Asking the right question: prospects for a people-powered NHS? - RSA

Asking the right question: prospects for a people-powered NHS?

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  • Drug & alcohol recovery
  • Health & wellbeing

Last Tuesday we pulled together a group of Fellows, on-the-ground practitioners and experts to discuss public health in the context of being people-powered; something that we’ve been exploring for a while. Three speakers set the scene: Susie Pascoe, Head of Whole Person Recovery at the RSA, explored what we’ve done to create a service based around the needs of users and service providers on the ground; Charlotte Alldritt, Director of Public Services and Communities, explained some of the work she’s doing with data as well as an introduction to our area of work.

Finally, Roger Taylor FRSA, Co-Founder of Dr Forster and Author of God Bless the NHS, highlighted three areas challenging health at the moment: Unreliability in the system; lack of patient-centricity; and the unsustainability of the current financial model – and outlined how people-powered health can begin to challenge some of these.

Each table of Fellows and invited experts then put their collective heads together to discuss their concerns, opinions and experiences in health and wellbeing, and came up with some key questions or comments:

‘People-powered’ raises more questions than it answers as a term. It implies that people either aren’t in control of their health at the moment, or that it makes people more than fairly responsible for things they shouldn't have to be responsible for – and doesn’t explain how people-powered breaks down on different levels: individual, family, community, state

There’s a clash between localism and the national standards which are intended to prevent a postcode lottery. If – hypothetically – East Sussex prioritised healthcare based on its slightly older population, would that mean that swathes of younger people move to somewhere where they’re more likely to get the care they and their young families need?

Limiting healthcare to the NHS restricts the quality of discussion and interventions. There were perceptions from the tables that the NHS is primarily for intervention, whereas healthcare fit for a 21st Century is far more focused on prevention – and relies on a cross-collaborative method of care and wellbeing – health is about more than fixing an ill person.

Delivery of healthcare is often challenged through how the system works - including how people work, how empowered they feel to work, and the command/control culture. People-powered health could be the ability of practitioners to engage much more immediately with more autonomy with people who are within the system or at the start of the system.

People view public services now through a consumerist eye, so expect to get something much more tailored to their needs. This poses a problem in the healthcare sector: we're all individuals but we all use the same services (albeit in different ways) – so how do we get an individual system that can be scaled up or delivered en masse?

How does a system dependent on data work when people are nervous of handing over their data? Some of the best models rely on quite intricate levels of data – either self-reported or tracked in other ways. If it’s self-reported, how can doctors rely on it as evidence? There’s a lack of clarity whether people definitely want to be a part of this big data revolution or not – and more evidence needed of a robust and well-worked system.

(As an aside, on the topic of data my colleague Charlotte has been doing work analysing public services data that’s well worth a read.)

In conclusion, asking the right question is critically important. In this case, what became very apparent was that the health isn’t limited to the NHS, and people felt that people power might be the solution to particular problems – but to avoid it being a catch all for the entire domain of health at large.

Next steps...

We are keen to build on the momentum generated from the meeting. There are a number of ways that you can stay involved:

Connect with Fellows- Create your online profile, Find like-minded fellows and Engage with projects in your area.

Be part of a project- Develop a new project, help with an existing one and propose new partners or potential funders by getting in touch.

Be inspired- Read the RSA Journal, submit an opinion piece to RSA Comment or join the discussion on our RSA blogs.

If you're not already an RSA Fellow and you support our mission of 21st century enlightenment, find out more about joining us.

Joanna is Project Engagement Manager, working to connect Fellows with the RSA’s research in Public Services and CommunitiesEmail her or follow her on Twitter at@joannacmassie


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  • Some of the innovations we've seen via NHS GATHER have delivered step change improvements simply by re-allocating healthcare delivery roles in non-traditional ways.  This can be challenging to certain people in the system - particularly, it seems, some senior clinicians - but the results are often startling.  For example, in one case study 50 out of 52 patients with chronic conditions who were previously hospitalized for 6-12 months at a time were able to return home, with only positive care outcomes and (of course) both improved quality of life and significant financial savings (such beds cost close on £2000/day).  The problem is that implementing such innovations is highly complex and involves sensitive, structured, long-term collaboration across a range of disciplines.  Not everyone is capable of planning, organizing and pushing through such transformations - but some people are, their approaches can be replicated, and the NHS needs to learn from them.  "Reinvent the NHS, not the wheel"!  To me, this is people power at its most effective, since copying is itself a form of learning, and has the potential to create a new generation that takes change in their stride.

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