We must never forget the human touch. It's what today's NHS is lacking

This government confused customising services with humanising them, writes IPPR's David Robinson.

Britain’s most respected institution was the star of the show at the Olympic opening ceremony a year ago but our beloved NHS has taken a brutal kicking ever since. First the Mid Staffs report revealed "a lack of care, compassion and humanity", then similar revelations about several other hospital trusts, an enduring crisis in A&E departments across the country and now, it seems, the 111 call service is falling apart at the seams. 

Of course even the best managers will struggle when demand is rising and funding is falling, and some parts of the NHS are seriously lacking in the best managers department. But the underlying story of the last 12 months has not just been about money or management. It has also been about culture and about reaping the consequences of a prolonged and systematic shift in custom and practice. A fundamental change that has not been confined to the NHS but is endemic across our public services.

Commenting on the Mid Staffs report and shortly after starting work as the new NHS national medical director Professor Bruce Keogh promised earlier this year that hospitals would be fined if they failed to provide the best care. Is this really the answer? Care driven by fear of punishment? 

The prospect is discomforting but it isn’t new and it isn’t unique to the health service. Talk to social workers, teachers, probation officers and care workers and you will find that regulations and systems, impersonal transactions and a fear of risk and reprisal shape the culture in which they all work. Public services in recent years have been reduced to a set of transactions when the real need is for a more personal relationship, for common sense and for human kindness.

Callers to 111, patients in A&E, and particularly families using Mid Staffs haven't, for the most part, been complaining about the medical science. Rather, they say, it’s the human touch that’s gone missing. The time to talk to an anxious relative in A&E, the opportunity to appreciate that a patient needs a drink as much as a pill, and the common sense to understand that a monitoring phone call at 5am in the morning may not be the most useful way of helping a stressed parent. In short, the capability and, critically, the management support to see the person not the operational target. 

This government and the last one confused customising services with humanising them – both are worthwhile goals, but they are quite different. 111 call centres or big polyclinics may offer a service that will meet individual needs more quickly, efficiently and flexibly than the individual GP working on their own, but the service will be less personal. The polyclinic suits the busy commuter seeking holiday jabs (customised); the small-practice GP may be preferred by the parent of a chronically sick child visiting the surgery every week (humanised). A huge body of evidence now supports the proposition that consistent, high-quality relationships change lives and that better results are achieved where, in design and delivery, primacy is given to the quality and consistency of the individual interaction – that is, where the service is humanised.

Such “deep value” relationships should be the organising principle at the heart of our public services, not because they are a “nice to have” on the margins of the core service, but because they have a material impact on the outcomes and on the long term costs. 

As conference season approaches politicians and commentators will be preparing their prescriptions for the NHS. They must not – in the words of TS Eliot – "dream of a system so perfect that no one will have to be good". We've been there and it isn’t working. Systems, upheld by inspection and punishment are, at best, not enough. We need the maturity and the good sense to talk about love, what Barbara Fredrickson has called "that micro-moment of warmth and connection that you share with another human being", to understand the place of trust and kindness in the public realm and, above all, to consistently and deliberately design it into service reform, not design it out.

A patient is wheeled into a lift in Queen Elizabeth Hospital in Birmingham. Photograph: Getty Images

David Robinson is co-founder and now senior adviser to Community Links

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PMQs review: Angela Eagle cheers Labour MPs against an improved George Osborne

The shadow first secretary of state revelled in the Tories' splits. 

For months, Labour MPs have despaired at their party's failure to exploit the Tories' visceral EU divisions. But at today's PMQs, Angela Eagle gave them cause for cheer. Facing George Osborne in her capacity as shadow first secretary of state (David Cameron is attending the G7 in Japan), she brandished Iain Duncan Smith's description of him as "Pinocchio". "Who does the Chancellor think the public shoud listen to," she dryly remarked, "his former cabinet colleague or the leader of Britain's trade unions?" Eagle later roused the House by noting the scarcity of Brexiters on the frontbench. Her questions were too broad to pin Osborne down, and she struggled to match the impact of her first performance - but it was a more than adequate outing.

After recent reversals, the Chancellor delivered a ruthlessly efficient, if somewhat charmless, performance. When Eagle punched his Google bruise (following the police raid on the company's French offices), Osborne shot back: "She seems to forget that she was the Exchequer Secretary in the last government, so perhaps when she stands up she can tells us whether she ever raised with the Inland Revenue the tax affairs of Google?" 

He riled Labour MPs by describing the party as anti-Trident (though not yet announced, Corbyn will grant a free vote), a mark of how the Conservative leadership intends to use the issue to reunify the party post-referendum. "We look forward to the vote on Trident and he should get on with it," Eagle sharply retorted at the start of the session. But Osborne inevitably had more ammunition: "While she's sitting here, the leader od the Labour Party is sitting at home wondering whether to impeach the former leader of the Labour Party for war crimes." He compared Labour MPs to prisoners on "day release". And he gleefully quoted from Jon Cruddas's inquiry: "In their own report this week, Labour's Future, surprisingly long, they say 'they are becoming increasingly irrelevant to the working people of Britain."

The muted response from the Tory benches demonstrated how badly the EU vote has severed the party. But Osborne will be satisfied to have avoided any gaffes or hostages to fortunes. His performance today, his best to date at PMQs, was a reminder of why he is down but not yet out. 

George Eaton is political editor of the New Statesman.