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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Which CLPs are nominating who in the 2016 Labour leadership contest?

Who is getting the most CLP nominations in the race to be Labour leader?

Jeremy Corbyn, the sitting Labour leader, has been challenged by Owen Smith, the MP for Pontypridd. Now that both are on the ballot, constituency Labour parties (CLPs) can give supporting nominations. Although they have no direct consequence on the race, they provide an early indication of how the candidates are doing in the country at large. While CLP meetings are suspended for the duration of the contest, they can meet to plan campaign sessions, prepare for by-elections, and to issue supporting nominations. 

Scottish local parties are organised around Holyrood constituencies, not Westminster constituencies. Some Westminster parties are amalgamated - where they have nominated as a bloc, we have counted them as their separate constituencies, with the exception of Northern Ireland, where Labour does not stand candidates. To avoid confusion, constitutencies with dual language names are listed in square [] brackets. If the constituency party nominated in last year's leadership race, that preference is indicated in italics.  In addition, we have listed the endorsements of trade unions and other affliates alongside the candidates' names.

Jeremy Corbyn (46)

Bournemouth East (did not nominate in 2015)

Bournemouth West (nominated Jeremy Corbyn in 2015)

Brent Central (nominated Jeremy Corbn in 2015)

Bristol East (nominated Andy Burnham in 2015)

Cheltenham (did not nominate in 2015)

Chesterfield (did not nominate in 2015)

Chippenham (nominated Yvette Cooper in 2015)

Colchester (nominated Yvette Cooper in 2015)

Crewe and Nantwich (nominated Jeremy Corbyn in 2015)

Croydon Central (nominated Jeremy Corbyn in 2015)

Clwyd West (did not nominate in 2015)

Devizes (nominated Jeremy Corbyn in 2015)

East Devon (nominated Jeremy Corbyn in 2015)

East Surrey (nominated Andy Burnham in 2015)

Erith and Thamesmead (nominated Jeremy Corbyn in 2015)

Folkestone & Hythe (nominated Andy Burnham in 2015)

Grantham and Stamford (nominated Jeremy Corbyn in 2015)

Hampstead and Kilburn (nominated Yvette Cooper in 2015)

Harrow East (nominated Jeremy Corbyn in 2015)

Hastings & Rye (did not nominate in 2015)

Herefore and South Herefordshire (did not nominate in 2015)

Kensington & Chelsea (nominated Jeremy Corbyn in 2015)

Lancaster & Fleetwood (nominated Andy Burnham in 2015)

Liverpool West Derby (nominated Andy Burnham in 2015)

Leeds North West (nominated Jeremy Corbyn in 2015)

Morecambe and Lunesdale (nominated Andy Burnham in 2015)

Milton Keynes North (did not nominate in 2015)

Milton Keynes South (did not nominate in 2015)

Old Bexley and Sidcup (nominated Yvette Cooper in 2015)

Newton Abbott (nominated Liz Kendall in 2015)

Newark (did not nominate in 2015)

North Somerset (nominated Jeremy Corbyn in 2015)

Pudsey (nominated Andy Bunrnham in 2015)

Reading West (did not nominate in 2015)

Reigate (nominated Yvette Cooper in 2015)

Romford (nominated Andy Burnham in 2015)

Salisbury (did not nominate in 2015)

Southampton Test (nominated Jeremy Corbyn in 2015)

South Cambridgeshire  (did not nominate in 2015)

South Thanet (did not nominate in 2015)

South West Bedfordshire (did not nominate in 2015)

Sutton & Cheam (nominated Jeremy Corbyn in 2015)

Sutton Coldfield (did not nominate in 2015)

Swansea West (nominated Jeremy Corbyn in 2015)

Tewkesbury (nominated Jeremy Corbyn in 2015)

Westmoreland and Lunesdale (nominated Jeremy Corbyn in 2015)

Wokingham (nominated Jeremy Corbyn in 2015)

Owen Smith (12)

Altrincham and Sale West (nominated Yvette Cooper in 2015)

Battersea (nominated Yvette Cooper in 2015)

Blaneau Gwent (nominated Jeremy Corbyn in 2015)

Bow and Bethnal Green (nominated Jeremy Corbyn in 2015)

Reading East (did not nominate in 2015)

Richmond Park (nominated Jeremy Corbyn in 2015)

Runnymede and Weybridge (nominated Yvette Cooper in 2015)

Streatham (nominated Liz Kendall in 2015)

Vauxhall (nominated Liz Kendall in 2015)

West Ham (nominated Jeremy Corbyn in 2015)

Westminster North (nominated Yvette Coooper in 2015)

Wimbledon