Abstract
Background: While the basic principles on which the NHS was founded remain the same, our society has shifted, our individual needs have changed, and technology has advanced.
Introduction: With 80-90% of good health coming from factors outside our health and care systems, they cannot be remote from the rest of our daily lives. Wider impacts on health must permeate other public planning and decision-making processes and we must act to radically rethink how we can all take responsibility to maintain our health and wellbeing and use our services most prudently.
The Bevan Commission, in collaboration with ARUP (global engineers), identified and explored five steps that capitalise on the current pace of change to create a more effective health and care ecosystem: a system which supports – and is supported by – our people, places, communities, economy, and environment.
Approach: Interviews were conducted with a broad spectrum of city leaders, health board leaders and private-sector stakeholders from across the valleys, rural and urban areas of Wales and covered two main subject areas:
- What challenges and opportunities are we facing?
- What could the future of health and care look like?
Results: Interview transcripts were analysed with responses categorised as follows:
Where are we now: Scale of the current health challenge, including lifestyle factors, staff wellbeing, and sustainability issues. Drivers of change including the climate emergency were explored and case studies identified.
The way forward: Five key ingredients to transform health and care in Wales:
- Consider people and place
- Invest in a preventative model
- Drive a culture-shift
- Change models: from medical to social (and from general hospitals to community-based health and care)
- Embrace technology to bring about change
A vision of a more prudent future health and care ecosystem that can be co-produced using a people and-place-based approach emerged.
Making it happen: At its heart, this model needs to be based on preventing people falling ill and, where possible, enabling them to manage their own well-being and based on a philosophy of continuous innovation and transformation, which challenges the conventions and barriers that exist locally and nationally.
This health-and-care-ecosystem approach recognises an innate relationship between factors that impact on health – including the environment, technological advances and the application of new research. It acknowledges a fundamental link between economic health and human health and the important part that people have to play in this.
Implications: Longer-term, we must see a shift in the roles of government, health leaders, city planners and policy makers. Better collaboration, cooperation and coordination across agencies, organisations and professional boundaries is essential to deliver an effective healthcare ecosystem.
A new approach to funding and policy that reconnects the mechanisms for shaping and improving places where people live, work and play, with measures to prevent ill-health.
The Bevan Commission is now working with Welsh Rugby Union, industry and the high street to develop and test new ways of thinking and planning to deliver more integrated facilities.