Oliver Smith, Director of Strategy and Innovation, Guy's & St Thomas' Charity
Feb 03, 2015
In the last week I have been struck by the different conversations the NHS tries to have with the public, and how they can seem in conflict.
In a discussion on integrated care, the focus of debate was how the NHS needs to be better at understanding public and patient needs – with most agreeing that more listening is required. But in a discussion on A&E the tone was very different. There was a strong feeling that the public needs to behave differently, to know when to use A&E and when to go to their GP.
To try to get under the skin of where the public stand, we commissioned work to understand how people view and experience their health. We wanted to know how important health is to people, in particular when examined alongside other aspects of their life. Although only a small sample – 40 short chats and 30 in-depth interviews – the results begin to show why the NHS struggles to talk to the public and why it is imperative to find new and better ways of engaging with people on health matters.
The challenges of keeping healthy
For most people, most of the time, health is not a priority. Their focus is putting food on the table, spending time with family and their job. Although most did not put it like this, health is largely seen as a means to an end. However, health leaps up the list of priorities when it is no longer there or is threatened.
This complex dynamic plays out most interestingly when people explore their sense of responsibility towards their health. People overwhelmingly say that they are first and foremost responsible for their health, and by and large they know the things they need to do to stay healthy. But it’s at this point that the conversation quickly turns to why such healthy behaviours are difficult to put into practice. People can find it hard to fit things like exercising regularly or eating healthily into their lives. People’s professed personal responsibility for their health is in many ways notional.
Messages to build resilience
Discussing these findings last week with some local partners, the concept of resilience kept coming up. How can individuals be supported to prioritise health before they become ill? Two issues were debated. Firstly, the NHS doesn’t really understand why people behave the way that they do; we see them turn up to A&E but we don’t know why they made that decision. Secondly, in part because of this, the NHS often uses messaging that doesn’t resonate with the public at the right time. It is unlikely that someone will remember the advert on the back of a bus about not going to A&E when it is 10pm and they are worried about their sick daughter.
Understanding people’s priorities better and how these affect their behaviour and developing more engaging and targeted messaging will both be vital if the NHS is bring more coherence and resonance to the conversations that it has with people.
Over the coming weeks I shall be thinking about what role the Charity could play to support such work. I’d love to hear from others on this important set of issues. @olliewsmith
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