Missing in action – public involvement and the #NHSLongTermPlan

So there we have it. Earlier this week NHS bosses published their New Year’s resolutions for the NHS.  

The 10-year NHS Long Term Plan promises more money, a focus on prevention and health inequalities, better use of digital and new technology, an emphasis on health in early-years and ageing well and much, much more. What’s not to like?

Similar plans have come and gone over the years. I like this one’s breadth, its sense of purpose and energy. But not its lack of depth in terms of setting out a way forward. Or its superficial regard for the role of research and innovation, in driving forward a modern NHS which meets the priorities and needs of people.

Research is relegated to a 3 page sub-section of a chapter – 2 pages if you eliminate a whopping great graph about cancer recruitment which adds little. I sometimes think that NHS bosses are only interested in research when it presents itself as a new and shiny gizmo rather than evidence to challenge, inform and guide.

What is most interesting and at times troubling to me about these plans – after you’ve waded through the 136 pages including appendices – is the lack of a coherent vision of the partnership that NHS leaders and indeed Government Ministers want to have with patients, carers and the public in creating a healthy society and an innovative and efficient NHS at its centre.  And they are in too much of a hurry to deliver their utilitarian view of life to find out. They are certainly not invested in the principles of public involvement as one of the ways we build a sustainable NHS.

The NHS Long-term plan hops, skips and jumps between various notions of what its authors think patients, carers and the public need. From empowering people through greater use of digital Apps to seeing us as a volunteer force to help the NHS overcome its shortcomings, or as consumers who can be easily manipulated with better health messages and marketing.

It can not decide whether patients are victims to be saved, heroes to be supported, or ignorant fools who smoke and drink and for whom a good telling-off is way overdue. As I said in a blog earlier this week we have gone from a Government that used to chide others for advocating anything that smacked of a nanny state (is that pun intended or not, I don’t know) to one which now thinks the best way to change behaviours is by wagging its finger. Go figure. Someone in Whitehall has been watching too much Mary Poppins I think.

There seems no role for you and I to be involved in and co-design services and treatments so that they meet our priorities and needs in ways which will make the NHS more effective. In fact public involvement and co-production only get a passing mention. Partnership with charities, the voluntary sector and equivalent is oft-mentioned but the words are deceptively warm. There is no model for the way forward. I am almost pining for the heady days of the ill-conceived and always ill-fated NHS Citizens Assembly. As others have pointed out there is nothing which strengthens the accountability of the NHS to you and I.

I know what some will say – because I get the same in the many places I go when talking about public involvement in research – ‘It’s embedded and integrated in everything we do, or it’s ‘threaded throughout our work.’ Or, the one I dislike most – ‘It’s like a stick of rock.’ This is the homeopathic approach to public involvement in which people would like us to believe that the more diluted it is, the more effective it will be. We should no more readily accept this argument than scientists do the arguments behind homeopathy in medicine.

It is certainly true that the noise and and activity around public involvement, co-production has increased massively in the last few years with great work being done in many paces. But it remains too variable and fragile an activity in the current environment for it not to be a deliberate and detectable act that is required of and open to scrutiny in every health and social care organisation.

For the moment, it has gone missing in action.

Have a good weekend.

(For other (and perhaps better) blogs on the NHS Long Term plan I can highly recommend pieces by Don Redding at National Voices and patient leader, David Gilbert.)

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