The doctor will tell you what is good for you…

As those of us whose lives involve far too much CBeebies know, a new programme aimed at toddlers called ‘Get Well Soon’ has hit our screens recently. Starring the not unattractive Dr Ranj, and a group of puppet toddlers, Get Well Soon explores common childhood illnesses and health issues. It’s great. During one of the multiple times this was on in our house this week (damn you/thank you Virgin On Demand) the theme song became a permanent fixture in my brain.

Be happy, be healthy and get well soon
‘Cos the doctor and nurse, they know what to do (They do!)
They’ll always take good care of you.

Be happy, be healthy and get well soon.
The doctor will tell you what is good for you.
Be happy, be healthy and get well soon.

It’s those middle lines that jumped out at me. It is what we mainly want from the NHS: we’re ill, we need it sorting, we want someone with expertise to fix it. We’re lucky to have one of the world’s best health systems, we’re proud of the NHS and rightly so.

For some people it’s a bit more complicated though. If you have a long term condition that makes a big impact on your day to day life it’s more difficult for the NHS to support you well. Medication may make a big difference, and some therapies will help but ultimately the doctor can’t cure you. You’re the one trying to live as best you can with it every day. This is not easy –  maybe your health stops you working, makes you more dependent on your family than you want to be, and prevents you from getting out and about. All this will drag you down and further damage your emotional and physical health.

This is a challenge the NHS is trying to rise to, but it can’t do it on its own, and many of the shared care planning approaches being introduced recognise this. These tap into your own expertise about your life and how your health condition affects it. Together with the clinical advice of health professionals you come up with a plan that feels like its yours, not the doctor’s.

Personal health budgets are the version of this I know most about. The added component here is that you get to understand how much money the NHS has available for helping you stay healthy and maintain your well-being, and the plan says how this will be spent. Knowing the money is important because it frees you up to come up with solutions that are outside what the NHS can traditionally offer. It also means that the conversation between the person and the health professional is different, more equal.  So it’s not (all) about the money, but this component of the idea is fairly critical.

The final evaluation from the Personal Health Budget pilot programme is due out soon. Results from anecdotal reports, plus the interim reports already published show that this could work for people.

One of the videos on the pilot programme’s website feature Anita and Trevor from Hull, who were struggling to cope with the effects of Anita’s Huntington’s disease. They say how the original solutions the NHS was able to offer, such as going into a nursing home, or having agency staff coming in to help with bathing, just wouldn’t have worked. By coming up with other ideas based on what Anita liked, and by having control over who did come in to help, Anita is happier, and Trevor feels much less stressed.

There’s also an interview with David, who was able to make a relatively small change to the way the NHS supported him, that has meant he is able to get to work on time.

These people still needed their health professionals to help, but in different ways, and on different terms.

So Doctor Ranj, (and your colleague Nurse Morag) you’re still needed. But as part of a different conversation.

And anyway, you sing songs for toddlers about constipation. That’s a big deal in my house. So you’re still my hero.

2 thoughts on “The doctor will tell you what is good for you…

  1. Great blog Zoe. There is obviously some trepidation amongst some professionals and organisations – what are the best ways of helping people see this improves the NHS offer rather than undermines it?

    • Thanks Martin. Good question and I’m not sure entirely but the following have got to be part of the answer:
      The facts – it being clear as this is explained that it is still the NHS offer – still free at the point of delivery, resources being adequate to meet health needs; clear policies to avoid top ups etc.
      In addition you’d hope the direct experience of practitioners in personal health budgets would help drive this – that this helps them do the job they want to do, to work with people to provide solutions that are much more flexible and responsive than is often possible at the moment. Then it’ll be those clinicians’ ability and willingness to convey this to their peers that will change understanding.
      I also think it helps to understand the actual detail and reality of who is getting personal health budgets, what they get already and what they choose to do differently rather than to immediately assume this is going to be something that will affect all of the NHS. For example one of the areas the government has already indicated a commitment to roll out in is NHS Continuing Healthcare – the bulk of this funding is already spent outside the NHS on agency care for people with really high health needs. Personal health budgets don’t change this, they just give people the option to choose from a range of providers (including sticking with the one NHS has a contract with), negotiate a more tailored package with a provider, or take on employment of staff directly through using a direct payment.
      I also think that the soon to be published final evaluation report should help – it’ll provide an evidence base for personal health budgets of a scale not available anywhere, a solid basis for the NHS itself to understand how and where best to implement this.

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