All three main party leaders put the NHS at the heart of their conference speeches this autumn. This was no coincidence – a recent poll revealed it to be to be the issue at the top of most voters’mind when considering how they’ll vote next year, and the NHS remains unique amongst British institutions as an object of affection.

In recent years though a consensus has developed within much of the’health sector’. A stronger focus on providing care for people at home, through GP and community based health and care services, would both address many of the challenges the NHS and social care systems in the UK currently face, and also lead to better outcomes for patients and service users. There is also agreement that greater investment is needed as demands rise, especially from an ageing population.

However, the public fiercely resists change, especially if it entails closing a much loved local hospital, resulting in a stasis within an increasingly risk averse political establishment. Against this backdrop, members of the Richmond Group of health charities commissioned BritainThinks to conduct qualitative research to understand how best to make the case for change.

We ran focus groups representing a spread of socio-economic groups exploring spontaneous views on the health and social care systems. We also tested alternative expressions of the case for change. Our research revealed how much the public’s views differ from the health community on this topic. Understanding this is crucial for anyone wishing to bring the public on-side with change in the NHS.

The first key difference is that people do not perceive a’crisis’in the NHS. In the early 2000’s, ahead of Gordon Brown’s national insurance rise, it was widely believed that the NHS was on the brink of total and irre­versible collapse. Today, whilst experience of healthcare services and anecdotal evidence clearly suggests that the NHS is under strain, the problems the public see are not identified as symptoms of systemic failure. Talk therefore of a’crisis’and the subsequent need for’urgent change’in the system often fails to either engage or convince.

Secondly, unlike those in the health sector, the general public lacks interest in the system or the processes that underlie service delivery. Instead they are preoccupied with what the NHS is able to deliver to them personally. We asked participants to draw their own diagram of’the healthcare system’. The result was a simple,’me-centred’perception of the NHS, showing a patient’s journey from doctor or hospital, through treatment to aftercare.

Thirdly, the public’s views on the types of pressure that the NHS is under are a further point of departure with the health com­munity. Any appreciation of the rising cost of health and social care is largely absent.

Rather, there is a deeply ingrained belief that all of the problems in the NHS can be attributed to two things: endemic waste and inefficiency; and large numbers of people currently’taking’from the system who have not contributed to it.

Finally, when presented with alternatives for service delivery, people, while broadly accepting of arguments like prevention not cure, saw the propositions as common sense solutions rather than examples of innovative or radical change. Even the groundbreaking reconfiguration of stroke services in London was seen solely as an exercise in improving efficiency in the system.

This research has four clear implications for how politicians should talk about the NHS to make a compelling case for change. Any successful narrative should position such change, first, as evolution not revolution, rather than a radical change that is in response to a crisis. Second, it should be an opportunity to improve services for patients, rather than as primarily a cost-saving exercise. Third, it must be seen as a’‘common sense’response, rather than an ideological vision. And fourth, change should be understood as a response to a growing ageing population and increase in long term conditions.

It will also be vital to avoid creating the sense that’change’means a reduction in the provision of NHS services. The general public are particularly sensitive to losing the NHS touch-points that they see as vital to their accessing the service: GP surgeries and A&E departments. As Caroline Abrahams, Age UK Charity Director, who commissioned the research on behalf of the Richmond Group said, “the angst among policymakers about how to communicate the need for change in the NHS largely misses the point – the public expects the NHS to evolve in response to changing needs and will support you getting on with it. But clearly, you close the local A and E at your peril! It seems however that you can change much else that happens behind the hospital front door without undue public alarm.”

This work is just a start – there is much more to be done – for example, gaining a better understanding of how best to communicate community-based care – but it highlights the gulf in perceptions held by the health community and by the general public. Only by really understanding where the public are, and reflecting this in communica­tions, can we hope to take them with us as we make the case for change.

This article from BritainThinks first appeared in the Fabian Review 

 

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One Comment

  1. ” Any successful narrative should position such change, first, as evolution not revolution, rather than a radical change that is in response to a crisis. Second, it should be an opportunity to improve services for patients, rather than as primarily a cost-saving exercise. Third, it must be seen as a’‘common sense’response, rather than an ideological vision. And fourth, change should be understood as a response to a growing ageing population and increase in long term conditions.”

    When assessing the needs of the health service, you first have to ask whether it is a publicly owned service or private that is your choice.

    Then you need to reflect on what has happened to a service prior to Neo-Liberal interference in the way a public service has been delivered.

    Neo-Liberalism took hold in this country around 1970 when Milton Friedman was given massive publicity by the BBC has to how society could be improved by having less regulation, less taxation, and a smaller state.

    Thatcher first implemented those aspirations and then produced a blue print, her 1982 Cabinet Papers “The longer term options:”

    http://discovery.nationalarchives.gov.uk/details/r/C13318082#imageViewerLink

    This document outlines exactly how the state would be privatised, and even the kind of resistance that government would meet from the public.

    Unfortunately the reason people are ignorant about this actual agenda and how privatisation has slowly been introduced is because New Labour are Neo-Liberal and align themselves with the Tory Agenda, which is why they introduced the internal market into the NHS.

    The story behind these changes and in fact deliberate deception of the public was that we can’t afford our public services and that it would be more efficient to let the private sector intervene to remedy the so called short comings of the public sector, neatly forgetting that the NHS before all this NeoLiberal interference was the most comprehensive, the cheapest, and efficient.

    This short video explains why the Tories are wrong in saying that we have a deficit problem and that it can only be solved by austerity (balancing the books) as portrayed by New Labour, and that we can’t afford our public services, New Labour of course have never tried to prove that they did not cause the deficit problem which stems from the Banking Crash; because they will pursue the same policies as the Tories and are therefore trapped into re-enforcing the Neo-Liberal mythology that we have to employ more austerity in order to be financially sound.

    The facts are though, that that is the opposite of the truth and more austerity is the means to shrink the state, in a couple of words, more “cuts.”

    https://www.youtube.com/watch?x-yt-ts=1421914688&v=gcI-Y5ydd4I&x-yt-cl=84503534

    The truth is we have been lied to by the people we thought represented us and there is a secret Neo-Liberal agenda being pursued, only when return to real Labour values will we ever have a health service that works for people as it did before the Neo-Liberals came into office.

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