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  1. Richard Hazledine permalink
    April 26, 2017 10:52

    Hi Mark

    A very interesting read as usual.

    For me the sentence that speaks loudest was your challenge re:

    ‘Bringing the outside world and the lived experience of inequality into the Sustainability and Transformation Plans’.

    From what I can see the current mainstream health care system really struggles to do this. The evidence would seem to indicate this is a deep and entrenched issue affecting organisational and professional culture in health care.

    I would be speculating as to the reasons why this situation exists but would suspect much of this is about power, fear, and misunderstanding. There is probably an underlying tension around loss of control by involving outside, unknown influences in a climate of austerity – self-protection is a basic human instinct that could be at work here. Although I have never accessed a clinically related degree course I am concerned that concepts like ‘lived experience of inequality’ and ‘coproduction’ or ‘patient focus groups’ etc probably do not significantly feature in course content – if at all. If this is the case then surely this is another contributory factor to the culture that currently exists.

    If any service provider or body responsible for influencing public service design is not willing to get close to the consumers of the service then the chances of coming up with dysfunctional solutions are surely increased? This seems to be a blight affecting much public provision in the current climate. I see parallels between the situation in health in the employability arena too – and its interesting that we now even have an evidence based film which has been released on this issue ‘I Daniel Blake’ is an interesting watch. Perhaps there is too much of a ‘command and control’ dynamic at work – there is lots of ‘top down’ developments taking place but a paucity of real lived experience filtering back up into the system as you’ve highlighted.

    Might be wrong in certain areas – but these are some of the wider issues I suspect are at play here.

    Concerning times.

    Kind regards

    Richard Hazledine

    • April 26, 2017 17:44

      Cheers Richard – a thoughtful response – I particularly like your point about “There is probably an underlying tension around loss of control by involving outside, unknown influences in a climate of austerity”. Best Mark

  2. Hilton Mayston permalink
    April 26, 2017 13:26

    Clearly if appropriate patient participation was taking place the deficits in engagement wouldn’t exist. Sadly it is the closed shop mentality that maintains the disconnect.

  3. April 26, 2017 17:45

    Thanks Hilton – agree – a stronger public voice would really help address some of these deficits. Mark

  4. Linda Tully permalink
    April 28, 2017 20:55

    Hi Mark,
    As always, enjoyed reading your article.
    Your opening comment “technically right and so very wrong” nails it. We know that Service improvement, health inequality and financial pressures have been on the health agenda for years, so nothing new there. The three aims are of course interdependent. Therefore the “drift” (is that too generous a description?) to achieving economies becomes all consuming. It must be possible to achieve all three objectives by addressing the root cause of the problem rather than ignoring (at worse) or sticking an Elastoplast (at best) on vulnerable groups. Your two suggestions would seem very well placed to address this.
    Best wishes – Linda

    • May 1, 2017 16:27

      Thanks Linda – always good to hear from you – I think you have pitched this just right! All the best – Mark

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