Health

Lord Mawson Excerpts

Thursday 26th November 2015 Lords Chamber

[Lord Mawson (CB)]

My Lords, our health is too important a matter to be left simply in the hands of doctors and health professionals; it belongs to all of us. We must all own our well-being. It no longer sits in a convenient government silo marked “Health Service”—by the way, it never has—but what does a health-creating society look like in practice; how do you turn these aspirations into practical realities on the ground, up and down this country; and how does the health service move on from its outdated silo approaches to health and make these aspirations real in local communities? Three words are used again and again in the Health and Social Care Act as the key hallmarks of a modern health service: innovation, integration and enterprise. But how do we make them real and why are there so few examples in the health service?

I have spoken frequently, in this House and elsewhere, about the 30 years I have spent in east London, establishing an entrepreneurial ecosystem built around the Bromley by Bow Centre, which today offers a fully integrated health centre, including traditional health services, yes, but also offering a wide range of employment and housing services, the opportunity to set up your own business and a wide range of artistic and creative projects, all at one point of entry. The centre today operates on 25 sites across Tower Hamlets and offers services to 36,000 patients across a network of four integrated health centres. We have also taken this experience and a built a street in St Paul’s Way in Tower Hamlets, bringing together a wide range of services and organisations, the details of which can be seen on my website and read about in Hansard—there is not really time to describe in detail what this has been about. There is a helpful Radio 4 feature on the website and the Minister may be interested to listen to it.

I should like to share, in the brief time I have, some of the lessons we have learnt over 30 years. Over the years, one of the most challenging and regular questions we have to answer at the Bromley by Bow Centre is how our model can be replicated. Put simply, trying to replicate something as complex and contextualised as the Bromley by Bow Centre is not possible. The reality is that the centre is a response to a series of deep-seated and complicated social conditions and has evolved over a long period, not by following a clearly established recipe but by trial and error and a great deal of experimentation. However, that process of experimentation has not, in itself, led us to the “right answer”, which can then be pinged out across the whole system so that something magical will happen.

On the contrary, one of the reasons for our success is the very process of experimentation itself and a whole range of diverse people co-creating a new way of doing things over an extended period. So it is in the design process that we have created the unique model that is Bromley by Bow and, of course, this has now also happened in St Paul’s Way in Tower Hamlets. Our work is now beginning to infect the developments on the Olympic Park. A better way to frame the question is in terms of translation, rather than replication. This is a much better question and leads to a much richer answer, which is significantly different in substance and content, not just in tone. There is a basic principle behind the Bromley by Bow Centre’s model, which is that you start small and grow things.

It is a basic business model. Yet in public and statutory systems, often driven by politicians, the desire is to start big. Politicians like big programmes. They like building 200 city academies across the country or more than 300 healthy living centres, which have, by the way, not withstood the test of time. Our belief is that inventing something small and growing it in context might be far more effective in the long term; it might deliver much more bespoke and locally relevant services and be far more cost-effective long term. Our thinking is not to start with the totality of the Bromley by Bow operation—its structures, systems, budgets and business plans—but to start with the small, subtle stuff that sometimes lies under the surface.

When you spend time with us, you very quickly begin to see that the most powerful influencers of our model are very simple human principles. We are talking about a range of features that are often overlooked when new services are being designed or are put into a neat box to one side and treated like they are the icing on the cake, when in fact they are the cake.

What kind of things am I talking about? Here are my top 10 to start with. The first is the quality of the human relationships and how people interact with each other. The internet is a very important tool, but it will never replace human relationships. The second is compassion, an inbuilt sense of caring between people. There is a close correlation here with the sense that we are here to serve. The third is generosity, the idea that giving freely to people creates a sense of self-worth for both the giver and the receiver. The fourth is mutual need, recognising that none of us is fully well and that we can share our humanity together and not be compromised as professionals. The fifth is positive design and environments creating spaces that engage and provide a sense of welcome or safety, like being at home. The sixth is blurring the boundaries, as services work best when they are not in silos. We all live complex and sometimes chaotic lives, so neat solutions do not always work. The seventh is long journeys, as we are committed to generational change. So many health services seem to be obsessed with moving people on or getting them out of the door, but we believe in sticking with people. The eighth is building in fun, which is often seen as having nothing to do with work. That is a very big mistake as it is essential for success. The ninth is having big expectations. The model is all about raising aspirations and encouraging everyone, staff and clients alike, to assume it is possible. The final thing is to let go, encourage freedom to innovate and provide resources for people to be entrepreneurial.

These key features of the Bromley by Bow Centre model absolutely lend themselves to translation; we have translated them elsewhere. Every health service organisation could grapple with these features and find ways of translating them into practical changes in their own contexts. It would not lead to replications of the Bromley by Bow Centre model, but it would lead to services being transformed by shifts in culture and values. Of course, none of this is really about money or resourcing; most of it is about attitude and behaviour. Will the Minister tell the House what priority the Government give to the principles I have set out for a health creating society and what in practice they are doing to encourage this cultural change? The Minister might like to visit the street the noble Lord, Lord Crisp, and I have mentioned and see these human principles in action for himself.