The head of NHS England gets his blood pressure tested. Photo: Getty
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How people-powered personalisation could lead the NHS to recovery

The NHS needs a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities.

It’s been an important month for personalisation in the NHS. For the first time, around 60,000 adults eligible for Continuing Health Care now have the legal right to a personal health budget. Health and social care leaders have been finalising applications to participate in the potentially ground breaking Integrated Personal Commissioning Project seeking to blend social health and social care funding for individuals and allow them to direct how it is used. And publication of the NHS’s Five Year View set a course for the organisation that commits the organisation to enabling patients to have far more control over their care, including but not only through greater control over shared budgets.

Encouragingly, these moves towards personalisation appear to be based on a deep understanding of why producer-led forms of provision have had their day. The Five Year View makes a strong defence of the values and professionalism of today’s NHS, but makes no bones about where it has fallen short, operating as if health and wellbeing can be delivered to people, rather than achieved in partnership with them. 

It warns that the NHS has been prone to "operating" a "factory model of care and repair" instead of harnessing what it calls the "renewable energy represented by its patients and communities". At a point when 70 per cent of today’s health spend is on long term conditions, rather than isolated health problems that might respond to one-off "repair", agreeing forms of support that fit with people’s own lives and aspirations, and plug into their own resources, could hardly be more important. 

So, as health prepares to speed up its journey to personalisation, it makes sense to look at what can be learned from the experience of other sectors, particularly the sector in which personalisation was born – social care. Much of that learning is very encouraging. We now have detailed evidence of the impact of personal budgets, for example, on the lives of those who use them. 

This month saw the publication of the Third National Personal Care Survey. In line with previous research it shows that the overwhelming majority of budget users believe that their lives have improved in terms of independence, dignity and family and paid relationships. As Alex Fox has noted in a new report for the RSA, people who make long term use of social care have repeatedly demonstrated over the past two decades that they are often better than highly trained professionals at making effective use of public resources. 

Yet personalisation remains highly controversial as a philosophy and as a set of practices. Critics worry about colluding with neo-liberal models of individual choice and control, about the de-professionalisation and fragmentation of the workforce, about creeping inequities, and about abnegating proper risk management. Even some of those who are well-disposed towards its aims are concerned that personal budgets in particular have become expensive bureaucratic thicket in which rationing and provider-interest continue to thrive.

For Alex Fox, the way of resolving these problems is to go back to the roots of personalisation and recognise the true challenge it presents, which is not one of administrative adjustment but of profound culture change. Far from being founded on an individualised view of wellbeing, personalisation rests on a deep understanding and respect for how we thrive or falter as people who are embedded in families and communities. So personalisation must go wider than budgets and individual choices, as clearly recognised back in 2007 in the government’s Putting People First concordat. For personalisation to succeed it needs to be part of a shift towards prevention and the development of inclusive and supportive communities.

The RSA’s own research and practice supports this approach. Our work on social isolation and drug and alcohol recovery, for example, is based on building trust in the capability of individuals, families and communities to forge solutions that are right for them, with the support of services that are re-shaped to respect and support the support ecosystems – formal and informal – of the places they serve. 

For example, the RSA’s Whole Person Recovery Team in West Kent is testing, at scale, a service delivery model that fosters community networks in order to support sustainable, long-term recovery from drug and alcohol abuse. The service attempts to build people’s "recovery capital" by connecting them with the people, groups and places who can become their support ecosystem.  It is a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities. 

Ironically, given the aspirations of the NHS Four Year View, Whole Person Recovery explicitly rejects a medicalised model of addiction and recovery – a reminder, if one were needed, of the  and scale of the task ahead if the health service truly wants to embrace personalisation. For social care, the culture change challenge has been huge. For health, it is likely to be even greater.

Paul Buddery is director of RSA 2020 Public Services

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Political video has come full circle in Obama and Clinton’s mockumentary-style films

Political campaign videos are increasingly mimicking the specific styles of filmmaking created to mock them.

This week, Hillary Clinton released a campaign video featuring Barack Obama, in an attempt to persuade her supporters to vote early. It revolved around Obama’s self-professed earliness. “I’m always early,” he tells us, cheerily. Aides chip in to explain this irritating habit, which becomes progressively more exaggerated, his approach to timing absurd. “You know how you beat LeBron James one-on-one? Get there 45 minutes early. Then it’s one-on-none.” A former staffer sighs. “You try telling the President of the United States there’s no such thing as a one-on-none.”

This is an instantly recognisable mockumentary style – deliberately shakey camerawork, complete with lots of zooming in and out, as absurd corporate behaviour is interspersed with incredulous talking heads and voiceover. It has its roots in the Office UK, taking the States by storm with The Office US, 30 Rock and Modern Family, and developing a political subgenre in The Thick of It, In the Loop and, most recently, Parks and Recreation. (Vague comparisons between Clinton and Poehler’s Leslie Knope abound.)

The content, too, seems familiar – a politician talks to camera about a personality quirk that is broadly a strength for someone in government, but exaggerates it to create a geeky, optimistic goofball, and a pretty likeable character. Take Leslie Knope on never smoking weed:

In terms of style and content, they’re fairly indistinguishable. And this not the only Clinton campaign video influenced by mockumentary and comedy tropes . In March, the Clinton campaigned released a “mean tweets” video with Senator Al Franken in the style of a Jimmy Kimmel Live talking head. Three days ago, a video campaign starring “Fake Lawyer” Josh Charles, an actor on The Good Wife, was released. It borrows heavily from mockumentary styles as well as self-mocking celebrity cameos in advertising. Even some non-comic videos, like this lighthearted one about Clinton’s granddaughter, have the exaggerated camerawork of the genre.

Of course, we can trace these campaign videos back to Obama again. His campaigns have always been heavily video based, and he’s taken the piss out of himself for Buzzfeed to promote campaigns. But the White House’s official channels are also in on the joke. In 2013, they released a mockumentary starring Steven Spielberg and 30 Rock’s Tracey Morgan, in which Obama plays Daniel Day Lewis playing Obama.

Earlier this year, the channel released another mini mockumentary, featuring Obama preparing for the end of his time as president. (The film even ridicules a less self-aware style of video – Obama posts a misjudged Snapchat about Obamacare, and asks “Did it get a lot of views at least?”)

A politician whose ideal evening consists of children’s movie marathons with colleagues? Where have we seen that before? Yes, political video has come full circle. Personally, I’m waiting on the Hillary Clinton break dancing clip

Anna Leszkiewicz is a pop culture writer at the New Statesman.