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What’s going on with our NHS?   Pt 2. What do we want? Yes – us!

What’s Going On With Our NHS? Pt 2. What Do We Want? Yes – Us!

What’s going on with our NHS? Pt 2. What do we want? Yes – us!

What we want from the NHS depends upon a multitude of things. Who we are, our beliefs, our health experiences, our political leanings, our age, social circumstances, gender, and so on. You and I may disagree, but that does not mean either of us is wrong. We are just different.

But how do we, as a society, make rational decisions about priorities within the service? Someone, somewhere, has to decide.

An illuminating exercise:

About 20 years ago I was invited to hold a series of seminars for GPs and other health service staff about setting appropriate priorities within the NHS.

I wanted to get across the point that the answer depends upon who you are. Obvious, you say. Yes, it may be; but the implications are enormous. Who sets the priorities? Because, whoever they are, their priorities will clash with those of other people and other groups. One group’s intensive care units for premature babies may be another’s support for the elderly at home.

I divided the audience into groups and asked each of these to go into a huddle and collectively role-play a discussion group deciding the priorities for their local services. They were told that the local health authority had to prioritise services, and was seeking their advice as representative groups within the community. Members of one group were to be hospital doctors, another health authority managers (you can see it was some time ago!), and a third, avid readers of The Daily Mail. The fourth were to be GPs, the fifth equally avid readers of The Mirror, and finally, there was a group from the local Diabetic Association. Clearly, the groups I chose were artificial but it made the point.

I gave the groups the same list of ten services, such as intensive care beds for premature babies, health visitors, hip replacements, infertility treatment, and psychiatric services – you get the idea. The exercise was to decide which three on the list would they increase in priority, and which four would they decrease? Nothing less; nothing more. They wrote out their priorities and handed them in.

And what happened?

It was a bit nerve-wracking because I could never be sure, as they dissolved into their roles with tremendous enthusiasm and commitment, that I wasn’t about to fall flat on my face! But the exercise worked out every single time I tried it. The resulting lists were never the same as each other.

So that is one of the difficulties. In this nationwide healthcare service that is all inclusive not only for people but also pathology, we want different things, and we think some things are far more important than others. It would be a stretch to deny that in matters of health, our personal experience influences our opinions.

Cynical consultative exercises:

Although consultative exercises sound right for this sort of thing, I am rather cynical about their effect, other than to place a tick in the box saying they have taken place. It is human nature to look for “evidence” that supports our own preconceptions. As an example, at the moment I am thinking of buying a new car. Although still diligently researching the market I think I know already which I want. I find I am actively seeking reviews that support my decision and, preferably, rubbish the other ones on my short list. That makes the decision easier. Maybe you are familiar with this human trait.

Although consultative exercises sound right for this sort of thing, I am rather cynical about their effect, other than to place a tick in the box saying they have taken place. It is human nature to look for “evidence” that supports our own preconceptions. As an example, at the moment I am thinking of buying a new car. Although still diligently researching the market I think I know already which I want. I find I am actively seeking reviews that support my decision and, preferably, rubbish the other ones on my short list. That makes the decision easier. Maybe you are familiar with this human trait.

And if we are experts, seeking the opinions of others who we see as less expert, then this predisposition can be very hard to resist. The result of some “consultation programmes” is pretty much bolted down before the exercise even starts. But they did ask; it was a collective decision. Tick.

Conclusion:

What is the message here? We have disparate views on NHS priorities, even as collectives. But someone has to decide the direction of travel. The greatest power lies with the government. My next post will look at what governments want for the NHS.

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