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April 26, 2010

Welsh Institue of Health and Social Care Blog
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» Is England a Foreign Country?

The parties’ general election manifestos show just how different health policy in England has become from that in Wales.

The manifestos, of course, are talking about the English NHS. Superficially, England and Wales seem to share some objectives, such as improved access to care, protecting investment in the NHS, and spending money wisely. But the latest eye-catching ideas from England seem to have little to do with Wales.

The three main parties all agree on the key issue for England – how to drive up the performance of the NHS. Their shared recipe has three ingredients: help NHS workers take over and run their own services; encourage a range of provision; and give people lots more information on how well local services are performing.

This is as far from the debate in Wales as would be discussion about the merits of SATs in schools, or the transport infrastructure around the Olympic stadium.

Our ingredients for driving up performance include getting the public sector to work together, encouraging clinical networks and benchmarking, and a strong steer from the centre.

Contrast this with English Labour, where all the talk now is of getting good performers to take over the poorer ones, enshrining patient rights in legislation, and making primary care available from “8 ‘til late”.

The difference is startling, as is the consensus amongst the main parties in England.

None of this difference need matter, of course, and actually it might be a good thing to experiment with different approaches and see which works best. A moment of quiet reflection, however, might reveal a paradox: how can we be proposing two so completely different approaches to improving the NHS – to achieving essentially the same goals? One might wonder whether anyone actually knows which approach is best, or whether we are not all going with our gut instincts and the herd?

Surely not.

Written by Professor Marcus Longley, Director, WIHSC

April 21, 2010

Welsh Institue of Health and Social Care Blog
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» The Yanks are still coming

Having just returned from a holiday in the USA it was interesting to read David Hands’ blog about President Obama’s health reforms. Those of us brought up with the virtues of the Welfare State running through our veins find it astonishing that such a large body of American opinion should oppose enabling an additional 40 million American people to access health care. One news story I picked up in Florida was of a doctor placing a sign in his surgery saying supporters of Obama were not welcome. He later said that he was merely making a point and would not, of course, have turned any of his patients away!

My immediate reaction to the US health care debate was to conclude that the political ideology which underpinned the thinking of Obama’s opponents was so distant from mainstream thinking in this country that everyone would be as surprised as me that there should even be a debate. A bit naïve and idealistic perhaps but my way of offering my own personal vote of confidence to our National Health Service. Then I watched the first Prime Minister television debate and began to reflect on how much we have been influenced by the American way, or certainly American initiatives, in the last 30 years or so.

Here are some of the examples which came to mind. Out of town retail parks; Macdonalds and other fast food outlets; deregulation of public transport and the growth in car use; 24/7 opening hours; Starbucks and other coffee houses; 24/7 news coverage; 4×4 trucks; the internet; mobile phones; the growth in commercial television; and the acceptance of a whole new way of spelling our language, epitomised by the acceptance that it is ok to spell it ‘epitomized’. We could have a poll on which are good and which are bad, which we like and which we don’t, but the truth is that all these things, and others, are here to stay.

The worry I have is that I think a tacit acceptance that ‘what America does today, we should do tomorrow’, has crept into our culture and if this is allowed to run its ultimate course it would lead to the demise of the NHS, the BBC and any other institutions which were based on the notion that the collective good is more important than the individual. The first TV election debate summed this up perfectly. It was all about which of the 3 party leaders could impress us more, not which policies would produce the best way forward for our country. The fact that they are representatives, albeit leaders, of their parties seemed to be lost. It was described by some journalists as the most public job interview in history. It was an American presidential debate superimposed on a British political system.

Personally, I thought the first debate was a dispiriting event and, again naively perhaps, find it offensive and concerning that voters should be influenced by the colour of a suit and tie, the degree to which you looked down the lens of the camera, and your ability to tell a joke, all of which featured in the post-debate analysis. Interestingly, Karen Lewis’ blog on the 15th April about the richness of storytelling as a means of understanding real issues was in sharp contrast to the universal opinion of the political journalists that the 3 leaders had all been guilty of overdoing the anecdote, typified by ‘a cancer patient in wherever was telling me last week that he couldn’t get the right drug because….’.

We are yet to see, of course, whether the TV debates will actually lead to changes in voting but we should all be concerned that 90 minutes of television, which covered no more than 8 questions, all relating to home policy, can lead to such dramatic movement in opinion polls. We are told that there is now no going back and that the debates will now be a permanent feature in Parliamentary elections. And if you think I’m overstating this Americanisation theory, have a look at the way all the parties seem to be supporting the introduction to Charter schools which many believe represent the potential end of our state schools.

I’m sure if Alistair Cooke was still alive and presenting his ‘Letter from America’ we would all be listening in carefully to find out what we’ll be doing differently in the next few years.

Written by Tony Garthwaite, WIHSC Senior Fellow

April 15, 2010

Welsh Institue of Health and Social Care Blog
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» What’s the Story?

The Election Campaign Express is now gathering speed as the competing voices of politicians grow ever louder and – dare I say it? – become almost interchangeable, merging into a relentless cacophony whipped up by the media. There’s blogging and twittering, there’s Dave Cam and live television debates – the electorate now has more access to the views of its political leaders (and would be leaders) than ever before. So why does the hubbub of this election soundtrack often seem so far removed from the reality of our daily lives? Why do so many people simply “switch off” when politicians begin to ramp up their campaign battle cries? Is it perhaps because the talk, debate, argument, questioning, is almost always about policy, not people?

As human beings we make sense of our lives through our own personal narratives, not by studying a policy framework or a set of guidelines. It is through creating and sharing our stories that we connect with each other, with our past and with our future, and the constant reshaping and retelling of our own life story lies at the heart of who we are.

After over a decade of working with “ordinary” people and helping them to share their real-life stories, I continue to be dismayed by the deference with which individuals offer their testimony. They will often describe their story as “not very interesting” or preface their narrative with “who would want to listen to what I have to say?” (Not phrases we would often hear a politician using). In fact their stories are always of interest and value to the listener and, in turn, their experience of being listened to is immensely rewarding and validating for them.

We have been privileged recently at StoryWorks (1) to have gathered a series of rich stories from carers of people with dementia in Wales, and the insight this has afforded into the complexities of the condition and its impact on the individual and their family has been profound. The glimpse into the minutiae of daily living, and the accompanying emotional rollercoaster, say more to me about the need for this condition to be seen as one of the major challenges facing our ever ageing population than any report on dementia care.

Similarly, the powerful stories that cancer patients at Velindre Cancer Centre have shared with us have offered a very human glimpse into the real experiences that lie behind the shocking statistics. When these stories were shared with staff at Velindre, there was a genuine sense of a different type of learning about what it means to live with cancer and a view that the narratives highlighted

“…the importance of remembering that patients are people with their own lives.”

Of course we need our politicians and leaders to create and implement policies and procedures; that’s what we pay them for. But we also need them to be reminded of the human impact of their decisions and the stories of the individuals whose lives that they will affect. In the age of sound bite and spin let us ensure that we – and our decision makers – continue to listen to the real stories of real people, and learn from them.

Written by Karen Lewis, Project Leader, StoryWorks, WIHSC

1. To see more about our work visit Storyworks.

2. Quote from Velindre staff member on feedback form