Prof Andy Brooks
NAPC Clinical Chair
The film ‘Everything Everywhere All at Once’ was released in 2022. Evelyn runs a laundry and is battling with many competing demands, including financial, relational, institutional, cultural and health issues, and probably more that I didn’t pick up on. The movie explores the multiverse, telling the story in many film genres and includes several philosophical ideas. The title is apt.
Chapter 2 of the NHS 10-Year Health Plan is called ‘From Hospital to community: The Neighbourhood Health Service, designed around you’. We certainly haven’t been short of reading, hearing, or perhaps even saying the word neighbourhood since then. Can we go as far as saying it is ‘everywhere’? Its meaning is used variably from small local projects, to just about ‘everything’. The implementation appetite from some is to start small and for others to make it happen ‘all at once’. For those at the frontline, however, it might feel more like ‘nothing, nowhere, never’.
Why the variation?
One factor is certainly how hard it is to grasp the enormity of the shift from hospital to community. Whilst the film jumps from one universe to another many times in the space of just over 2 hours, I am not sure how much I have got my head around exactly what the multiverse is. Our rational brains might naturally conclude that moving from hospital to community means a consultant working in a GP surgery, rather than a bigger building further away.
The shift required though is much more profound than a switch of location. A hospital is a building that houses an institution and comes with a certain culture; a more intermittent and transactional way of working with financial & management systems, leadership, and risks that are a universe apart from community. From a health lens, community is much more about longer term, interdependent and undifferentiated problems. And that is just the health lens. The multiverse features social care, education, housing, voluntary and faith sectors and more. No wonder there are multiple opinions. The left shift is more about a mindset change than a care location change.
If it’s so complex, where do we start?
Perhaps the best place to start, is to do just that – start. Doing nothing is not really an option, and doing ‘everything’ will require time/space travel. Doing ‘something’ is within our gift. This is particularly true for the operational integration of community-based teams. This requires leadership and management to be permissive for their staff to shed an organisational lanyard & allegiance and put on a population hat.
The National Neighbourhood Health Implementation Programme (NNHIP) kicked off last month with 43 sites spread across England. So, for 43 sites ‘something’ is happening. Senior NAPC faculty members are coaching in 16 of these sites. We are witnessing real energy and innovation. It is not just happening in these sites as others around the country continue with ongoing projects. However, these other sites do not have as much support from the national programme. One thing that is within the gift of the NHS is to move from ‘somewhere’ to ‘everywhere’, with a boost to the national programme.
Moving from ‘somewhere’ to ‘everywhere’
Given the prominence placed on this policy by government and the NHS, it might be assumed that the programme already comes with significant resource to implement and is accompanied by a shift in the funding flow to the various community components that make up the NHS. It doesn’t appear (yet) that either of these is happening. It needs the whole NHS to get behind it. The mindset change not only needs funding moved (or applying differential uplifts), but it also means a shift away from funding programmes that focus on hospital activities, for example outpatients or A&E.
As well as changing financial allocations, a clear strategy is needed to help communities make this happen. It can’t happen ‘all at once’ and nor should it ‘never’ happen. Strategy needs to focus the attention at regional, ICB, organisational and place level on supporting neighbourhood development. It requires the alignment of narrative, finance, leadership, performance, assurance, quality, and risk. Strategic priorities of focusing on patient and staff experience via a developmental approach has the potential to deliver the activity changes that are desired to meet constitutional targets. This could happen now and can build over time towards the vision set out in the 10-year plan. At NAPC, we are getting behind this approach.
If you haven’t seen the film, it is worth a watch. In the NHS, the eventual aim is to realise the vision of a comprehensive, universal and accessible neighbourhood service. Whilst we work towards this we should be doing, ‘something, everywhere, now’. The film was very successful, at NAPC we are keen that neighbourhood health is even more so.
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