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

Photo: Getty
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Who will win in Manchester Gorton?

Will Labour lose in Manchester Gorton?

The death of Gerald Kaufman will trigger a by-election in his Manchester Gorton seat, which has been Labour-held since 1935.

Coming so soon after the disappointing results in Copeland – where the seat was lost to the Tories – and Stoke – where the party lost vote share – some overly excitable commentators are talking up the possibility of an upset in the Manchester seat.

But Gorton is very different to Stoke-on-Trent and to Copeland. The Labour lead is 56 points, compared to 16.5 points in Stoke-on-Trent and 6.5 points in Copeland. (As I’ve written before and will doubtless write again, it’s much more instructive to talk about vote share rather than vote numbers in British elections. Most of the country tends to vote in the same way even if they vote at different volumes.)

That 47 per cent of the seat's residents come from a non-white background and that the Labour party holds every council seat in the constituency only adds to the party's strong position here. 

But that doesn’t mean that there is no interest to be had in the contest at all. That the seat voted heavily to remain in the European Union – around 65 per cent according to Chris Hanretty’s estimates – will provide a glimmer of hope to the Liberal Democrats that they can finish a strong second, as they did consistently from 1992 to 2010, before slumping to fifth in 2015.

How they do in second place will inform how jittery Labour MPs with smaller majorities and a history of Liberal Democrat activity are about Labour’s embrace of Brexit.

They also have a narrow chance of becoming competitive should Labour’s selection turn acrimonious. The seat has been in special measures since 2004, which means the selection will be run by the party’s national executive committee, though several local candidates are tipped to run, with Afzal Khan,  a local MEP, and Julie Reid, a local councillor, both expected to run for the vacant seats.

It’s highly unlikely but if the selection occurs in a way that irritates the local party or provokes serious local in-fighting, you can just about see how the Liberal Democrats give everyone a surprise. But it’s about as likely as the United States men landing on Mars any time soon – plausible, but far-fetched. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.