May 15, 2019

Personal Responsibility

As part of our ‘What If’ series on change in the NHS, we spoke to Turnaround Director Gail Newmarch and asked her: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”

If I could change one thing…

If I could change one thing about the NHS, it would be to reduce its paternalistic culture in favour of real personal responsibility.

The value and place of the NHS is not in question, nor is its contribution to the quality of all our lives. But something needs to change if policies on personal responsibility are to embed more widely.

Increased demands, workforce and service costs, create pressure at every point of health delivery. Yet analyse the data of any GP practice or Hospital and see the variations in diagnostic testing, emergency thresholds for admission or even prescribed medication. Our clinically led health system needs to shift in favour of patient led decision making. Do I need the chest x-ray my GP just prescribed? Does the frail elderly person picked up by Ambulance following a fall need to go to hospital when the paramedics have assessed there is no injury? But to be safe he/she will. Once there, diagnostics tests will find something wrong – or even just because it is late at night – a clinical decision to admit will likely follow.

Might it be better to find ways to have a different conversation with patients, with information and options to help them make and own the decision? I went out with an ambulance crew and heard first-hand the number of 80+ aged patients say they didn’t want to go to hospital. But their voice is inaudible over the warnings and cautions and ultimately a decision is made for them. End of life care is perhaps the pinnacle of this position. Most of us don’t want to die in the current pathways of repeat emergency admissions or on a hospital ward. In pursuit of value, quality of care, but mostly personal responsibility – isn’t it time we truly empower individuals and families to make informed decisions about their care?

About Gail

Gail is an interim director focussed on system resilience, turnaround and world-class commissioning. She has more than 15 years’ experience looking across these challenges in very different health economies across the country.

About Practicus

Practicus provides problem solving and recruitment. To find out more about the company, see here

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