Why is behavioural science important in health? The operating manual for a healthy human mind and body is not a simple one. Successful maintenance requires us to make decisions based on uncertain futures, confront fear and embarrassment, and stick to habits often at odds with modern life.
The health and care system too makes cognitively complex demands of those who work in it: tired physicians have to diagnose and treat just as well as fresh ones; CCGs must overcome interpersonal dynamics to reach consensus; and managers must determine how to use limited resources when life and death hangs in the balance.
‘In a hierarchy every employee tends to rise to their level of incompetence’.
It was in the late 1960s that Laurence J. Peter introduced us to the Peter Principle in his book ‘The Peter Principle: Why things always go wrong’. His view - people are promoted based on performance in their current role. They eventually rise to a point where they are hopelessly out of their depth.
What is lobbying? According to the UK Parliament, “lobbying is when an individual or a group tries to persuade someone in Parliament to support a particular policy or campaign”.
Anyone can lobby the UK government, as an individual, small group or as part of a profit-making organisation. Lobbying in the UK is a £2 billion business, making it the third largest worldwide after the US and Brussels.
Most people will have heard about the fossil fuel and tobacco sectors trying, and succeeding to, influence policy through lobbying, but what does it mean for the health sector?
Social challenges are as tough and engrained as ever. With the increasing strain on health and care services, the mantra ‘more for less’ has become deafening and, on occasion, paralysing. In this intimidating context it remains just as important but altogether harder to ask the important question, how can we help change the way our society works to better serve the most disadvantaged?
It is a commonplace assertion that society, the economy and public services face unprecedented challenge: from demographic pressures to a stuttering economy; to critical workforce shortages and developments in technology that outpace our ability to harness them for public good. In order to survive (let alone thrive) we must change; work differently, think differently, live differently.
But all change is not necessarily a good thing. And not all new things turn out to be that ‘new’ after all. Don’t throw the baby out with the bathwater (das Kind mit dem Bade ausschutten), has been a German catchphrase for 500 years. In seeking out productive change there might also be things to retain, adapt or even revisit from the past.
By 8pm in most departments in most UK hospitals, the majority of people whose title implies a leadership or management role are on their way home, returning the following morning at, let’s say 8am plus or minus one hour.
Does this imply that for around half the average day, our great NHS hospitals are ‘un-led’ or does the mantle of leadership pass to another group who lead without access to fancy titles?
One hundred years since the vote was first extended to women in the UK and over 140 years since women were allowed to train as doctors in Britain, do we have equality of power for women in healthcare, either as professionals or as patients? What would real equality look and feel like, and what will it take to get there?
In our eagerness to be helpful, are we in fact, all part of the problem?
Entire industries rely on being needed to help people. Having people in need of help gives these industries a justification to exist. Ultimately, we can never get away from the uncomfortable fact that it pays many of our salaries. We all play our part in an expensive game of bidding, competing for and winning ‘work’.
You might hope the answer to that question is self-evident. Whatever your long-term goal, you need a plan for how you’re going to get there, particularly if you work in a complex, dynamic environment like the health service. And particularly if you’re relying upon multiple organisations to help you achieve that goal.
I am a psychiatrist. I love people. I believe in happiness and opportunity as basic human needs. As a teenager, I thought that if we could just live in a true democracy, we could have a peaceful world, where everyone could have equal opportunities to reach their potential. I was truly a product of the era of that great song “I’d like to teach the world to sing in perfect harmony”.
However, having no singing talent, to play my modest part in creating happiness and equality, I became an NHS doctor! This blog is written through the lens of my experiences with patients and communities.