SECOND OPINION
ers to the NHS, or part-time NHS special- ists who spend the other part of their time in private practice. Are vested interests try- ing to trump patient’s freedoms?
It’s also worth noting that this resistance is set against a background of changing at- titudes and what should be in the heart of every caring professional: virtues of kind- ness, gentleness, hope and professional- ism. There are many outstanding individu- als who work in healthcare, but reports of indifference, neglect and shoddy care are increasing. ‘Internal’ NHS changes in training and expectations have combined with the ‘external’ cultural trends of self- centeredness and transience to undermine the commitment, grace and discipline that good care requires. Whilst outside the in- fl uence of legislation, there are many ways in which these virtues can be encouraged and shaped.
The recent interest in mutuals, social en- terprises and partnerships has been both because of the sense of ownership and belonging to the organisation that they inculcate, and the control over standards and attitude of service they give to staff. Likewise, the increased emphasis on the importance of the patient’s experience and those ‘un-measurable patient care mo- ments’ that make the world of difference
to the recipient. Kindness matters. As the new Commissioning Groups form, NHS Foundation Trusts expand and new pro- viders emerge, much of their success will depend not on their centrally described internal structures but on the local leader- ship qualities and whether they engender a sense of belonging, control, confi dence and community in the staff.
But despite the rhetoric of experience and ‘no decision about me’, the role of the indi- vidual is still weak. There is still no real in- centive for the individual to engage in their healthcare. It is not only possible but the usual experience that we are ‘done to’ by the health service. The root of the problem isn’t information, or transparency, though these are important. It is that there is no incentive or opportunity for the individual to take control of their health and health- care. We can’t shop around, many people are totally cavalier about the costs of care that they demand and we have little real choice over who delivers or arranges that care. Unless we change the dynamics and connect every individual patient with the reality of their basic health costs (not emer- gency) with incentives to remain healthy, those at the centre can burn themselves out trying to control demand whilst simultane- ously stoking our expectations, but it will end in another round of covert rationing,
vested interests raising their voices, some acrimony and a reorganisation.
We talk of contracts in the NHS, implying the minimum that should be undertaken by a supplier, but we need to move to a dialogue of ‘covenant’. To be successful, healthcare requires the covenant attitude encouraging dignity and tacit promises on all sides, more than can be written on paper. It requires the honest to be protected, the vulnerable to be safeguarded and the public to be communi- tarian. After all the rhetoric, power actually needs to be placed in the hands of the in- dividual through meaningful, total personal budgets, genuine choice and effi cient and informative electronic health transactions. We can’t always control our health, but by taking authority for our choices, we re- new the relationship and balance between the cared for and carer in a way that is healthier for the whole of society.
Julia Manning
FOR MORE INFORMATION The themes of this article are explored further in a forthcoming chapter, ‘A healthier Society’, to be published as part of a policy review in October 2011.
Julia Manning sits on NHE’s editorial board. national health executive Jul/Aug 11 | 17
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