Who is the NHS really talking to?

The way in which we frame our relationships determines the outcomes we will achieve.

If we invite people to answer a question they will (because they want to be helpful) attempt to help us answer it. So, consultations on services usually come up with ways in which a service might be improved rather than question whether or not the service should exist in the first place, its relative importance or its relationship with others.

The NHS has a long tradition of framing its relationship with the public in a particular way and although the language may have changed along with government policy (patients, consumers, users etc) the focus has remained the same:

“we would like to talk to you about the health services we provide”

This framing usually leads to a rather distorted view of how NHS Patient and Public Involvement perceives us – citizens.

I think there are three ways of thinking about people:

• We live – work, play, have families, learn. pay taxes and so on
• We give – we contribute to civil society – we volunteer formally and informally
• We receive – we are recipients of services – in this case health services.

I think that the NHS tends to see us like this:

This perception pushes us into being less of a person – we are instead ‘a consumer’ or ‘a patient’ and both of these roles carry with them assumptions of passivity.  We receive healthcare and when our opinions are sought they are only understood to be valid within the context of our role as patients or consumers.

I think we are actually more like this:

Of course, when we become unwell the relative proportions of who we are may change – so we may be more of a patient (receiving) for a period of time.

Despite good intentions I think it is very hard for the NHS to break away from thinking in this sort of way. This leads to discussions which have increasingly diminishing returns as we try to use patient experience to help us improve services and efficiencies. This is because the discussion happens acontextually – not recognising the wider factors that impact on our lives, that have a greater effect on our health and wellbeing – employment, education, housing etc and our view of ourselves as more than a consumer or patient – a citizen.

We need to develop an ease in speaking about wellbeing if we are to move away from procuring services in silos. This means giving a greater focus to mental health and talking more about the social determinants of health.

I think that the continued survival of NHS services increasingly relies on us moving to a dialogue which is about us as citizens and our wellbeing, the alternative is a narrow consumer dialogue – promoted by this government in particular – which drives us more quickly to increased marketisation and privatisation.

What do you think?