Fellow-led insights: How to move social models of health into the mainstream

At the RSA’s Health and Wellbeing Fellowship Panel, we saw glimpses of what a place characterised by widespread social action for health would look like. If a new social contract with the NHS was created in order for this shift to be sustainable, how would we ensure it worked within an increasingly pressurised system?

With the RSA’s convening power and our 28,000 strong Fellowship we have the opportunity to push forward social models of health and stimulate heightened awareness of these approaches like no other institution. We called together an expert panel to help us explore how we diffuse knowledge and existing practice to a wider audience, in order to influence the tendency of institutions, movements and people to implement social models of health at scale.

There is no poverty of talent in the RSA Fellowship and our panel was no different. Fellows that have been involved in pursuing a social model of health before - and those new to the approach - highlighted the opportunities that come in times of crisis, as innovation responds to the necessity of doing things differently.

We live in a tense time, characterised by a resource driven environment that in a health context has made the move towards a social model of health a necessity. However, Fellows stressed this shift should not be solely about saving money, but about a better way of delivering care that suits the needs of patients, as advocated by NHS England’s Anu Singh at a recent RSA event.

At the RSA we’re interested in behavioural hurdles and systemic barriers, and Fellows can provide unique insights into blockers to a wider spread and scale of social models of health. Fellows emphasised the way that a predisposition to seek academic and short-term financial evaluation slows innovation and the ability to take risks at a time when the health service feels under threat.

We need to move beyond adherence to academic evaluation of cost and impact and a predilection for interventions that can demonstrate linearity; and we need leaders who are willing to give away power to those around them, whilst being a driving force for change.

Fellows argued that the system in its current form does not provide the space to identify and cultivate this type of leadership. Those in positions of power often find it difficult shift budgets towards prevention work as they are accountable to treatment and cure outcomes. This led to two key questions:

• How can institutions engage with and facilitate changes of approach without trying to manage the process?
• How do you operate in the informal world when you’re trained in an institutionalised and formal world?

Our video from the Health as a Social Movement event in September gives some examples of where this is happening already in the UK. Valuing the capacities of those working on the frontline and trusting in their ability to create problem solving networks in their communities is a powerful way to affect change in our health system.

So where do we have to look to for hope? We can look to Holland, where propelled by the Buurtzorg movement of self-managing networks of community nurses the nation is adopting a model that has demonstrated considerable successes, particularly in the impact of nursing capability and self-management in delivering better patient care as well as significant cost savings.

By inviting health and social care staff across the UK to embrace taking more responsibility in their roles, can we experience a similar ground up revolution? The logic goes that if those at the top of the hierarchy will only transfer these responsibilities with caveats, the power has fundamentally not been transferred at all.

Fundamentally changing the way we view health care requires a new approach to the way all stakeholders interact with one another, and a focus on the importance of reciprocity in our interactions. In the coming months we will be working to imagine what this place might look like, and how we might most effectively work together to reach a place where this vision may become a reality.

There are stories already emanating from both within and from outside the vanguard network of the benefits communities are experiencing through pursuing a social model of health, but we’d like to hear more – please send us your case studies of best practice from around the country – women’s health groups running peer-to-peer support groups or diabetes suffers setting up walking or cooking groups, so we can better understand the ways in which the health service can empower and support people into staying well.