Thursday 11 April 2013

How to save public services

I have a feeling that history will see these years in the UK rather differently to the way we see them now.

We imagine that austerity will dominate the history books.  In fact, I have a feeling that the real issue will turn out to be something different - it is whether or not we grasp the urgency of the need to save our public services, the NHS and the rest of the caboodle.

In that sense, the present round of cuts are barely relevant compared to what is coming - not just here but in most western countries.  What with Barnet's Graph of Doom and the various Wanless Reports warning about the future of the NHS, the clues have been there for some time.  Demand is rising so fast, costs are rising so fast, and the last decade or so have equipped our services with a series of reforms so expensive and sclerotic that they may kill the patient.

And at the same time, the economy is going to carry on struggling, as the focus of the world shifts eastwards.

It is extraordinary, given this scenario, just how tame the debate is.  The right just wants to privatise, when profits are going to be pretty scarce, and anyway rather begs the key question.  The left just wants to go back to 1945, to what is arguably the original flawed design that has led us here - the disempowering idea that grateful passive consumers have their needs attended to by busy professionals.

Where is the real debate we need if we are going to protect the kind of society that looks after itself?

I found myself wondering this on Tuesday when I spent much of the day at the very impressive NESTA seminar on People-Powered Health, the not-quite-final hurrah of their ambitious project to apply the ideas behind 'co-production' to long-term conditions - the most expensive, least successful aspect of NHS work.

The central message is that we have missed the critical untapped resource - the users of the system, their families and neighbours.

Conventional thinking suggests that this approach - from peer support to co-delivery - is fraught with dangers and compromise.  Actual experience, as described in a series of films which the People-Powered Health team made, is that it can be transformative, changing the power balance between people and professionals.

Part of the problem is that politicians and policy-makers regard the public as pretty apathetic.  When it comes to sitting on committees - which politicians regard as the highest form of existence - they may be right.  But there is a huge untapped demand from patients and service users to use their time and human skills to help other people, as long as it is in some way mutual.

It would be glib to say this is the only way out of the coming crisis, but it is an absolutely vital part of the jigsaw.  The trouble is that there is what one speaker called a "huge coalition of inertia" when it comes to rolling out change.

But I did find out one absolutely vital piece of information at NESTA.  Their calculations, based on a range of studies, is that People-Powered Health along these lines will cut NHS costs by at least 7 per cent and maybe up to a fifth.  Even 7 per cent comes to £4.4 billion.


Anonymous said...

There has been a siesimic shift since the 1970's in connection with increased intervention of the state in private lives. There has been an enactment of laws to give power to social workers and health professionals to intervene in family life on no more than mere suspicion, without factual evidence, to support damning indictments of perfectly normal and innocent families.

The inexorable growth in the hypocrisy that is 'safeguarding' (to which read witch hunt), with the 'outings' of persistent abuses / neglect of the vulnerable by state institutions purporting to protect them, has started to grip the public- thanks to a few persistent media journalists.

Never will government manage the large scale public support needed to encourage large scale family assistance to look after family members in need to a preventive degree.

The current scenario of coercion and control by the state of fallible human beings will increasingly be the deterrent. Most behaviours are common, to varying degrees, to the majority of people / families and mostly not criminal or with criminal intent, yet often treated as such.

Many will not want to risk false accusations of abuse of neglect etc., on top of the huge stress of supporting or caring for a loved one when ones own financial and physical resources are depleted. There is only so much that people can take without breaking down.

Expect more people to be 'dumped' on the state system , (e.g. bed use by elderly people). There have been cases where elderly people were abandoned at the hospital door. Children too may come to be more often abandoned, if not abused or neglected.

Government cannot have it every which way. Life is not perfect, even in caring and loving families who are not without, often hidden, problems. The policing of family life of the less elite or fortunate will have social consequences. The derision / distrust with which social workers (and MP's) are increasingly held by the public is a reflection of how the public see life in this country. And you expect co-production to take off? Dream on; small pilots do not reflect what would happen on a larger scale. The health 'expert programmes' have shown to be of limited value at national level. as they engage largely those already the most motivated.

David Boyle said...

Thanks so much for writing. I completely agree with you about the so-called safeguarding regime and the way it is used to undermine children. But I don't agree, needless to say, about co-production. When it is tried on any scale, there is a huge response from people - 17,000 health champions in Yorkshire alone. It works if and only if it shifts the power relations in public services which, as you say, are currently stuck in a counter-productive imbalance.