The greatest lie in the land of localism in health care and it’s all about power

This afternoon I have had cause to work with patients, carers and professionals from the world of health and social care service provision.  A somewhat different world for me but, as ever, I learnt so much.

One participant described their recent experience as a patient as like ‘being captured like a spy,’ technically proficient and efficient, but ultimately dehumanising.

The comparison prompted a few chuckles.  But I could see from the many nods around the table that it was a powerful metaphor.  It certainly resonated with us all.

‘Power’ is a word cropping up frequently at public involvement events I have been too lately.  I see the new CEO of the NHS, Simon Stevens, even talked about ‘patient power’ as an important force for change in his first public speech.  I couldn’t agree more.

But first, patients need to feel they have some power before they can exert their right to influence. And the words and phrases I most hear in the same breath as that word power are ‘lack of’ or ‘imbalance’ or ‘less,’ as in less power or powerless or powerlessness. Many of the people I speak to are adamant that it has got worse.  Pockets of good practice exist, they say, but it doesn’t travel far or last for long.

They see the lie of the land change around them in terms of changing structures.  The complete muddle that organisations are getting themselves into as they transition from national to local.  A lack of purpose accompanied by purposeless dialogue that is soaking through organisations new and old until.

Others that were supposed to be ‘theirs’ such as local ‘Healthwatch’ are struggling to cope with the challenge.  It is almost as if the straw huts of patient and public involvement that once existed around the country have been blown away to leave colleagues weathering the storm in flimsy shanty towns and tent cities.

True, many organisations have designs on patients.  But more often than not these feel as though they are about giving legitimacy to the actions of Boards or managers or professions, not about legitimising the patient voice or people’s rights.

They hear how this change is intended to put the patient first or at the centre or at the heart.  But their belief is being stretched to the limit.  They sense that the greatest lie in the land is that none of these changes have changed or will change the power dynamic for them or their colleagues.

In such circumstances, suspicion and mistrust can grow and spread faster and more damagingly than Japanese knotweed.  In such moments of transition – poorly led and managed – do bad habits prevail.  That is when the system is in danger of pressing ctrl-alt-esc to return itself to factory settings.

It would be the worst result possible for all of us, patients, carers, health professionals and staff.





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