Working together for change

This week I attended an interesting round-table meeting, hosted by the Academy, to discuss “Shifting the focus of care and taking the public with us.” The discussion was positive and engaging but I was troubled by the title of the event. It brought to mind an old Kevin Costner film, Field of Dreams, in which Costner is (mis)quoted as saying “If you build it they will come.” The implicit message in “taking the public with us” seemed to echo Costner’s advice to go ahead with your dream and then wait for it to come true.

To be fair, I don’t think it was the intention of anyone at the round-table that major changes to provide services closer to home should be imposed against the wishes of patients and the public. Anyway, most patients don’t want to be in hospital longer than necessary. They have wanted treatment, care and services at home or in their local communities for decades, so why would they need to be persuaded?

All the same, the essence of “taking the public with us” is an interesting semantic relic from a more paternalist era. But language matters as it influences values and mindsets as well as reflecting them, so it’s important to frame the debate in the most helpful words so that patients can be the drivers for positive change.

Of course, there are instances where overwhelming scientific evidence does require a firm steer from professionals, backed by effective messaging to build public support. The successful development of centralised stroke services is one example, and the need for a more cautious use of antibiotics may well be another. But, by and large, patients and the public know best what their needs are. And because of their personal experiences, they are often deeply interested in the issues that must be addressed to deliver effective and appropriate services.

I’ve said it before, and I’ll say it again, grand visions and strategies are only as good as the implementation that supports them. People who use services, and their families, have first-hand experience of what works – and of what stops a service from working effectively. For example, the practicalities of communication with patients after diagnostic tests, being clear about how to obtain follow-up advice when clinical or social needs change, real-time reporting of glitches that only patients know are happening: these are everyday examples where patients’ experiences can turn dreams into reality.

So, can we all agree that our future field of dreams will be based on patients and the public being valued as equal partners alongside those who plan, commission and provide health and social care? This is a much more ambitious project than a post-hoc attempt to convince people of what is supposed to be good for them. But given that the large amount of rhetoric about strengthening community services has not, so far, led to consistent and sustainable improvements across the country, surely it’s worth a try.

Ros Levenson

Chair of the Patient and Lay Committee, Academy of Medical Royal Colleges