We don’t want a transactional NHS – so what do we want?

Maybe because it’s NHS Confederation Conference week, there have been several really thought-provoking articles making the rounds right now about the challenges faced by the NHS. Since it’s on everyone’s minds, here’s our take, which is from Hilary Cottam’s Relational Welfare.

Our welfare state, and by extension our NHS, is facing some fundamental challenges. Firstly, there is a mismatch between the services on offer and the needs of the population. Challenges such as ageing, chronic disease and the scale of entrenched inequality were not foreseen in 1942. For example, today, one in five Britons has a chronic disease – problems such as diabetes, asthma, obesity and heart conditions – that medical interventions cannot cure. A health service designed in the 1950s as a centralised, industrial system to distribute drugs and combat the prevalent infectious diseases of the day (usually in hospitals) is struggling to cope.

No-one is to blame for this. As citizens, we believe in the NHS and the medical profession and look upwards for help. Keen to provide that help, the institutions and professionals who work within them medicalise or reformulate the problem, offering us statins for our heart, insulin for our diabetes and operations when all else fails. The costs are exponential: 80 per cent of hospital costs are now associated with chronic disease. Yet our health rarely if ever improves.

photo-2With 80 per cent of the nation’s health problems lying beyond the effective reach of a medical model, the answer cannot be further reform of the existing institutions. Both preventing and living with these conditions requires motivation, lifestyle change and, in the later stages, palliative care. All of these are best addressed locally, in the home, the workplace and the community. However, the re-structuring of the health service around a model of GP commissioning offers only a mechanism for re-ordering the NHS and ostensibly achieving financial efficiency. What this and previous reforms (the reduction in waiting times, the re-building of hospitals, the introduction of consumer choice) do not do is focus on the heart of the problem: how can we support a healthy nation.

These issues, if not explicitly debated by politicians, have not gone unnoticed by them, but the reforms on offer – the introduction of quasi-markets and the private sector under Labour, and an intensification of this strategy accompanied by fast and draconian cuts under the Coalition – have to date rarely improved outcomes, and have often made things worse. Most importantly, this activity and accompanying innovation has taken place within a 1950s paradigm: in other words, the mass, industrial model of service delivery and centralised bureaucracy has not been fundamentally questioned, as evidenced by the vision of the Lean Toyota health model, rather than an alternative socially based one.

The social and cultural effect of the market reforms has been to intensify a transactional relationship, when what is actually wanted is something more human, caring and time rich.

-Hilary Cottam


Want to hear our solution? Read about how we can move from an industrial, transactional system to a more human, caring one in the essay from which this post was excerpted. You can also take a look at Wellogram, a service we’re testing out that provides real life human support for people with long term conditions within the NHS. 

The enemies of compassion (and how to defeat them)

Over the weekend, we attended a seminar with American philosopher Martha Nussbaum. We went because she inspired our thinking about capabilities, but it turned out that she wanted to talk about something entirely different: compassion. Continue reading The enemies of compassion (and how to defeat them)