Comment: Looking after the NHS is quite a challenge

Picture: TSPL
Picture: TSPL
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HEALTHCARE system needs nurturing and developing to improve well-being, writes Audrey Birt

We can be in little doubt of the pressure on our health and social care and support systems. The fact that we share those pressures with other western health systems is no comfort to the people whose lives this impacts on, or the politicians who are held to account every day for its shortcomings.

A recent book by Mark Britnell titled In Search of the Perfect Health System reflects on his vast experience in global healthcare systems. In it he concludes there is no one perfect system but many excellent examples to learn from. Our National Health Service stands out for its values and universality and unsurprisingly that’s why it has become such a political issue across the UK.

The challenge therefore to politicians, public service and third sector leaders is to transform the health and wellbeing of our citizens whilst securing the value base and healthcare for all that we as a nation rightly treasure. No-one pretends it’s easy or that any one person or organisation has all the answers. Recently the Health and Social Care Academy, based at the ALLIANCE, brought together leaders in Scotland to consider the ­question: “Creating wellbeing – What is needed to transform Scottish society so that all citizens are able to thrive?”

Those at the think-tank included public, third, voluntary and independent sectors leaders alongside people who use and offer health and social care services. There were also representatives of academia and wider public services like the police and fire service.

Inevitably it’s impossible to capture the richness of a discussion like this and indeed the coming together in this way to explore the deeper questions is also the part of the road to transformation; but on analysis five themes emerged. The themes are potentially standalone but more meaningfully they interconnect to create the right conditions for transformative change. The five themes are Courageous leadership, Nurture Transformation, Emphasise humanity, values and flourishing, Target Culture, Cede Power.

All of these themes were core throughout the discussion. Transformation to be real and sustainable takes time which a system of short term funding or a culture of quick results cannot create. The conditions also need to be right. If political systems and media focus on short term and arguably meaningless targets does that stifle innovation and improvement of the type we seek? The cultural change in this theme is not merely about systems and services but about how we engage as active partners in our health and wellbeing; both as individuals and in communities.

The need to emphasise humanity, values and a focus on flourishing for all within the systems of health and social care comes from the recognition that an unintended consequence of modern systems has been an undermining of the human side of care. Focussing on medicalisation of care too has diverted attention from what helps us flourish in our communities and for each of us as individuals. We need to relearn how to foster flourishing both internally and externally.

Ceding power has already started if we look at the personalisation and self-management movement for example but to transform it needs to go further and deeper so that power to effect change is with those who are able to enact it; in communities, in organisations and in ourselves. All of this takes courage and courageous leadership is perhaps the theme that underpins all of this. The word courage comes from the Latin word for heart “cor” and to do this work it will need leaders who are willing to take brave decisions, yes, but also those who will do it with their hearts.

Are the themes outlines here of themselves unique? Perhaps not – but the transformation will lie in taking the bold steps needed to enact them and that first step as always has to start each and every one of us.

• Audrey Birt, Associate Director, Health and Social Care Alliance (the ALLIANCE)