BLOG: Can policymakers use a steam-age mantra to improve health outcomes today?

STOP LOOK AND LISTEN….. and we’re not talking Marvin Gaye.

If only there was a way of getting people who shape the narrative to check in with people at the bottom of the food chain every now and then.  It might…bring the conversation about society into sync with how society is really being experienced[1].

How you talk to – and engage with – people matters. If policymakers want to make a difference to people’s lives, they need to stop, look and listen to what people are trying to tell them about their health and the lives they lead.

Getting ‘buy-in’ from those on the receiving end is a start.  It’s certainly better than the mutual incomprehension that can arise between the people delivering a policy and those receiving it. Health policy needs a better balance between [the voices of] professionals, policymakers and the public if it is to be effective, something we have been exploring at the Wellcome Centre on Cultures and Environments of Health.

Efforts to improve health by well-meaning but ‘condescending and patronising’ practice have a long lineage, both before and after the NHS was established.  People switch off in the face of such messaging, undermining the chances of meeting the aims of the policy. Not all patients are as feisty as the Lancashire mothers who told the local clergyman to go and play at marbles after he had told them how to bring up their babies more than 100 years ago[2]. These days, most of us have to grin and bear it – or miss out on the services that we need.

Unfortunately, such practice is not confined to the past.

The DeSTRESS project[3] has shone a light on the relationship between poverty, mental health and prescribing.  The ‘hostile environment’ promoted by austerity and welfare reform has sharpened the powerlessness of many, creating a state in which many people are ‘done to’ by the system. It risks victimisation and stigma for individuals and families, while perpetuating poverty and inequalities in communities.

It has also forced many doctors to resort to the prescribing pad for patients with mental health issues resulting in a boom in anti-depressant use.  Not all hardship among people requires a mental health diagnosis or a prescription and – it has been argued – doctors risk “surrendering their common sense” with such practice[4]. GPs were also cautioned to avoid a mindset which said ‘we think we know what our patients know’. Simply put, more effort is needed to understand the reality of people’s lives.

There are other routes to better mental health beside pills – including social prescribing – which requires the engagement of patients, articulating their ‘lived experience’, and the willingness of health professionals to look and listen to what people are telling them in the patient consultation. GPs need to understand that it is not necessary to ‘fix’ every patient by themselves.  They need to work together in partnership with their patients to find a way that will best support them – their patients – in their lives.

This is not just about mental health. A lack of such partnerships between professionals, policymakers and the public in biomedicine threatens to take us back to the dark days of Victorian England where infection and death were never far away.

Combatting antibiotic resistance also requires a more inclusive approach. A Centre/WHO Europe seminar recently heard that controlling antibiotic use in hospitals through top-down approaches does not work. Instead of trying more of the same, we need to stop, look and listen to users to understand what is happening and why.  Such an approach needs to go beyond the scientist’s bench and the policymaker’s desk to take account of “the social and cultural dynamics that shape patterns and [people’s] experiences of health and illness”[5]. It will also help guard against the consequences of fake news spread by social media – as over vaccination – by engaging everyone in a more informed process.

The NHS has a listening problem too.  The Mid-Staffs inquiry – the Francis inquiry – (2013) found that the board responsible for the service “did not listen sufficiently to its patients”.  Repeatedly, it seems, service leaders fail to engage with patients and relatives, widening the gap between the treatment of disease and the treatment of patients as people[6].

So, while a recipe of ‘stop, look and listen’ may sound straightforward as a way of improving policymaking, opening up a space to engage people’s views and experiences is no easy matter.  The NHS will, however, need new thinking if it is to deliver on its latest Long-Term Plan, beyond asking patients for their thoughts[7].

‘Reinventing the wheel’ is one of the hazards of policymaking.  Learning from history – and the experience of previous policies – is a critical lesson.  Failure to do so will simply ensure that previous mistakes are repeated.

Many policies have sought to harness the voice of local communities. They include, the community development projects of the seventies and city challenges of the nineties.  Not all succeeded, but the New Deal for Communities pointed to positive outcomes arising from community engagement[8]. Likewise, the Wanless Review (2002) built-in a high level of public engagement as integral to its ‘fully-engaged’ scenario.  A scenario that anticipated the best health results for the least spending[9].

Making time for such reflection is vital. This will help get the best from our services for all citizens, especially as spending remains tight. As government departments seek to develop a more systematic approach to policy, not least by the creation of a policy profession, identifying new forms of public engagement that build on patient experience by looking and listening to what people say offers a way of delivering effective care and optimising health outcomes.

[1] McGarvey, D (2017) Poverty Safari  p. 132

[2] Dyhouse, C (1981) Working class mothers and infant mortality in Biology, Medicine and Society 1840-1940 ed. Charles Webster, p.96

[3] The DeSTRESS project is about understanding and dealing with stress in low income communities.  It is supported by ESRC and the universities of Exeter and Plymouth – www.destressproject.org.uk

[4] Poverty, Pathology and Pills – the DeSTRESS project conference 15/16 January 2019 – www.destressproject.org.uk/2018/11/destress-conference-2019/

[5] Ledingham, K (2019) Antibiotic resistance: using a cultural contexts of health approach to address a global challenge. WHO Europe Policy Brief No. 2 – http://www.euro.who.int/en/data-and-evidence/news/news/2019/2/new-policy-brief-on-tackling-antibiotic-resistance-provides-policy-guidance-using-a-cultural-contexts-approach

[6] Sibley, M et al (2018) Making the best use of patient experience in Journal of Clinical Nursing 2018; 1-3 – https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14504

[7] NHS England (2019) NHS Long Term Planhttps://www.longtermplan.nhs.uk/

[8] Popay, J et al (2015) Impact on health inequalities of approaches to community engagement in New Deal for Communities regeneration initiatives in Public Health Research No. 3.12 September 2015 – https://www.ncbi.nlm.nih.gov/books/NBK321028

[9] Wanless, D (2002) Securing Our Future Health: Taking A Long-Term View Final Report

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.