Last night was the first meeting of the ‘wider’ Health and Wellbeing Board for Wandsworth. And a bit of a milestone in the progress towards implementation of the government’s health service reforms. In fact yesterday was something of a health reform day for me, with a meeting in the afternoon between south-west London NHS sector, councils and primary care trusts in the afternoon.
I remain convinced that the Health and Social Care Bill present a magnificent opportunity, perhaps a once in a generation opportunity, to improve health care, and most importantly, the health of Wandsworth.
The move to GP commissioning has attracted the lion’s share of comment – and criticism – but to me this is a perfectly rational move, the GP is the one who knows most about the patient in front of them. And in practice the patient will see no difference – and nor will they care – if a GP refers them on, they get referred on. The commissioning process is neither here nor there to a patient concerned about getting better.
However, the most exciting changes are the move of public health to the council alongside the structural reforms that will help develop a much closer working relationship at all levels of health and social care provision.
The Director of Public Health gave a presentation on the health needs of the borough. What struck me most was how clearly the picture emerged that most health problems are not related to healthcare, but instead to lifestyle choices.
So on each indicator Wandsworth was scoring poorly it wasn’t down (in the most direct sense) to a council, GP or hospital letting people down, but their ‘decisions’ to smoke, drink too much, eat unhealthily or engage in risky behaviour.
This is the sort of area in which I feel my paternalistic and libertarian Conservatism traits clash. Part of me doesn’t mind if people smoke or drink, that’s their choice and – generally – it’s their health they are affecting. Indeed, morally it’s very hard for me to criticise anyone for bad lifestyle choices, in my past I smoked and drank far too much. And while I’ve avoided drugs, I can’t claim to have ever been troubled too much by healthy eating. If there is anything that puts me on the side of the angels it’s my attempt to undo some of the damage with slow trots around Battersea Park.
In the world of Nudge however, there probably needn’t be that conflict between libertarianism and authoritarianism. People are still able to make their own decisions, even if we think they might be the wrong ones. But we should make it easier to make the right ones and pushing them towards those choices where appropriate.
But even there, while I would argue the council is probably in a better position than the NHS to help people make those changes we still aren’t the best people. Those present from the voluntary sector were concerned that they were still not part of the process. Personally, I can see how we will be using them far more than we ever have, working at ground level to help bring about those small improvements that make a dramatic difference over months and years.
But, where we are, it’s hard to reassure them. We’re in the middle of reform and moving towards closer working between two very different cultures. We have the broad vision for where we want to be, but we don’t have lots of the detail filled in. I have my views, but it might not be the same as everyone else around the table (indeed, I might not even be there when the powers are formally transferred from the PCT to the council and GP consortia!)
It’s an exciting time. But however far advanced we think we are – and Wandsworth is further along the process than many, if not most, places – there is still a long way to go.
Where do you think we should be? Do you know any areas we make it ‘hard’ for people to do the right thing?