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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Sooner or later, a British university is going to go bankrupt

Theresa May's anti-immigration policies will have a big impact - and no-one is talking about it. 

The most effective way to regenerate somewhere? Build a university there. Of all the bits of the public sector, they have the most beneficial local effects – they create, near-instantly, a constellation of jobs, both directly and indirectly.

Don’t forget that the housing crisis in England’s great cities is the jobs crisis everywhere else: universities not only attract students but create graduate employment, both through directly working for the university or servicing its students and staff.

In the United Kingdom, when you look at the renaissance of England’s cities from the 1990s to the present day, universities are often unnoticed and uncelebrated but they are always at the heart of the picture.

And crucial to their funding: the high fees of overseas students. Thanks to the dominance of Oxford and Cambridge in television and film, the wide spread of English around the world, and the soft power of the BBC, particularly the World Service,  an education at a British university is highly prized around of the world. Add to that the fact that higher education is something that Britain does well and the conditions for financially secure development of regional centres of growth and jobs – supposedly the tentpole of Theresa May’s agenda – are all in place.

But at the Home Office, May did more to stop the flow of foreign students into higher education in Britain than any other minister since the Second World War. Under May, that department did its utmost to reduce the number of overseas students, despite opposition both from BIS, then responsible for higher education, and the Treasury, then supremely powerful under the leadership of George Osborne.

That’s the hidden story in today’s Office of National Statistics figures showing a drop in the number of international students. Even small falls in the number of international students has big repercussions for student funding. Take the University of Hull – one in six students are international students. But remove their contribution in fees and the University’s finances would instantly go from surplus into deficit. At Imperial, international students make up a third of the student population – but contribute 56 per cent of student fee income.

Bluntly – if May continues to reduce student numbers, the end result is going to be a university going bust, with massive knock-on effects, not only for research enterprise but for the local economies of the surrounding area.

And that’s the trajectory under David Cameron, when the Home Office’s instincts faced strong countervailing pressure from a powerful Treasury and a department for Business, Innovation and Skills that for most of his premiership hosted a vocal Liberal Democrat who needed to be mollified. There’s every reason to believe that the Cameron-era trajectory will accelerate, rather than decline, now that May is at the Treasury, the new department of Business, Energy and Industrial Strategy doesn’t even have responsibility for higher education anymore. (That’s back at the Department for Education, where the Secretary of State, Justine Greening, is a May loyalist.)

We talk about the pressures in the NHS or in care, and those, too, are warning lights in the British state. But watch out too, for a university that needs to be bailed out before long. 

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