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“How can we take the pressure off health and social care?”  This was the question posed to a panel of professionals by the Lunar 21 discussion group on April 3rd, 2017. The original Lunar Society was a group of 18th Century Midlands’ friends and business men – engineers, factory owners, entrepreneurs – who met to share ideas, always on an evening near the full moon so they would be more able to find their way home afterwards. Lunar 21 is a revival of that spirit, open to members of the public who want to meet, hear and ask questions that shed light on Derby’s place in the 21st Century. Graham Bennett, an architect by profession, painstakingly recruited and briefed the panel, made up of a CCG chair, a hospital clinical director, a former chief executive of two NHS trusts, a journalist, and me, representing social care. Graham opened the discussion, introduced the panel and skilfully chaired the meeting so that many people attending had their say.

Asked whether the productivity of health services could be improved if the expertise of industry were brought to bear on the NHS, the general view was that the benefits of managerialism had largely been realised by now; the NHS has been transformed into a lean machine. However, the budget needed to meet all its targets is simply not available; there is simply a need for more cash. While the speakers and audience largely agreed on this, the mantra that nobody ever votes to increase taxes was invoked. From a different perspective, clinicians on the panel pointed out that continually-rising expectations of the NHS need to be restrained.  It’s not the panacea for all of society’s ills, and we therefore were asked to reflect on what is the main purpose of health and social care. By implication, then, what should not be within the remit of the NHS? We were reminded by the journalist that happiness is not well correlated with healthcare expenditure, and that rates of happiness are in fact higher in some countries, including Italy and Spain, where less is spent on healthcare than in the UK.

Healthy lifestyle came up as a contributory factor to conserving limited resources for healthcare, as the room was full of obviously well-preserved baby boomers. There was also recognition that young people - in particular those from disadvantaged backgrounds, and even primary school children, need to be educated to take responsibility for their own emotional and physical health. Supporting older people with dementia is another way that families clearly save the NHS and social care budgets.

Therefore, the support of families for their members, education of young people and healthy personal lifestyles were all endorsed as means to take the pressure off the NHS. To this rather familiar refrain a community organiser added a fourth less well-understood mechanism: community development to improve health.  This ‘asset-based’ approach has particular appeal in areas like Derby where there is ethnic diversity and considerable health inequality. How are community organisations already contributing to the welfare and health of the population?  Members of religious groups, sports and leisure clubs, civic organisations and the like already promote trust and wellbeing through their activities. These organisations may also provide a platform for building health literacy and for health promotion interventions. How much more could they do?  The answers to these questions could be good news for a cash-strapped health service.