Keith Harrison-Broninski: time to focus on wellness, not illness

Keith Harrison-Broninski identifies the focus on illness, rather the promotion of wellness, as the flaw at the heart of the NHS.

As health trusts warn that NHS services face an “impossible” budget crisis, it is surely time to cut the Gordian knot.  What is the systemic problem facing healthcare?

Today we have two complementary services, in which 1.6 million NHS staff take the front line while 5,000 Public Health England staff try to reduce the scale of the problem.  Together they form a National Illness Service that is fighting a health war, and although prevention is at the forefront of everyone’s mind it’s being handled tactically rather than strategically.  Is a 10 minute GP appointment enough to address the complex issues of even a healthy old age?  Are services set up to prevent and cure disease the right way to handle the frequent flyers of A&E and the medically unexplained symptoms that cost £3 billion every year (£50 for every adult and child)?

The root of the problem is a focus on illness.  The term “wellbeing” has been adopted by the medical community as a shorthand for disease prevention, but “wellness” is more than eating well, moving more, and stopping smoking.  It also means participating in culture, staying safe, meeting people, lifelong learning, getting around, managing money, and addressing other lifestyle matters.  We should each be part of a local support network in which we give as well as take.  Building wellness is a challenge not only to communities, which must create grass roots infrastructure, but also to government, for whom the return on investment will be to take the war against illness from hot to cold.

Every village, town, city, and region has assets – places, spaces, groups, services, and activities organised by and for local people – that can make an overwhelming difference to local wellness.   However, many communities have a crisis of confidence.  They don’t recognise their assets or know how to realise their value.

Productive collaboration

The solution is to develop productive collaboration between the different stakeholders in community assets.

First there are providers of services, organisations and individuals from all sectors who can contribute to local wellness.  They need to publish activities, services, and events to community members, and seek participation.

Then there are health professionals.  Clinicians need to refer patients to community assets as well as to medical pathways.  They may refer patients to a mentoring team, which not only helps curate, develop, and promote community assets but also works with community members to help them create personal “wellness plans”.

As a community member, your wellness plan captures how you manage life issues.  You use it to self-assess for depression and anxiety.  You record your “personal network” of family, friends, neighbours, carers, clinicians, therapists and mentors.  You choose community assets, indicating how they help you – feedback that helps providers improve and promote their services.  You share your wellness plan with key people from your personal network so that they understand how you cope, and can follow your journey.

The final relationship required to make community assets effective is to give commissioners, funders, and community leaders from all sectors information about asset effectiveness and the ability to address gaps and overlaps​.  This completes the virtuous circle, empowering communities to measure and hence to manage its own wellness holistically.

These relationships can be enabled by creating a network of community level digital hubs, often alongside real world physical hubs, which bring together the different stakeholders in a structured way that supports service delivery, enables measurement, and empowers positive change.

For the true challenge is not financial at all.  In 2014 the Chief Economist of the Bank of England released figures showing that the total amount of volunteering in the UK is equivalent to 10% of all paid hours worked, which has an economic and social value of at least £100 billion per year and, taking multipliers into account, possibly 10 times that.  What we need to heal is our divided society.  Government must help communities fractured by the immense social and technological change of the last 50 years to leverage the primordial human instinct to help each other.

About the author

Keith Harrison-Broninski is a keynote speaker, author whose books include “Human Interactions” (2005), and leader of the Town Digital Hub project.  Sponsored by the Royal Society of Arts, Birmingham South Central CCG, and Frome Town Council, Town Digital Hub is a free social prescribing Web solution that has been commissioned by communities from rural towns to inner cities.  For more information see