So Farewell then the Policy Update
After five and a bit years, I have decided to stop producing the weekly policy update – a summary of news items related to health and wellbeing policy. Unfortunately it was just taking up too much time, which I’d rather use for other things.
So here are a few reflections from the experience. In particular, 6 C’s about people and their individual and collective behaviour that have struck me from writing the update.
Clever – Individually people can be very clever; witness the many skills of doctors and others working in health and social care. Collectively, we have been able to build on each other’s work, as scientific research has developed exponentially, which has, for instance, had a dramatic effect on our ability to tackle cancer.
Individually we are often cleverest through ‘intuition’ or pattern recognition, based on experience, (despite its biases and errors). Perhaps that’s why we so often reach for familiar solutions – like restructuring or reconfiguration – rather than tackling the underlying issues.
Crazy. We are also capable of crazy decisions such as having a system for deciding which drugs are worthwhile, but then creating a separate fund for those which aren’t.
Collective incompetence. Collectively, there is the possibility that one amongst the number can just ‘see’ what is needed, that they have the necessary ‘intuition’. Without that, there is a need to logically work things through with that process being co-ordinated effectively – which we are not terribly good at. In either case, conflicts, power struggles and ‘he or she who shouts the loudest’ can impede the ability to find the best answer. No wonder, perhaps that the Better Care Fund hasn’t been more successful.
I am often struck by how people who are individually clever can form a collectivity that is incompetent. I have seen it in health and wellbeing boards, where the collective output is sometimes worse than what any individual would have decided on their own. Nationally and locally, it is sad to see the inability to tackle the underlying causes of ill health and poor wellbeing. It’s not that the problems aren’t understood, but we can’t manage to work together effectively. Perhaps that partly explains why strategies, from the Five Year Forward View, to joint health and wellbeing strategies and Sustainable Transformation Plans, haven’t fully succeeded in developing approaches that support the long term working of ‘whole systems’. Our collective intelligence is a fraction of the sum of its parts.
Carelessness. The search for another ‘C’ perhaps makes this more forgiving than it should be. But failure to address issues such as climate change and air pollution, where there is strong evidence of harms which we could prevent, is concerning. Equally worrying are the things that undermine democracy and open the door to authoritarianism (so indirectly, but profoundly, affecting health and wellbeing), such as weakening access to justice, not defending the judiciary, attacks on investigative journalism and a plural media and threats to freedom of speech.
Callousness. Some decisions, such as financial attacks on the poor and disabled may result from, but can’t be excused by, political greed and ideological blindness. Building in a six week delay before paying universal credit and making the system only available online were foreseeable decisions that would cause harm to vulnerable people.
Compassion. But towering above these, ever present but I’m afraid underreported by me, is compassion. Despite all the problems regularly reported in health and social care, mostly because of restricted funding, the thing that continues to shine through is the caring and compassion of the staff.