NHS: Health Improvements

Lord Mawson Excerpts

Wednesday 26th November 2014 Grand Committee

[Lord Mawson (CB)]

My Lords, I thank the noble Lord, Lord Kakkar, for introducing this important debate. I will focus my remarks on innovation in the primary care setting.

The report Creating Change: Innovation, Health and Wealth One Year On, published in December 2012, makes two references to community. The first was the procurement community and the second was the research community, and therein, I suggest, is the fundamental problem.

If you look at how primary care is being run in developing countries, you will find a clue to what works and what is cost-effective. They do not send in professional teams at great expense to change the behaviour of patients. They invest in informal networks, particularly among women, because that is how you get the key programmes running at the front edge. In this country we seem determined to professionalise everything. Instead of creating relationships, networks and local gossip, we churn out papers and reports.

I have made these opening remarks because my conversations with the senior consultant at Barts and the London, who is responsible for working on our national diabetes crisis, tells me that his department is already overwhelmed by the scale of the health problem and that the only real solution to it lies in the community.

An impending epidemic of diabetes faces this country. It has already arrived in east London. It is not because people are ill but because they have unhealthy lifestyles. To address this challenge we genuinely need everyone working together in the local community: the school, the health centre, the pharmacy, businesses, the voluntary sector and local parents. This is where innovation is needed, yet we turn to the procurement community and research community. The message for patients is, “Health is not something I own; it is something that professionals do to me”.

At the moment there are lots of projects that try to join up service delivery and connect with the community, but the delivery of actual programmes affected does not change very much because often the professionals say that they cannot afford the overhead of the meetings needed to discuss the programmes, so people revert to type. Thus innovation and change become stifled. We need people collaborating on practical projects—“learning by doing”—but doing things in a significantly different way.

Let me share a practical example of what I mean. I declare an interest as the director of the St Paul’s Way Transformation Project. Seven years ago I was asked to intervene in a group of deprived housing estates in Tower Hamlets by the then CEO of Tower Hamlets council, Christine Gilbert, and the CEO of the local health service. A young man had been murdered and another set on fire, and there was serious concern across the public sector and beyond. Despite the many years of successive Governments talking about joined-up thinking and the need for integration, I found a failing secondary school with 1,000 pupils, the GP practice next door injecting 11,000 patients with dead vaccines stored in a cheap domestic fridge, and the excellent pharmacist across the road, a respected member of the community, being ignored by public bodies. Everybody was operating in silos and basic human relationships between the key leaders in health and education were not in place. No one was investing in any joined-up thinking, let alone action, and little innovation was taking place.

Six years later, by bringing the key leaders together and building relationships between them, we have a rather different situation. The new, recently opened £40 million school, to which only 35 families applied five years ago and which was one of the bottom 10 schools in the country, had 1,200 families apply this year. Six months ago Ofsted rated the school outstanding in every regard. Across the road from the school, the local social housing company has built a new £16 million health centre, with the agreement of the then PCT, in a campus development. The plan is that this will open shortly with a team of new GPs, working alongside a diabetes DNA research laboratory run by the school and Queen Mary University of London. The students at the school will be researching the causes of diabetes in the 11,000 patients, many of whom are extended family members.

The first phase of 500 new mixed-tenure homes has been built, alongside a new community services centre. Support from JPMorgan Chase, just a few hundred metres to the south, is now enabling pupils at the school to start their own businesses. Our patron Professor Brian Cox and I have just run a very successful third science summer school, addressing the issue, “You are what you eat”. This year the science summer school brought together 30 schools in east London.

How did we do it in six years? At its core, it was about establishing relationships between the key leaders responsible for the local health service, education and housing and getting them to communicate with resident leaders and to be entrepreneurial. The result is a piece of innovation that is now generating further innovations in health, education and housing. We are all learning by doing things together. This is where innovation and integration start. None of these individual activities alone will solve the diabetes crisis in east London but, by combining our shared efforts and resources over a period of time, we will change behaviour patterns and patients will start to see themselves as responsible for their own health.

Innovative, integrated programmes like this are the exception rather than the rule. Why is this? Negotiations on securing the integrated health centre that I mentioned have dragged on for seven years, through one NHS structure after another. Jeremy Hunt helpfully assured me in the summer that we were nearly there, yet minutes before I came into this Committee I was unexpectedly phoned by the chairman of the housing company that is bearing all of the costs and was told that she, a very experienced businesswoman, had had enough—today, yet again, another group of civil servants asked to renegotiate the lease.

Bernadette Conroy is a former colleague of the noble Lord, Lord Green, and a senior person who used to work at HSBC. She has now given the NHS 24 hours to come up with a decision rather than prevarication, or she will walk away and this opportunity at the frontier of health innovation will fall. I ask if the Minister can help. We have been on the case for seven years and we are all becoming exasperated.

Innovation in the health service is a very challenging business. When you are operating at a new frontier, you need friends and leadership that grasps the opportunity when it arrives. The opportunity for innovation in health has now arrived at St Paul’s Way in Tower Hamlets. I ask for a helping hand from the NHS.