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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This election has sparked a weird debate – one in which no one seems to want to talk

 The noise level hasn’t risen above a low gurgle in the background.

If this is a general election in which the tectonic plates are shifting, they’re the quietest tectonic plates I’ve ever heard. All the parties are standing on pretty radical platforms, yet the noise level hasn’t risen above a low gurgle in the background, like a leaking tap we can’t be bothered to get fixed.

Big issues are being decided here. How do we pay for care, or health, or education? How do we square closed borders with open trade, and why isn’t anyone talking about it? Democracy is on the line, old people are being treated like electoral fodder, our infrastructure is mangled, the NHS is collapsing around us so fast that soon all that’s left will be one tin of chicken soup and a handful of cyanide capsules, and we face the prospect of a one-party Tory state for decades to come. All this and yet . . . silence. There seem to be no shouts of anger in this election. It’s a woozy, sleepy affair.

I knew something was afoot the moment it was called. Theresa May came out of No 10 and said she was having an election because she was fed up with other parties voting against her. No one seemed to want to stand up and tell her that’s a pretty good definition of how functioning democracy works. Basically, she scolded parliament for not going along with her.

Why were we not stunned by the sheer autocratic cheek of the moment? With news outlets, true and fake, growing in number by the day, why was this creeping despotism not reported? Am I the only one in a state of constant flabbergast?

But the Prime Minister’s move paid off. “Of course,” everyone said, “the real argument will now take place across the country, and we welcome,” they assured us, “the chance to have a national debate.”

Well, it’s a pretty weird debate – one in which no one wants to talk. So far, the only person May has debated live on air has been her husband, as Jeremy Corbyn still wanders the country like an Ancient Mariner, signalling to everyone he meets that he will not speak to anyone unless that person is Theresa May. Campaign events have been exercises in shutting down argument, filtering out awkward questions, and speaking only to those who agree with every word their leader says.

Then came the loud campaign chants – “Strong and stable” versus “The system’s rigged against us” – but these got repeated so often that, like any phrase yelled a thousand times, the sense soon fell out of them. Party leaders might as well have mooned at each other from either side of a river.

Granted, some others did debate, but they carried no volume. The Ukip leader, Paul Nuttall, achieved what no one thought possible, by showing the country that Nigel Farage had stature. And there’s a special, silent hell where Tim Farron languishes, his argument stifled at every turn by a media bent on quizzing him on what sort of hell he believes in.

Meanwhile, the party manifestos came out, with titles not so much void of meaning as so bored of it that they sounded like embarrassed whispers. Forward, Together; The Many Not the Few; Change Britain’s Future: these all have the shape and rhythm of political language, but nothing startles them into life. They are not so much ­clarion calls as dusty stains on old vellum. Any loosely connected words will do: Building My Tomorrow or Squaring the Hypotenuse would be equally valid. I still pray for the day when, just for once, a party launches its campaign with something like Because We’re Not Animals! but I realise that’s always going to stay a fantasy.

Maybe because this is the third national vote in as many years, our brains are starting to cancel out the noise. We really need something to wake us up from this torpor – for what’s happening now is a huge transformation of the political scene, and one that we could be stuck with for the next several decades if we don’t shake ourselves out of bed and do something about it.

This revolution came so quietly that no one noticed. Early on in the campaign, Ukip and the Conservatives formed a tacit electoral pact. This time round, Ukip isn’t standing in more than 200 seats, handing Tory candidates a clear run against their opponents in many otherwise competitive constituencies. So, while the left-of-centre is divided, the right gets its act together and looks strong. Tory votes have been artificially suppressed by the rise of Ukip over the past few elections – until it won 12.6 per cent of the electorate in 2015. With the collapse of the Ukip vote, and that party no longer putting up a fight in nearly a third of constituencies, Theresa May had good reason to stride about the place as cockily as she did before the campaign was suspended because of the Manchester outrage.

That’s why she can go quiet, and that’s why she can afford to roam into the centre ground, with some policies stolen from Ed Miliband (caps on energy bill, workers on company boards) and others from Michael Foot (spending commitments that aren’t costed). But that is also why she can afford to move right on immigration and Brexit. It’s why she feels she can go north, and into Scotland and Wales. It’s a full-blooded attempt to get rid of that annoying irritant of democracy: opposition.

Because May’s opponents are not making much of this land-grab, and because the media seem too preoccupied with the usual daily campaign gaffes and stammering answers from underprepared political surrogates, it falls once again to the electorate to shout their disapproval.

More than two million new voters have registered since the election was announced. Of these, large numbers are the under-25s. Whether this will be enough to cause any psephological upsets remains to be seen. But my hope is that those whom politicians hope to keep quiet are just beginning to stir. Who knows, we might yet hear some noise.

This article first appeared in the 25 May 2017 issue of the New Statesman, Why Islamic State targets Britain

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