Public services in the community
The measles outbreaks taking place across the country tells us a lot about how public services, such as hospitals and schools, can be reformed so that they have a better relationship with the communities in which they operate. Much has been written about how much the abuse and neglect that took place in Mid Staffordshire NHS Trust between 2005 and 2008 tells us about how the NHS should be reformed. Much less has been written about what the measles outbreaks tell us about reforming public services (since so much attention has been on the role the media played in causing the outbreaks). Radio 4′s Today programme featured interviews with mothers in Manchester on why they had or had not got their children vaccinated against measles. Click here to listen to mothers discussing why they didn’t get their children vaccinated Strikingly, people did not mention media scare stories as the main reason for not getting their children vaccinated. Instead, they recounted stories about someone they knew being convinced that the vaccine had caused autism and said that this was the deciding factor. What can an organisation like the NHS do in the face of these community pressures? Clearly, simply doing traditional public information campaigns using leaflets and posters is insufficient. In addition, the NHS needs to be have a better understanding of how information flows through communities and a better ability to tap into these networks (more on this general argument here). This leads to 1 of Tony Blair’s 7 questions that the Labour party needs to answer.
How do we take the health and education reforms of the last Labour government to a new level, given the huge improvement in results they brought about?
My answer would be that in general schools and hospitals should be reformed so that they have a better, more dynamic relationship with the communities in which they operate. Education doesn’t only happen at school Much of the energy around educational reforms is based on improving the performance of schools. This is an understandable but limited approach. As we all know, a lot of education happens outside of schools. We learn from our friends and families and we do homework at home or in the library. There is an extensive amount of academic research which shows that the degree of ‘parental involvement‘ is one of the key factors determining a child’s level of educational achievement. However, many schools and teachers have quite limited interaction with parents. There are parents evenings most terms and parents of poorly performing children are often brought into school for special meetings. In addition, there are often parents represented on governing boards and in PTAs. This could be dramatically expanded. In America the Learning Dreams approach involves supporting the parents of children who are struggling at school, so that these parents develop a more positive attitude towards education. Closer to home, the Ocean Maths approach does a similar thing. You can hear more about Ocean Maths here. Health doesn’t only happen in hospitals Talk to any doctor or nurse and they will tell you about their annoyance with patients. They don’t take their medicine, they miss appointments and they don’t do their exercises. Behind these frustrations is the simple fact that patients have to put work in to get healthy. Approaches like the Expert Patient Programme give patients the skills they need to manage their conditions. This is especially important given the rising cost of outpatient admissions for the NHS. The NHS could learn a lot from the “People Powered Health” movement on how you can work with patients to empower them to better deal with their illnesses and become more healthy. For a practical example of how this works you can look at the “Connecting People” study. Here is the diagram that shows their approach. What you can see is that the worker sees that their role is not just to use their skills to assist the individual being helped but also to support that person to develop their skills, connections and confidence. Public services in the community Many people involved with reforming public services rightly concentrate on improving the quality of these services. They are right to do so. But if we are to take the reforms of the last Labour government to the next level we need to do some from an understanding that education doesn’t just happen in schools and healing does not just happen in hospitals. Once we recognise that we can begin to think about how schools and hospitals can work with the communities in which they operate to make them better educated and healthier. Courtesy of Tom Neumark via Dream Housing