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Does the NHS need a new hero?

I recently watched a TV debate about smoking and the NHS.  One man was arguing forcefully that it was his right to choose whether he smoked, how much he smoked and what he smoked, and that it was the job of the NHS to provide care for him when he needed it.  In his mind the two were in no way linked and he was irritated by the notion that the NHS might have a role in influencing his behaviour in relation to smoking.

In this country we love the NHS.  In the celebration of Britain at the Olympic opening ceremony the NHS took centre stage.  We are proud of our system because it is available to all, is free at the point of delivery, and is based on clinical need, not ability to pay.  It is our hero, because when we need it, it will do everything it can to save us.

As we consider our future vision for the NHS, the key is not so much understanding what the NHS is, but understanding our relationship with the NHS.  The man in the smoking debate was clear: the NHS for him is something akin to a ‘safety net’, there for him when he needs it.  And this is not an uncommon view.  The current furore over A&E and winter is driven largely by the symbolic importance of A&E as the front line of the safety net that the NHS provides.

Our attachment to the NHS is driven by stories of how the NHS (our hero) saved me/my grandmother/my father/my niece.  These are powerful stories from key moments in our lives.  Regardless of what happens to me or my family I know the NHS will be there for me when I need it, and that is why I will do whatever I can to protect it.  My attachment is built on this metaphor of the safety net, reinforced by powerful, personal stories.

Conversely, prevention does not create the same stories or drive the same level of attachment.  In the same way that a safety engineer that spots an irregularity in an aircraft maintenance check and prevents an accident ever occurring will never be a hero in the same way as the pilot who safely lands a misfiring plane on the Hudson river, so the flu jab will never be a hero in the same way as the hospital that nursed my grandfather back from the brink of death from flu.

And herein lies the problem.  Because our vision for the future of the NHS is one that has prevention as its hero, and that has citizens as active partners with the NHS in improving their own health.

Paul Pholeros has given a great TED talk on ‘Housing for Health’.  You can find the transcript here.  He describes how in 1985 a man called Yami Lester saw that for the aboriginal population of Central Australia 80% of the illnesses walking into clinics were infectious diseases caused by a poor living environment.  They examined the housing conditions of 50,000 Indigenous Australians and found that only 35% had a working shower, only 10% were electrically safe, and only 58% had a working toilet, all primarily due to a lack of routine maintenance.

The Housing for Health project works on toilets, showers and electrical safety, and as a result over 10 years has delivered a 40% reduction in environment related hospital admissions.  I am not doing this story justice here and I would encourage you to read it for yourselves, but the point is that providing great treatment for the infectious diseases was not the answer; rather it was preventing the diseases from occurring.

We are fortunate not to be dealing with the same developing world poverty of the Indigenous Australians in Central Australia.  But if we believe that the role of the NHS is also to improve health in partnership with the population, and not to simply provide a safety net for all, then our work on a 5 year vision for the NHS must start with this as the conversation.

Delivering 5 year plans to improve health will be impossible if we end up fighting a public whose primary goal for the NHS is to defend the safety net and the hero of curative medicine.  We need to create a new hero for the NHS, to build a belief in the power of prevention and partnership, and we need to do this by developing powerful, engaging stories like that given by Paul Pholeros as an antidote to the stories that are shaping our current thinking.

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