Published: 11 June 2020
Authors: Professor Sir Chris Ham


The emergence of COVID-19 has challenged many assumptions about the health and care system. Digital technologies have been embraced as an alternative to face to face consultations, staff have worked flexibly with many practising to the top of their license, and more support has been provided in people’s homes to avoid use of hospitals for vulnerable patients.

One of the most profound lessons has been understanding that tackling COVID-19 is everyone’s business. Staff working in the formal health and care system of course have a vital contribution to make but so do the people and communities who have been affected. Measures like hand washing and social distancing have helped slow the spread of the virus in the community and are tangible examples of what can be achieved when all our assets are used.

As the NHS embarks on reset and recovery, there is an understandable desire to sustain and extend new ways of working. That same desire must be harnessed to support people and communities to play their part both in avoiding a resurgence of COVID-19 and in other areas of health and care. Now is the time to embrace the ‘fully engaged’ scenario described by Derek Wanless in 2002 by involving communities and patients in improving health and wellbeing.

The Wigan Deal is an example of meaningful community involvement in one area of England. The deal has emerged through dialogue between Wigan Council and residents in which the emphasis has been placed on listening and responding to residents’ concerns. The Wigan deal for health and wellness sets out what the Council and its NHS partners will do and the contribution that every resident can make, including to lead a healthy lifestyle and make use of leisure facilities.

Across England, partnership with patients is at the heart of shared decision making where patients and clinicians work together to improve outcomes. Many patients have also found benefits in supported self-management in the form of the Expert Patients Programme and similar initiatives. Peer support and education involving online networks, group-based peer sessions and peer tutor programmes are another means of enabling patients to take greater control of their health.

These and other examples illustrate the value of what I’ve referred to as ‘shared responsibility’ for health and wellbeing. Shared responsibility is not to be confused with personal responsibility which places the onus on people to ‘look after themselves’ and ‘use services responsibly’. It is also different from social responsibility which sees government as taking the lead in tackling the wider determinants of health and wellbeing.

Shared responsibility depends on people being supported to make choices conducive to health, recognising that this is much easier for some than others. It challenges over dependence on health and care professionals by seeing people as agents in the therapeutic relationship. This matters for everyone, especially people with long term medical conditions like diabetes whose choices about diet, exercise and the use of medications have a major impact on their health.

My thinking on shared responsibility has been shaped by Hilary Cottam’s wonderful book, Radical Help, which makes a powerful and persuasive case for rethinking how public services are planned and delivered. Cottam argues for a shift in emphasis from supporting people when things go wrong to developing people’s capabilities to live healthily and connect to one another. This means listening to what matters to people and working with them to find more effective ways of helping everyone to fulfil their potential.

Reset and recovery must continue the journey of transforming relationships with people and communities while sustaining new ways of working. Wigan has demonstrated that this is possible when public sector leaders are willing to think and act differently. The NHS should do the same.