Fit for the Future: Good Conversation, Fine Words – Now Show Us the Follow-Up

 

Fit for the Future: Good Conversation, Fine Words – Now Show Us the Follow-Up

I recently attended a public workshop looking at the NHS “Fit for the Future” programme being developed across Sandwell, West Birmingham and Dudley.

I went along with a fairly healthy dose of scepticism.

Not because I am against change. Far from it.

But anyone who has spent any length of time dealing with public bodies will know that we are never short of strategies, visions, engagement exercises, colourful diagrams and phrases such as transformation, co-production, community first and working together.

The real test usually comes a few months later when you ask:

“So what actually happened?”

On this occasion, however, I have to say that I came away from the meeting feeling reasonably positive.

There were some good round-table conversations. People were encouraged to speak openly. There were different views and experiences around the tables, and I did get the impression that those leading the event were genuinely interested in hearing them.

That is a good start.

But it is only a start.

So what on earth is “Fit for the Future”?

Let us strip away the NHS management language.

In simple terms, the NHS wants to change how and where more of our healthcare is delivered over the next few years.

Nationally, the Government's 10-Year Health Plan is based around three big changes:

Hospital to community – providing more care closer to where people live rather than automatically sending everyone into hospital.

Analogue to digital – making greater use of the NHS App, online services, shared digital records, remote monitoring and technology.

Sickness to prevention – trying to identify risks and illness earlier instead of waiting until somebody becomes seriously unwell.

Locally, Sandwell and West Birmingham NHS Trust and The Dudley Group NHS Foundation Trust have built their own Fit for the Future strategy for 2026–2031 around those principles.

The model being presented is basically:

Healthy neighbourhoods – helping people stay healthier for longer.

Then:

Community First – more care and support in people's homes and local communities.

Then:

Planned Care Hubs – local centres providing appointments, tests, outpatient services and planned treatment.

With:

Two acute hospitals – Midland Metropolitan University Hospital and Russells Hall Hospital concentrating more on specialist, complex and emergency care.

Put simply, the ambition is that fewer people should have to go into a major hospital when their care could safely be provided somewhere closer to home.

On the face of it, there is plenty to like.

Who genuinely wants to travel miles, find somewhere to park, sit in a hospital waiting room and travel home again if the same quality of service could safely be provided locally?

Who would argue against diagnosing illness earlier?

Who would object to the NHS, councils, GPs, social care and voluntary organisations actually talking to one another instead of sending patients from pillar to post?

Not me.

But there is a very important “however”

This is not just a friendly little health and wellbeing project.

Fit for the Future could fundamentally change where and how many of us receive NHS care.

It potentially affects:

where outpatient appointments take place;

which services remain in hospitals;

what is provided through community hubs;

how much care takes place in people's homes;

how much responsibility is placed on patients and families;

how heavily the NHS relies on digital systems;

how NHS buildings are used;

where staff work;

and how money is divided between hospital and community services.

So this matters.

And it matters to everyone.

You may not think an NHS strategy has anything to do with you today.

You may think differently when your next outpatient appointment is moved.

Or when you are told that your follow-up will now be online.

Or when an elderly relative is discharged home earlier because care is supposedly available in the community.

Or when a service previously delivered locally is provided somewhere else.

That is exactly why people need to engage now, while these new ways of working are being shaped.

What have local people already said?

One of the handouts we were given drew together messages gathered through previous World Cafés, People Panels, Guided by You events and other community conversations.

And, to be honest, local people seem to be talking a great deal of common sense.

They have said:

People and relationships matter.

Start with what is strong in our communities.

Help people find support.

Support should feel local.

Work with communities, not for them.

Prevention matters.

And:

Places matter too.

That last one is particularly important.

Our health is not simply determined by what happens when we walk through the doors of a hospital.

Housing matters.

Poverty matters.

Employment matters.

Community safety matters.

Mental health matters.

Isolation and loneliness matter.

Green spaces matter.

Community venues matter.

Having somewhere safe to walk, meet people and feel connected matters.

All of these things contribute to whether people remain healthy or eventually arrive at the NHS door needing treatment.

So I welcome the fact that the conversation is beginning to look beyond hospitals.

“Work with communities, not for them”

For me, that is probably the most important phrase in all of the material we were given.

Work with communities, not for them.

Excellent.

Now let us see it happen.

Because we have all seen engagement exercises before.

People give up their time.

They attend meetings.

They share often very personal experiences.

They fill in forms.

They write on Post-it notes.

They put coloured dots on boards.

Everyone has a cup of tea.

A report is produced.

Then...

Silence.

Until somebody launches another consultation asking many of the same questions twelve months later.

That cannot happen here.

There has already been considerable engagement through World Cafés, People Panels, community conversations and now Fit for the Future workshops.

At some point, we need to move from:

“We are listening.”

to:

“This is what you told us and this is what changed because of it.”

What I would like to see next

For me, the follow-up should be incredibly simple.

Every workshop should eventually produce something along the lines of:

What You Said

What We Heard

What We Are Going To Do

Who Is Responsible

When It Will Happen

What Eventually Happened

And where something cannot be done?

Tell us.

Where an idea is unrealistic?

Explain why.

Where something needs more investigation?

Tell us who is looking at it and when we will hear back.

People are adults.

We do not expect every suggestion made around a table to suddenly become NHS policy.

But we should expect to know that it was considered.

That is the difference between meaningful engagement and simply collecting comments.

Community First must mean something

There is one area where I remain particularly watchful.

The phrase “Community First” sounds excellent.

But it needs investment behind it.

Moving services out of hospital only works if the services waiting for people in the community are actually there.

That means staff.

Buildings.

Equipment.

Transport.

Social care.

District nursing.

GP capacity.

Mental health support.

Voluntary and community organisations.

And proper funding.

Otherwise, there is a danger that:

“Care closer to home”

gradually becomes:

“Care removed from hospital and good luck when you get home.”

That is not transformation.

That is cost shifting.

So, while I support the principle of more care being delivered locally, I will continue to ask one very simple question:

Will the community services be properly funded, staffed and operating before hospital services are reduced or moved?

That is where the detail matters.

Digital must not mean digital only

The same applies to the move from analogue to digital.

Technology can make accessing healthcare much easier for millions of people.

Wonderful.

Use it.

But there must always be a proper alternative for those who cannot.

Not everybody has a smartphone.

Not everyone understands apps.

Not everybody can navigate online forms.

Some people have disabilities.

Some have learning difficulties.

Some struggle with literacy.

Some simply want to speak to another human being.

Progress should make healthcare more accessible, not create a new digital obstacle course.

So, was the meeting worthwhile?

Yes.

I think it was.

There were some very good discussions and some interesting ideas.

I also met people around the tables who clearly care deeply about improving health and wellbeing across our communities.

I came away more encouraged than perhaps I expected to.

And I am happy to say that.

We should criticise when things go wrong, but we should equally acknowledge when something feels constructive.

The NHS faces enormous challenges.

Demand continues to grow.

People are living longer with increasingly complex health conditions.

Waiting lists remain a concern.

Staff are under pressure.

Money is tight.

Doing exactly what we have always done probably is not an option.

Change is coming.

The important question is whether communities help shape that change—or simply have it done to them.

Now comes the real test

The presentations have been delivered.

The round-table conversations have taken place.

People have spoken.

People have listened.

Now comes the important bit.

What happens next?

I want to see the feedback.

I want to see the action list.

I want to see who is responsible.

I want to see timescales.

And I want the NHS to come back to the same communities and tell us what happened.

Because Fit for the Future will not ultimately be judged by the quality of its PowerPoint slides, its logos or how many engagement events were held.

It will be judged by something much simpler.

Can people get the care they need?

Can they get it safely?

Can they get it locally where appropriate?

Can they access it fairly?

Are vulnerable people protected?

And did the people who use our NHS genuinely have a voice in shaping it?

I left the meeting feeling positive.

But I will also be watching what comes next.

Because listening is the easy bit.

Being seen to listen is even easier.

The real proof will be showing us that our voices actually made a difference.

And perhaps the NHS should keep one of its own messages firmly in mind as Fit for the Future moves forward:

Work with communities. Not for them.

Now let's see it happen.

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