures of care.’ In this blog, he reflects on that discussion and takes a look at how this might work in practice. 

What does it mean to go from new models of care to new cultures of care? The NHS Five Year Forward View asserts that reform requires “a new relationship with patients and communities”. A new culture of care means responding to the full and radical implications of that insight.

NHS reform is understandably driven by the concerns of those trying to sustain the system from the inside. They ask “We are the NHS, what kind of relationship do we need with our users?” The challenge is to make sure that the equal and opposite question is heard with equal force:  “We are the people, what kind of relationship do we want with our health and with services?”

The People and Communities Board that I chair – a group helping to keep the focus on chapter 2 of the Five Year Forward View – launched six principles to help frame the thinking here. What would a new NHS culture look like set against these principles?

Principle 1 is that care and support is person centred. The New Labour government promised more patient choice and a care plan for everyone with a long term condition.  Andrew Lansley promised “no decision about me without me”. Yet in 2016, nearly half of patients still report that they are not as fully involved as they want to be in decisions about their care and treatment.  Personalised care planning remains a minority pastime.  Commissioners remain reluctant to invest in self- management programmes. A new culture of care would ensure that people’s experience of involvement and of being supported to self-manage would be treated as key measures of success for the NHS.

Principle 2 is that services are created in partnership with citizens and communities. The most forward looking parts of the NHS are getting there: patients involved in recruitment and contracting; in experience-led service design; in clinical education. Some services even have patient directors. But the NHS still struggles with this in a new culture, citizens would feel meaningfully involved in the 44 Sustainability and Transformation Plans. And it’s not just about being invited onto official turf.  We need to set our own agenda as citizens. In the words of one patient: “I don’t want a service, I want a life”.

Principle 3 is a focus on equality and narrowing inequality. Theresa May launched her new government with stirring words about the appalling mortality gap between rich and poor. A new NHS culture would be energised by this injustice. That would include thinking differently about “hard to reach” groups. As one NHS manager recently put it: “people from communities you call hard to reach are working in your trust”.

Principle 4 is that carers should be identified, supported and involved. Despite much policy and strategizing, carers remain an after-thought. In a new NHS culture, staff would be inquisitive about the significant others in a patient’s life.

Principles 5 and 6 are about the power of the voluntary and community sector and of volunteering and social action. It is what David Cameron once called the “Big Society”. It is what people in the NHS are increasingly recognising as the potential of social prescribing, peer support, and other asset based community approaches.

But it’s also about recognising the importance of community-based activities that are not always associated with “health and care.” Volunteer befrienders and peer supporters provide a valuable service, but so do local libraries, shops, pubs and clubs.  And so, critically, do jobs. Unfortunately just as people are starting to get what the “Big Society” really means, it is getting a lot smaller, as austerity bites into communities and the voluntary sector. In a new NHS culture people would be thinking a lot more laterally and creatively about how to connect with and support the health making forces in communities.

New models of care should not just be old wine in new bottles. In a new NHS culture, staff would be working with patients, understanding what keeps them well; and figuring out how to deploy the vast NHS resources to reinforce the creation of health and wellbeing.

Jeremy Taylor

Jeremy Taylor is chief executive of National Voices, the national coalition of health and care charities for England.

Jeremy acts as a representative, expert advisor, writer, commentator and speaker on issues that National Voices champions, especially person centred care, and patient and public engagement.

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  1. Kassander says:

    Mr Taylor writes
    The People and Communities Board that I chair
    If one looks at the membership of that Board it’s full to the brim with people who are
    Directors of
    CEOs of
    Chief officers of

    Even those who might be considered to be of the Lay variety are firmly bound into the Health Industry Committee Fee scheme and being Health journalist, Health academics, and the like
    Where are the ordinary Patients and Public (P&P) ?
    Where are the P&P who have been chosen by their peers to speak on their behalf and then report back to those peers?
    Enough of self appointed and self designated Patient Leaders
    Enough of CCG Lay NEDs appointed from their own, and retained by, the Private sector GP contractors who run the CCGs and distribute our NHS’s £70 000 000 000 / year without tangible reference to we, the P&P who are both the users, and the financiers, of our NHS
    We’ve even had our voice to the NHS via Citizen-Gather destroyed overnight and not restored despite the Conference on 12/09/16 Why not?

  2. Kassander says:

    Mr Taylor writes : NHS reform is understandably driven by the concerns of those trying to sustain the system from the inside. They ask “We are the NHS, what kind of relationship do we need with our users?”

    Oops, Mr T. Who are these They who claim to be the NHS?
    No one IS the NHS – as with the earth, these things are in out temporary guardianship, and all of us owe it to the next generations to hand this legacy on in an even better state than we inherited it from the previous generations who put so much effort into improving our NHS, and for some of the greedy ones, messing up our beautiful globe.
    It may be a slip of the keyboard that you wrote that you did – but given your influential position that sort of ill considered statement will be used by ‘Them’ to deny ‘US’ (P&P) our rightful place at the Policy tables. And those are the real seats of power, not the ones which discuss ”What colour bandage would you like today?” Important tho’ such considerations are..

  3. Linda Farley says:

    This makes interesting reading. At the moment we as acouple don’t need to be friendshipped or make contacts in the community, we need a Doctor! Our GP surgery has failed and because of that we don’t have access to a GP. Yes we can talk on the telephone to him but we may not visit him, I dont know why. We may see a senior practise nurse, who looks at a screen and comes up with a medication,this is not person centred medicine, this is poor box ticking! Recently I was taken into hospital with a suspected stroke and got excellent care, and continue to do so from the hospital but I do not have access to a GP if I have any other problems. My husband suffers from gout and it has got very much worse, he may not see a GP.No qualified Doctor has looked at or touched his foot. He also is very sensitive to the drugs he needs to take and is spending most of the time currently with bowel problems. The care we receive locally is frankly lousy and not peopled centred or actually caring.

  4. Andrew says:

    Sounds like the same old message wrapped up in new phrases. Surely the patient is everyone’s priority and we should not have to be reminded. Lets get real and act as well as talk.

    • Jeremy Taylor says:

      Unfortunately the evidence suggests that the patient is not everyone’s priority. Nor is dealing with the factors that lead to people becoming patients in the first place.

  5. John says:

    Not more new culture, what is wrong with the old one ?

    • Jeremy Taylor says:

      Paternalistic, not holistic, too clinically focussed, too fragmented, too acute hospital focussed, not listening to and involving patients, communities and front line staff sufficiently, too top down, too short termist, too political, too focussed on finance, not sufficiently focussed on quality. Apart from that the old culture is fine.

      • Kassander says:

        ​And the membership​​ ​of the People and Communities Board that you chair; that’s going to help bring about this culture change?
        Chock-a-block with Directors and CEOs
        Even the ​Fee paid​ ​Lay members are ​employed ​in the Health Industry​ as widely published Health journalist​s​; Health academics,​ etc
        Where are the ​grassroots​ Patients and Public (P&P) chosen by their peers to speak on ​our​ behalf and then report back to ​us​?
        Enough of self appointed and self designated Patient Leaders.

        Why weren’t you at the Citizen & Gather (Online forum) re-launch run by Anu Singh (Director NHSE – PPPI) on Saturday, to put the case for this new culture?
        All 3 000 P&P members of that means of ‘Holding NHSE Board to account’ saw it destroyed overnight, without consultation or notice.
        Despite all the Top down dictats on Saturday, nothing was resolved.
        Oh. There might be ‘consultations’. Probably with reps designated by NHSE to speak FOR us, but without us.
        New culture?
        Byzantine more like it.

  6. Dr; John Davies says:

    Testing new models of care
    Like lab rats or mice in tubes ?

  7. Dr John Davies says:

    For New Model of Care read privatisation – remember that other Orwellian semantic euphemism – Alternative Sources Of Funding = privatisation