All our work on meeting need, reducing demand, spending national £s more wisely to improve care, involves collaborating with people and communities. There are warning signs in the NHS Long Term Plan that these vital lessons are being ignored. The NHS’ previous Vision (Five Year Forward View) took a more asset based approach to people who own, pay for and use health services. But the ‘old world is biting back’ – the best indicator of this is in the Plan’s section on social prescribing, where the investment is going into ‘link workers’ not developing local community solutions with local people. Our experience with colleagues such as Altogether Better, and our colleagues in Leeds Social Care is that people in communities have the assets to help each other and help themselves, and that the best thing we can do is help professionals learn how to collaborate with communities. Our models of doing this keep reverting to a dependency model or one where a person’s own assets are distorted by an intermediary. However I decided to ask a good friend and colleague for another view.
David Boyle is working with us on ‘The Asset Based Health Inquiry’ to give us his views. He sees a role for link people to enable professionals and ‘patients’ to navigate the wider landscape of support, and this is what he had to say.
I have always been a little sceptical about the idea of professional choice ‘navigators’ in the NHS. I had decided, when I was working on the issue of choice at the Cabinet Office in 2012/13 that they would not survive the next round of cuts.
So I was surprised this week, when I got referred to secondary care, to find myself calling up some professional choice navigators, part of the choose-and-book infrastructure of choice that still exists from the ancien regime.
It was good to have someone to help me choose, but they didn’t sound terribly pleased to hear from me as a patient. Nor, of course, could they actually give me any advice.
I have not changed my views: paid link people, navigators or signposters are uniquely vulnerable in periods of austerity. There used to be navigators in the education system, but they have long since disappeared, most of them. This is certainly the second incarnation of the idea in the NHS.
So what are we to make of the NHS Long Term Plan’s enthusiasm for professional link people, about which they say this:
“1.40. As part of this work, through social prescribing the range of support available to people will widen, diversify and become accessible across the country. Link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then.”
I humbly suggest that this may be another example of over-professionalisation. You do need some skills to be a navigator, but they are mainly people skills. You need some knowledge too, but not professional knowledge. I see no reason why these should not be volunteer roles, trained up from among those who started perhaps as health champions or expert patients, and who yearn for a new challenge but who can’t, for whatever reason – age, illness, disability – go back to paid employment.
Link people to help doctors and patients navigate the resources of the voluntary sector are pretty vital, but we hardly need to wait until 2023 to organise this in GP practices. We could start training them now, without requiring permission from NHS England to do so, and without carving such a chunk of badly needed money out of our overstretched budgets (though clearly some money will be required). I hope we do.
In my view the ‘link worker’ model never the intent of social prescribing (although as many of you know – my views are that the battle for the change in relationships and power was lost at the point at which the asset based approach became ‘prescribing’ putting it firmly in the old world language of the medical model). Cormac Russel has seen this coming as the NHS swallows up a collaborative asset based process into a professionalised top down deficit approach in his blog . Becky
David Boyle is an acclaimed author and Visiting Fellow at our Health Systems Innovation Lab at London South Bank University. He is the Co-director of the New Weather Think Tank. You can find more about him here