The Big Society and the NHS

Our conference this year opened with a look at what ‘the Big Society’ might mean for health care, with presentations by Phillip Blond (Director, ResPublica) and Geoff Mulgan (Chief Executive, The Young Foundation).

Phillip Blond opened his talk by looking at some of the more general ideas behind the notion of a ‘Big Society’.  According to Blond, the notion of the Big Society responded to two problems in British society: first, the ‘capture of every good’ (e.g. wealth, power, status) by an ‘elite’; second, the fragmentation of civic society and the dissolution of normal social bonds between individuals.

The former problem, he claimed, was evidenced through the increasing ‘concentration of assets’, both political and economic, in the hands of fewer and fewer people. The latter, through decreasing levels of civic engagement and volunteering, and the rise in one-person households.

The Big Society countered these concerns by envisaging a world in which wealth and power is shared more equally and devolved locally. In the Big Society, therefore, service-providers would be owned by local communities and mutuals, and businesses would have both social and economic missions.

In relation to the provision of health care services, this meant building ‘a greater sense of personal and shared responsibility’ rather than necessarily turning to the state.

As Blond explained, ‘we need to think about the “mass micro”, that is, ‘encouraging a range of different social and health enterprises, often by the patients themselves, which together can provide the transformative context which doctors and the Health Service cannot provide by themselves’.

One illustration he gave was KeyRing, in Wrexham, where a project about community allotments had allowed people to develop relationships in conjunction with support workers and carers. For Blond, the success of these sorts of projects showed how the Big Society was a ‘necessary condition’ of delivering transformative health care in the 21st century.

Geoff Mulgan, agreed with much of Blond’s argument, yet he was also keen to stress the extent to which the NHS already reflected the ideals of the ‘Big Society’. After all, the NHS has always been made up of thousands of small businesses, like GP practices and pharmacists, and it has always depended on the work of hundreds of thousands of volunteers, not to mention six or seven million carers.

In this sense, for Mulgan, the Big Society had already ‘delivered’ in health care. Looking to the future, therefore, is not about pushing forward a purely patient-based or clinician-based model of care, rather it is about building on the best ‘hybrid’ models already at work.

A critical component of this, Mulgan explained, would be to further develop the ‘ecology’ of knowledge in health care. The question for the policy-makers over the next few decades in health care would be how to combine empowered patients, a growing body of knowledge about what that patient might do for themselves, and a greater understanding about what might be done for them, by a hospital, a doctor, a provider and so on.

Hence, one of the jobs a ‘Big Society’ approach to health care would be to create a system whereby different actors had access to the best, most reliable, most meaningful knowledge at all the different points of the system, ‘from the diabetic waking up in the morning, to the child wanting to look after their parent with early onset dementia’.

In Mulgan’s view, twenty or thirty years from now, it would be this challenge that would be dominating policy talk, as much as talk about money and tariffs and incentives is today.