The Rules of Engagement

I am increasingly concerned by the use of the word “customer” to describe people who use the NHS and social services. I hear it often in meetings and it is, in my opinion really dangerous. It is dangerous for 2 reasons: firstly, it assumes that people “buy” services, which they do not (because our services are not and must not become based upon ability to pay); and secondly it creates a very unhelpful understanding of how we expect people to behave in relation to their own health and the health service i.e. as consumers, rather than participants.

 

I heard recently about a practice in Columbus, Ohio, in which before beginning an operation, each member of the team: the patient, the surgeon, the anaesthetist the nurse, the ODA and the recovery nurse all stand in a circle and agree who is responsible for which bits of the healing process. It takes into account the ‘checklist’ idea of Atul Gawande and expands it further. Each person, including the patient (except in emergency settings when they are unconscious) have some responsibility to take for the healing that is about to ensue. It is vital that the patient themself understands that they have a key role to play in their own recovery.

 

If people think of themselves as the ‘customer’ or we think of them that way, we can all too easliy exclude them from taking an active part in their own health journey. The NHS is not a sweet shop or a passive experience in which you have things done to you – at least it shouldn’t be. Creating a ‘customer base’ is the antithesis of a social movement for health and wellbeing and we need to stop this really unhelpful language now!

 

There is a step-ladder approach to thinking about engagement and participation which is really helpful. I’m not exactly sure who first drew this, so can’t give credit where it is due:

 

 

We are actively producing and encouraging a society of passivity and consumerism and we need a sizmic shift in our thinking to create a totally different approach to how we think about our health and wellbeing.

 

If we think of, or encourage people to think of themselves as customers of our health and social care services (and this applies across the public sector, so this could equally be written about education, the cleanliness of our streets etc) then we assign people to the bottom two rungs of the ladder as victims and consumers. It is no wonder that we are facing some of the issues we are. It has created an incredibly unhelpful and unhealthy power dynamic and has caused an enormous strain on our services.

 

I’m not talking uncompassionately here. I know that many people have to live with long term conditions that can be utterly debilitating and difficult to cope with on a day to day basis. What I’m talking about here is how we respond to people who live with those complexities every day. We don’t have to treat them as victims, nor as consumers. Surely, we want people at least to be able to translate what their choices are – what’s possible for me or even what is in this for me? It would be one step better for people to be able to actively participate in their own care – this can be both active and reflective. But what about people being able to shape or co-produce the kind of care they would like to see and what might their role be in this?

 

Co-production calls for a double accountability. What is the responsibility of the person who has a certain condition and what is the response ability of the service to work with that person or group of people around that condition/situation? It is not for us to be taking power away from people. We have to learn to work differently and to work with people.

 

People using the NHS and Social Services are not customers and we must stop talking about them in this way. They are active participants in their own health and social needs, who should be able to shape and co-produce the kind of services we all need to improve our health and wellbeing. This kind of approach is vital if we want to see an end of the consumer mentality and an embracing of a greater sense of corporate responsibility.

 

That is why I am so passionate that we take our financial difficulties and conundrums out to community conversation. It is not for those of us in positions of power to make decisions on behalf of our communities, (even though this is our statutory responsibility) because if we do, we will only deepen the victim/consumer mentality. No, we must be honest, change our language, share our problems and engage together to recognise that the future of the NHS and Social Care belongs to us all and is our shared responsibility.

 

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Hosting Conversations That Matter

In my last blog, I was exploring how some of the biggest determinants of our health and wellbeing have very little to do with healthcare at all. They are societal issues, with huge implications on how we live together. Issues like poverty, homelessness, loneliness and adverse childhood experiences are far greater drivers of health inequalities and outcomes than many of the other things we spend an inordinate amount of time and energy focusing on.

However, it is only a social movement of people, willing to face up to and do something about these kind of injustices in our society that is going to bring about real and lasting change. Our old ways of operating, in which public servants try to find the answers and ‘do things’ to communities to ‘fix’ the problems simply are not working. The change we need is only going to come from the grass roots, when communities get together, ask difficult questions, give space for really important discussion and learn to forge new ways ahead in collaboration.

 

Do we know how to ask good questions? Do we know how to explore complex issues? Do we know how to create the kind of spaces in which we can have really important conversations about the future we might like to co-create together, a future based on values we hold dear, like love, trust and kindness? How much more healthy and well might we all be, if we found a new way of being together, based on collaboration and cooperation? People talk about a new politics – politics is in essence about how people live together, not about how decisions are made in government. A friend and colleague of mine, Ian Dewar, is helping to host a health festival in Lancaster in a few weeks time and he is calling it – ‘The Lost Art of Living’.

 

The team I work with are committed to training and creating a network of people who would like to co-steward spaces in which we could host these kind of really important conversations. Our hope is that everyone in our area is able to live life more fully, in the best possible health and wellness for them. Here is an example of a training we did in Morecambe in February:

 

 

Together, we are are sharpening our skills and using these techniques in a variety of ways to help build this social movement for change in our health and wellbeing. Here are some more ways we are using it:

 

 

We are creating a community of practice, unashamedly using these techniques to help shape the cultures of our own organisations and communities and hope to further spread this practice as a method of holding space for new ideas to emerge. Taking time to connect as human beings, asking good questions and using techniques that can really help explore the issues at hand can be truly transformational. the ‘Art of Hosting’ is not a social movement in and of itself, but it helps give the tools and prepare the ground in which one can emerge and flourish. If you live in the Bay, come and co-create with us……if you don’t why not be a catalyst for change where you are?

 

In the months ahead, we will be offering more training and hosting conversations such as: how do we raise happy, healthy children? How do we live well? How do we work well? How do we age well? How do we die with dignity? Come and be a part of this and let us shape a better future for everyone.

 

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