The NHS is open for business…

This week I’m looking at some very immediate lessons that health care needs to learn by acting differently during the crisis and then by carrying the lessons learned into the difficult and new ‘normalcy’ of the world beyond.

Monday’s post concerned the awful lessons the crisis is teaching us about long-term conditions. Today I want to return to the first post in this latest series (from March 30) and look at how the relationship between the public and the NHS has changed and at what needs to continue changing in the future.

The infection crisis has brought us many startling images on the daily news. For me the collective care that takes place when many staff slowly turn over a very sick incubated patient is one I will never forget. This juxtaposition of very close professional teamwork between different types of carers, and the intimate nature of the activity is a powerful metaphor for the very best of NHS care. It may have been going on for years but to me it looks very innovative.

Equally striking on last week’s news was hearing Simon Stevens say that the NHS is open for business. “If you are sick – please come and seek care”. I know the NHS is always open for business, but over the last few years messages to the public (especially over winter) have been more along the lines of think very hard before you ask for help. Don’t just come to A and E. The door has not so much been open as ajar.

Both messages – the more common one of think hard before you come, and the most recent of being “open for business” – illustrate the problematic relationship that the NHS has with the public. It’s something we need to use the crisis, and our recovery from it, to substantially improve.

This may sound like rather an odd thing to say. Surely, in April 2020, with all the weekly clapping of thanks, and the genuine and moving outpouring of heartfelt (and it really is from the heart) thanks from the public for the NHS you might reasonably ask, “How could that be improved?”

And I don’t think the public can be more grateful to the NHS. I am sure that if you asked them, they would pay much higher taxes for the NHS (forgoing some of their own money to improve both the organisation and the wages of its staff).

No, this relationship cannot be improved.

But the problem with other examples of such love – with parents or partners for example – is that sometimes it can infantilise one side of the relationship. I believe in you so much that I want you to look after me completely, I want to ‘lose myself in you’, I don’t want to have to “worry about anything because I know you will look after me “.

All of this is a very understandable part of some relationships. But (and I cringe when recalling some of my own feelings) this isn’t real. Once beyond infancy we have responsibilities that go beyond “losing ourselves in others”. However much love you give and receive they don’t go away.  And it’s that responsible relationship between the NHS and its public which we need to use this crisis to develop.

The NHS doesn’t need more love from the public. It needs an interdependent relationship where both partners – the NHS and the public – are grown up. Both the public and the NHS need to recognise what is and is not the NHS’s responsibility.

I have enjoyed the ways in which there is some recognition of this in the crisis. Seeing staff in scrubs holding up signs saying  “We go to work for you; you stay at home for us,” recognises some – albeit pretty limited – reciprocal action from the public.

Over the last few weeks, for a variety of reasons – some out of fear and some out of duty – the public have not been going to A and E in such large numbers. GP appointments – video, telephone or face to face have dropped off. Sometimes this is the right thing to do – but not if it results in people not coming forward with serious illnesses.

These unreported conditions demonstrate that we are clearly not in the right place now. But returning to the over-dependence on crammed GP waiting rooms and A & E that we had before the crisis, would not be the right place either.

So the public and the NHS need to reset their relationship. It isn’t right to depend on us the way you did before. But neither is it right not to depend on us when you are worried that you are seriously ill.

For this to work we need the public, with the help of their loved ones, the community and a bit from 111, to assist in doing some of their own diagnosis.

Over the last few weeks we’ve seen this working. The public have been told about dry cough, high fever, and bad pain. If you’ve only got one of those you may be OK. If you have 2 – get on to 111 and ask for advice. So at the early stage of the virus we have depended on the public to self-diagnose first, and then ask the NHS.

If we used and funded patient organisations to promote similar symptom lists and checks, we would greatly enhance public capacity to do initial self-diagnosis. A few years ago there was a successful campaign around possible lung cancer that warned if you had a bad cough for 3 weeks – to go and see primary care. (The archive has more on this).

This is where the NHS is now. It needs to encourage people who are ill to go and see them to get advice. But it also needs some public capability to carry out some small initial diagnosis.

Patient organisations are trusted brands. Use them to increase public capacity to carry out initial self-diagnosis. This might just get us to the position where the NHS is not just ‘open for business’ but is ‘open for the right business’. For that we need a less dependent and more capable public.