The nhs needs people power to really make a difference to the big problems, like care for older people and mental illness. Communities around the UK have already risen to the challenge but the NHS needs to hand over more power.
On the April 1 we saw the watershed re-organisation of the NHS as the government's plan for the NHS Shifting the Balance of Power took effect. The 99 health authorities and 481 primary care groups covering the country were abolished and replaced with 302 primary care trusts which will provide or commission services from access to GPs to hospital operations and ambulance services as well as 28 new strategic health authorities which will monitor the new set-up.
In 1997 Primary Care Groups controlled 15 per cent of NHS budgets - in two years time, PCTs will control 75 per cent. The new Primary Care Trusts are expected to deliver quickly on meeting centrally directed targets, especially on cutting waiting times as well as helping to make the health service more transparent so that tax payers can see directly what difference their money is making.
It's a tall order with many PCTs starting with budget deficits and all of them having to deal with new systems and a new set up in what seems to be yet another NHS re-organisation.
But the change is promising for what it could deliver - health services that really make a difference by responding to community needs and involving people closely in the design and delivery of local services. At the New Economics Foundation, we are very excited by this promise and have undertaken a survey of existing health care initiatives to find out what challenges and opportunities exist for making Shifting the Balance of Power a reality.
Our report, Putting Life Back into our Health Services: Public Involvement and Health was launched in April, just as the new changes came into effect.
The starting point of the report is our experience with the successful "Time Bank" based at the Rushey Green Group Practice in south London, a scheme which encourages mutual volunteering among patients and which extends the services the centre can offer to friendly visiting, lifts, befriending and basic DIY.
But while this pilot has been successful - reducing the amount people call on the GP, for example - we wanted to find other successful examples of people getting involved in local health services and helping to improve both their own health and the well being of the community in the process.
What we found was truly inspiring: pioneering projects from all across the UK showing that where you involve people, at every level, you can have a dramatic effect on recovery, on budgets and on the really intractable problems of public health - like teenage pregnancy, ethnic minority health inequalities and mental illness.
We found hopeless estates with high rates of child abuse and teenage pregnancy, like the Beacon and Old Hill estate in Falmouth, have been turned around by residents working with the support of dedicated health visitors.
We found peer education programmes, reaching young people, young parents, black people and people with mental health needs - groups who have a very poor take-up of mainstream health services - by training lay people as the experts and supporting them to work with their own friends and relatives.
We found villages and towns, where instead of prescribing drugs for people's ills, GPs were looking at alternatives - exercise, social prescribing - putting people in touch with community groups that can help as well as each other.
Disappointingly, we found little corresponding evidence of the NHS handing over power to patients - especially when it came to making decisions about how to spend the money. And, just as importantly, we found few examples of staff and health workers feeling sufficiently valued and involved themselves.
Our report highlights some of the ways, we believe Primary Care Trusts can start to really put the life back into our health services.
To begin with, they need to start experimenting to find how far it is possible hand budgetary control over to local patients, and other lay-led management, so that patients can be encouraged to set the local health agenda, rather than simply participate in projects that are handed down by professionals or administrators.
In particular the report shows that:
Feedback from patients and potential patients - as well as from the various professional groups - is absolutely vital if health services are going to be planned efficiently. Self-management of health by patients can cut costs and reduce visits. Other forms of volunteering and mutual support can do the same. Mutual support among patients - from time banks to self-help training in exercising or healthy eating, or among diabetics or asthmatics - can often have a dramatic effect on people's health, and can be far cheaper than conventional drug therapies by themselves. Health targets need to be simplified and redefined so that they encourage rather than exclude participation, and so that local people can increasingly be trained to appraise health achievements and local health needs themselves. Health professionals need to be trained in the purpose and techniques of participation as part of their undergraduate and postgraduate degrees, and at other levels of training.
Carol was suffering from depression after she got divorced and her mother died - but she loves to sing and dance. Carol's psychologist suggested the time bank as a way for her to make friends and get out of the house. Her first job for the time bank was to visit an elderly lady, living across the road, who has a visual impairment.
Looking after the old lady gave Carol a reason to get up in the mornings. She is now a regular befriender and entertainer for the time bank and "spends" her credits getting small DIY jobs done around her home.
Most recently she has been able to use the time bank to get a lift to visit her eldest son who is in care: "I've been involved in the time bank right from the beginning, but when I got sick myself I was able to call on the time bank for help - it was then I realised what the scheme really meant to me."
mahmoud came to this country as a refugee and got a job as a bus driver. However he suffered a nervous breakdown and was referred to the time bank by his GP.
Mahmoud helps people with their gardens and joined the DIY team because he liked practical work. Recently he was awarded a refurbished computer as a reward for the many hours he has contributed to the scheme. In return, he has got help with filling in forms and writing letters as well as the opportunity to share meals with others in the time bank.
Mahmoud's mental health worker was surprised that he has become such a reliable and enthusiastic participant in the time bank - she had been unable to get him to attend a mental health drop in. The reason why the time bank works for Mahmoud is that he participates in the scheme because of the things he can do - not because of what he needs.
