On September 29th, The King’s Fund released an in-depth analysis outlining seven key priorities for the NHS to address health inequalities. These disparities have long existed, predating the establishment of the national health system. Unfortunately, recent challenges such as the global pandemic and the cost-of-living crisis have only intensified these inequalities.
Based on their extensive review, The King’s Fund has identified the following seven priorities for the upcoming 10-year health plan:
Develop a cross-government health inequalities strategy for the 10-year health plan to feed into.
Reorientate the NHS to focus on prevention.
Radically change the relationships the NHS has with people and communities, from ‘power over’ to ‘power with.’
Tackle racism and discrimination in the NHS and cultivate a culture of compassion.
Enable staff to identify and act on health inequalities and capture learning.
Empower place-based partnerships to take more decisions about how NHS money is spent.
Actively support local voluntary, community, and social enterprise (VCSE) organisations through changes in financial planning and commissioning.
Some of these seven points echo the findings of the Darzi report, published in September 2024. Following its release, we at Akumen shared our insights on how we can contribute to addressing the innovation opportunities highlighted in that report (refer to our previous blog post). In light of the latest priorities outlined by The King’s Fund, we would like to offer our thoughts on a few of these key areas.
Point 2 - Reorientate the NHS to Focus on Prevention
Our Thoughts on This Point:
Suicide Prevention: We believe that focusing on suicide prevention is crucial. Suicide remains a significant issue that needs urgent attention. For more details on why we are passionate about this cause, please refer to our previous posts. Currently, we are not learning enough from past suicides in England and Wales. By analysing coroners’ reports, we can identify patterns and themes that indicate where changes are needed to prevent future suicides. We have the technology to do this and are excited to launch a pilot project this month to begin this important work.
Expanding Our Approach: Once we demonstrate the value of analysing coroners’ reports for suicide prevention, we aim to apply this method to other preventable deaths, such as those involving drugs and alcohol. Additionally, we want to explore the impact of domestic violence. Our goal is to prevent as many deaths as possible, reducing the pain and suffering caused by preventable deaths. Even preventing one death would be a significant achievement, but we aspire to achieve much more.
Point 3 - Radically Change the Relationships the NHS Has with People and Communities, from ‘Power Over’ to ‘Power With’
Our Thoughts on This Point:
Asking the Right Questions: To understand what communities want and need, it is essential to ask the right questions in the right way. Instead of relying on Likert scales and NPS-style questions, which often fail to uncover the underlying reasons, we should focus on analysing the lived experiences of real people. Over a decade of analysing lived experiences has shown us that the best insights come from questions that encourage honest and detailed sharing.
Closing the Feedback Loop: It is crucial to inform people about the outcomes of their feedback. If individuals take the time to share their experiences, the least we can do is share what has/will change as a result. This prevents valuable data from disappearing into an “engagement black hole” and fosters a relationship where people feel valued and are more likely to contribute in the future.
Fair Compensation: When inviting people to participate in events that require them to share their experiences, it is important to compensate them for their time and any costs incurred. While the NIHR and NHS have guidelines on this, remuneration is often overlooked. Ensuring fair compensation is a key aspect of respectful and equitable engagement.
Meeting People Where They Are: Engagement should be made easy and accessible. Instead of expecting people to come to us, we should take the engagement opportunities to them, within their communities and familiar environments. Building long-term relationships with community and voluntary groups, rather than just transactional ones, is essential for meaningful and sustained engagement.
Point 4 - Tackle Racism and Discrimination in the NHS and Cultivate a Culture of Compassion
Our Thoughts on This Point:
Continuous Listening: This aligns with our earlier point about asking the right questions at the right time. The NHS needs to adopt a model of continuous listening to effectively measure employee and patient experiences. Creating workplace environments where psychological safety is present is crucial. Without this, closed cultures and subpar organisational practices can become the norm, negatively impacting both staff well-being and patient safety. Conversely, understanding and replicating areas where psychological safety and organisational excellence exist can help spread positive practices across the NHS.
Psychological Safety as the Norm: Psychological safety must become the standard. Currently, the CQC does not measure culture within its five domains, which is a significant oversight. This gap is frequently highlighted in inquiries into systemic failures, such as the Shanley report, which noted that the CQC’s methods were not sensitive enough to detect closed cultures.
Accountability and Change: We were encouraged by Wes Streeting’s statement before the election, where he emphasized that NHS managers who silence whistle blowers would be removed and barred from working in the NHS again. This is a critical priority for the system. However, a significant issue is that those deciding on the technology and methods for measuring employee experience may be the same individuals contributing to a closed culture. There needs to be a fundamental change in how experience in healthcare is measured, and we believe we have the solution to address this challenge.
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