Reflections on the Cumberland Health and Care Summit
Research Manager and Head of Health
Last Thursday, I went up to (the extremely pretty) Cumbria to attend the Cumberland Health and Care Summit. Rather than many Westminster conferences full of policy wonks, this was specifically a conference for decision makers within the NHS in Cumberland. This included a wide variety of people: various decision makers from the Integrated Care Board (ICB), nurses, innovators within the NHS and public health, accountants within the council, and many others.
I enjoyed this conference because it was so practical and specific. Save me from sitting in another conference hall where people nod sagely at a panellist generically saying “we just need to break down silos".
Because each of these people had a job to do and a service to deliver, the presentations and discussions on all the tables were about what they could do and change tomorrow, rather than what policymakers in Westminster need to do.
I had three major takeaways from my day:
1) I have never been more confident that devolution of healthcare is the right thing to do.
The presentation I delivered was on the future challenges for the NHS. And, crucially, the presentation that followed mine took these challenges and translated them into a specific Cumberland context. For a start, they have a much more ageing population than the national average. Their healthy life expectancy is declining more than the national average. And yet the idea that they would be beholden to a wide range of national targets that are not tailored at all to this specific context is both inefficient and ineffective, as we explored in Close enough to care.
And it’s not just about the ability to tailor services. Another benefit of devolution is system innovation. That is, smaller systems are easier to innovate. Much of the benefit from innovation comes from localised service redesign, and this is much easier to do at a smaller scale. They can more quickly and flexibly adapt their approach than larger organisations. There were two extremely compelling presentations, one on tech innovation in social care, and another on public health interventions in the Greater Manchester Combined Authority. Both of these were highly impactful, would be almost impossible to scale nationally but are straightforward to implement locally, as was abundantly clear from the presentations.
2) But delivering this at a local level is much more about human relationships than I would have guessed.
With this said, at both a local and national level, the NHS is a confusing institutional landscape. It is made up of a tonne of disparate, interdependent organisations and services with often overlapping remits. This means that delivering services effectively often comes down to the relationships held between organisations at every level — whether that’s the senior people commissioning services or those delivering them. You just need to talk to one person working in a hospital to know that they think a lot of their problems are due to problems in social care, for example.
In every single conversation I had, somebody would mention how their work was ultimately contingent on another team, whether that be in the trust, the ICB, or the local authority. And it was openly discussed in the conference how these relationships needed to be improved. It was clear that, universally, people saw this as a very tangible obstacle to the delivery of their work. I interpreted this as both a cultural and strategic problem. It is at its core a human and political problem. It is no secret that egos and territorialism play a role in local NHS decision making, particularly in the never-ending dominance of acute care. But there are ways of balancing out dominant voices — such as empowering local authorities more in ICBs — that are perhaps underestimated.
3) The NHS is still a long way off from navigating short term firefighting versus long-term vision.
It is the perennial problem in the NHS. How to tackle short term issues, such as the backlogs, while also meeting the long-term vision to improve the health of the country. In the policy world, everyone talks about prevention as if it's a given that everyone agrees with it. And the logic behind prevention is fairly agreeable. But I always realise when I speak to people on the ground that the idea of focusing on anything other than the immediate short term issues is somewhat alien.
For many of the people working in the NHS, it is not actually their job to deliver or think about the long-term vision, so of course they want to do their job — meeting short term need — as effectively as possible. The issues they deal with every single day naturally feature in their mind as the ultimate priority because if they didn’t deal with them people might die.
There are also decision makers who do have to deal with the long term thinking. But if, at a local level, the only people you speak to are the ones delivering the service, you too would become captured by short term demands. We did discuss briefly how these two aims are not actually always in tension, and you can have both evolution and revolution at the same time. But it involves doing the thinking — allocating the time and resource — for both simultaneously and this doesn’t always happen.
All in all, I had a great day. Meeting people that actually work in the services on the ground makes for significantly more impassioned and detailed conversations about the reality of the health and care system. I think anything that gives these people more power to do what they clearly know how to do very well — and much better than central decision makers in Westminster — can only be a good thing.