Do we have a clear vision of what constitutes success for the NHS?
Our goal for health needs to change.We need to move away from the notion that health is the absence of disease or infirmity to something that is much more about complete health.
A friend was experiencing periods of feeling low and despondent, which he had never felt before in his entire life. He went to see his GP, who he did not know as he had hardly ever visited the surgery. After some discussion, the GP decided that a blood test should be carried out "to see if anything shows up’.
When, after some time, my friend had heard nothing he rang the surgery and asked for the results. After protracted negotiations with the receptionist, he was finally able to extract his blood test results which were normal. ‘The GP says you do not need to see her again,’ reported the receptionist.
So was the NHS successful? No. The GP wanted confirmation of the absence of physical disease, and has received it. But my friend wanted help and his GP has not helped. My friend remains no further forward than when he started.
As we look forward, do we have a clear vision of what constitutes success for the NHS? Well, according to the executive summary of the recently published Five Year Forward View, we do.
It states that, ‘There is now quite broad consensus on what a better future should be’ (p3) for the NHS. This is ‘to provide the comprehensive and high quality care the people of England clearly want’ (p5).
But while the Five Year Forward View is sensible in tackling the problems that exist in the service today, it does not provide clarity on what success looks like.
If anything it is framed as a mechanism for sustaining and improving the NHS over the next five years (protecting what we have in an environment of austerity).
It talks about gaps that will emerge if nothing is done: the health and wellbeing gap; the care and quality gap; and the funding and efficiency gap.
According to some, we do not in fact have a positive vision of the future. This is a view clearly articulated by Nic Marks, a Fellow of the New Economics Foundation, in his publication, ‘The Happiness Manifesto’.
The problem, according to Marks, is that we frame the issue in terms of fear: fear of what we can’t afford; fear of the impact of an ageing population; fear that we will no longer be able to provide services free at the point of need to everyone.
Marks says that we need to move to an understanding of health as, ‘complete physical, mental and social wellbeing’. He believes we need a stronger focus on mental health, and on thinking about the social and psychological aspects of how patients are treated.
Figures published today show that more than 41,000 people working in the NHS had time off for stress and depression in 2014.
My friend still has times when he feels low and despondent, and does not know where to go to get help. If the GP won’t help you where do you go? I work in the NHS and, honestly, I do not know what to tell him.
We are not set up to look after the problems my friend faces. It is no longer good enough to discount physical disease and send someone on their way. We need to put aside our fear of losing what we have, and focus on the needs of individuals as people and on understanding what good health means in the 21st century.
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