Improving Health Care Sustainable benefits for all
By Dr Ollie Hart, Director Peak Health Coaching, Clinical Director Heeley Plus PCN
Oct 13th 2023
I want to propose two important mindset shifts that I think can make the NHS much more effective. They might come across a little controversial and challenging to some, or blindingly obvious to others, either way we are generally not doing them. As a result, I believe we are missing out on huge opportunities to improve outcomes. They are evidence-based, and I think open the door to a more realistic approach to health care, that resonates with real life experiences of staff and patients.Â
The first is recognising the ‘Medical Model’ can be significantly enhanced by attention to non-medical factors (also called ‘wider determinants of health’). We should give them equal parity, and equal resourcing in a health context.
We think of the Medical Model as those core traditional approaches to medical health care, diagnosis, medications, therapies, operations. It is based on science and is the core of medical education and practice. We put significant trust and faith in the Medical Model as a society. Decades of work of the likes of Sir Michael Marmot, The Health Foundation, Kings’ Fund, and many others highlight that social issues like housing, poverty, loneliness and self-belief are at least as important in determining health outcomes.Â
It is not one without the other, but we should rebalance them so the focus of our time and resource is more evenly balanced than it is now. We all have limits on our time and money, all we can do is decide how to apportion them both for best effect.
The second shift is to acknowledge that patients, and communities are more resilient and resourceful than we often give them credit for. Traditionally, we have closely guarded the professional validity of our pronouncements…..’doctor knows best…..leave it to us’. In doing so, we have created a culture of increasing passivity when it comes to thinking and acting on our own health. More complex treatment options have compounded this, reinforcing the mystery and confusion. Again, the evidence shows us that people who are more capable of understanding their health issues, become more active in self-management and prevention of illness and are consequently much more likely to have better health outcomes.Â
If we know these two shifts are so important, why aren’t we purposefully pursuing this way of working in the NHS?Â
Sometimes we are held back by worry that even if we do, we won’t be able to do anything about it. However, the recent pursuit of person-centred care in the NHS, the evolution of new roles like social prescribing link workers, care co-ordinators and health coaches, with a new set of skills and job descriptions, has opened the doors of possibility. We are developing robust approaches that make this rebalance of priorities doable.
I have worked with many others for some time in the field of person-centred care, and it is clear there are many examples of these two shifts returning great results, the town of Frome is a great example[1]. Scaling up, so these pockets of innovation, become the core approach of the whole NHS has so much potential to improve lives.
We certainly can’t change the social context for people through health care alone, but we can dedicate much more of our support towards helping people fight against the real root causes of ill-health. We can coach, educate, build self-confidence, and connect with social support. We can recognise the time to listen, treat people with kindness and compassion, is worth investing in as much as expensive medical treatments. We need not let this worry of not knowing how to do it hold us back.Â
Even though we have strong evidence for this shift of approach I don’t think we can rely on policy makers to lead, as there are too many conflicts of interest. I think it will take the collective mindset shifts of health care professionals, patients and local communities, before we see a refocus on the things that matter. Policy makers tend to follow popular opinion, and then we see the rebalance of funding and contracts to support and drive real change.Â