The current crisis in the NHS is not financial but cultural
International Futures Forum, By Margaret Hannah
“We are a wealthy country, we can afford to spend more on healthcare.” This has been a common refrain in the debate about the NHS. Since 1950, we have increased spending in healthcare at a faster rate than the economy has expanded from 3% to 10% of GDP. The UK is no different from other major countries in doing this and like many countries caught up in the Eurozone crisis and the wider aftermath of the financial crash, is now having to apply the brakes harshly. Having no experience of doing this, we are struggling – in terms of pressures in A&E, hospitals and GP surgeries, staff stress and burn-out and in the quality of care.
Whilst the symptom is a shortage of money, the illness lies deeper in the system. What were successful strategies for providing effective healthcare in the 20th Century are no longer working. Locating illness in specific organs of the individual human being may be helpful for “classical” diseases but less so for the chronic, multiplicity of symptoms which are so deeply enmeshed in the complex and alienating reality of 21st century life. Our experience of “dis-ease” may be helped or possibly stablised in their acute manifestations by modern medicine, but the true remedies lie less in drugs and surgery and more in personal motivation, goals and supportive relationships.
At the launch of Humanising Healthcare: patterns of hope for a system under strain in London, the audience of doctors, managers, policy-makers, analysts, futurists and others concurred with this thesis. The launch was a prelude to beginning a conversation about how we might respond and restore effectiveness in our interactions with patients, families, carers and communities.
“Self management” seemed too narrow a term to describe the shift in relationship and mindset which is taking place where healthcare is showing signs of more hopeful practice. Where the individual is seen more as a person (in the Carl Rogers sense of this word), it becomes possible to co-create developmental and relational solutions to what are often existential problems. How do I make sense of what has happened to me? What is my life for? What really matters to me? These become essential questions to support people to integrate their experience of illness and disability and to forge creative pathways to recovery.
Often these questions are addressed in palliative care, where there is acknowledgement that strenuous and invasive efforts to strive for survival are futile. But we only know for sure the end of life stage of illness has arrived at the funeral! Yet, these questions remain important for anyone addressing dis-ease in their lives.
What lies ahead for health systems to navigate the rapids of system pressures and seemingly incessant demand is not so much a financial but a cultural challenge. It is time to draw on the deep well of human creativity and resourcefulness to find new ways of responding to illness and suffering. We don’t have an evidence-base for this because we have not been asked to do this before in a modern context, but we can learn our way into a new system of health and care based on our common humanity, acknowledgment of our limitations and our possibilities.