(In what practical ways can we expand the capacity of the NHS to create better social solidarity?)
The last few days, in the run up to Christmas, we are seeing public behaviour more and more appearing to act as if there is no continuing threat from COVID-19 virus at all. Large numbers of people crowding together into Xmas markets has led to the closure of some. In December 2020 English people in are not behaving as if they are scared of close human interaction but as if COVID-19 is no longer a threat to them or society.
Commentators say that people are getting tired – after 9 months – of being careful. I can understand this explanation of getting tired and exhausted (we all are) but it is also the case that something you thought might kill you in April is clearly still able to kill you in December
In my last few posts I’ve been talking about how important a factor social solidarity has appeared to be for different society’s ability to combat the virus. Social solidarity sounds abstract and political, but in fact it is an explanation of one of the main sets of relationships that govern the detail of people’s behaviour, If people feel some responsibility that their behaviour will cause problems for others, they are more likely to change that behaviour. This doesn’t make them better or worse people, it means that they have a set of strong learnt experiences which impact on how they behave.
I’ve outlined how the NHS is one of the main institutions within English society that engenders feelings of social solidarity.
And it is true – but in a limited way.
The NHS is both a “we” and a “they”. It is a ‘we’ insofar as people really understand that we all pay for it and that it will look after us when we are sick. It’s a strong ‘we’ and people love it – as a ‘we’.
But it’s also a strong ‘they’. Those people who do all this difficult work; who are angels and who have all the medical knowledge are not ‘us’. ‘They’ do so much for us and ‘we’ are very grateful. All of these emotions separate them from us. They are the heroes, we are normal people, frightened of getting ill.
This reality of making the NHS into ‘them’ restricts its ability to become the ‘we’ that involves us all and because of which we might change our behaviour. The relationship built on us paying for all of this is a good one, but it also means that we pay for them. And the ‘them’ is detached from us.
This limits the capacity of the NHS to act as an organisation that builds day to day social solidarity. (I am not saying it doesn’t – compared to other ways of organising health care – it does, and well) but it doesn’t have the impact that it could and that I would probably say, needs to.
If you have been reading this blog these past five years or more, you will recognise that I have regularly raised the importance of involving patients much more in their own health care as an issue.
And if the NHS wants to involve patients more in their own care, it’s important that they have more knowledge to help them develop that care. And since a great deal of that medical knowledge is owned by the clinicians who are currently in charge of care sharing it could take place in every patient consultation.
If every consultation ensured that the patient left it with more practical knowledge with which to carry out their own healthcare, this would begin to change. Because there are a million consultations every 36 hours, within a few months millions of patients would know more about how to carry out more of their own health care.
This is not an outlandish idea.
What is interesting is that most Integrated Care System plans have, somewhere on the first page, a recognition that, if the NHS is to be sustainable into the future, their local populations need to be much more active both in looking after their own health care and their own health. Improving their ability to self-manage care will involve greater transfer of knowledge from clinicians to patients. This is a clear motive for NHS policy.
I believe that one of the reasons the NHS is experienced as a ‘them’ (and not just an ‘us’) is that medical knowledge is owned by them. Given they possess and guard that knowledge they are – by definition – separate from the rest of us. My point being that sharing it would reduce that gap.
This brings us back to the argument about social solidarity. My thesis is that the NHS, with its current set of relationships, has only a limited capacity to impact public behaviour because the public do not feel part of it. At the moment the solidarity created by the NHS does not influence public behaviour as much as it might.
Building a better, more extensive, joint experience of the relationship between the public and the NHS, would create more social solidarity in our society. This would be useful for a very wide range of reasons – including making it easier to change public behaviour during a future pandemic – but also, by the by, improving people’s health and health care.