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Soon after the NHS was created in 1948, the first mainframe computer was invented. It was about the size of garage - you walked in it to use it - and it performed minor mathematical tests Sixty years on and computers users have migrated from  the mainframe to the PC, to the lap top and now to the i-Pad and so on and so on.

These innovations have changed our lives.  Yet the real transformation has been in the way human beings have interacted  with technology.

We have created the internet and we are now able to chat with people across the world in real time, shop on line, arrange travel on line, and  increasingly create social movements (for good or for ill) on line.

Healthcare 2.0?

Why is this relevant to the NHS? Well, the truth is that we have our own story of change over the same 60-year period.

In our story, we have seen hospitals change shape and size.  We have seen locations alter and services shift from hospital to community settings, in some cases to the high street.

All  these advances can be compared to the mainframe to laptop changes in the IT sector.

But where – and what -’ is the equivalent  transformational change in the way that people interact with the health services? Answer..... it is sadly lacking!

As a consequence, virtually every health system in the world is facing increasing pressure to devote more and more of its GDP to healthcare delivery.  

And in the ‘mature democracies’ -under the cosh of the economic downturn -this is simply no longer sustainable.

In the NHS, we thrash about wildly trying to salami slice our way out of trouble.  

We implement efficiency programmes (QIPP) to try and give us a medium-term benefit but we know that delivery is uncertain because of the increasing demands upon us.

Facing up to the bigger issues

Yet still, little thought or action is given to answering this bigger question.   

I believe the answer is to change the relationship that we have with our own health and thereby change the way in which we consume heath service resources.

And the idea of the ‘care footprint’ makes this concept real. Obviously it is shamelessly built on the success of the carbon footprint concept that connected people to the major issue of energy consumption and environmental sustainability.

Ten years ago if you recycled you were considered a crank; now if you don’t recycle you are considered a villain! That didn’t happen as a result of a
Government programme.   It happened because of a social movement founded on our personal engagement as individuals with a global issue.

The care footprint concept could help create a similar effect.

Clearly some use of health service resource is not discretionary... if you get knocked down by a bus or are born with a hereditary condition for example.

But a large part of our resource use is discretionary and relates to our lifestyle choices and behaviours.

Look at the way alcohol-related health problems are mounting in most health economies and the significant consequences for taxpayers.

Care footprint offers a way forward


As with carbon, if individuals or communities could see their care footprint, they might be motivated and empowered to work out ways of reducing it.

For years we have tried a traditional public health approach to this and found that they succumb too easily to the charge of nanny statism or victim blaming.

Why? Because they have not started where people are - initiatives have been imposed on the public who have never owned the agenda themselves.

That has to change, and it can’t be done by Government or the new NHS Commissioning Board.

What they can do of course is to support and enable any emerging social movement -providing whatever might prove to be the equivalent of ‘green bins’, and if necessary legislative change at the appropriate stage.

But, success will also require a fundamental shift in mindset on the part of NHS leaders.

If we operate, as sometimes has been the case, through benignly intended paternalism or misguided vested interest, we will not deliver the change needed.

And that fact is that NHS leaders experienced in driving performance delivery are not always best placed to engage emotionally with the public or facilitate a social movement.

Leading change - a job for us all


So the question has to be: where will the leadership come from to make this happen? And this is a pressing matter. If there is a silver lining to the recession for the NHS, it is that it provides an opportunity to engage with the public honestly about this issue.

But NHS leaders are already off the pace as we have yet to take the plunge and raise this debate seriously..

It may be we all need to work together collectively, through membership of the NHS Confederation, to take the lead.

Written by Mike Farrar CBE
Wednesday, 24 August 2011 11:11

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