“Public Service –What’s that all about” by @Mac_imar


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We have seen from recent blogs that we celebrate 66 years of the NHS (Happy Birthday NHS !!!!! by @shazmcgarva & @Emmcg2, 04 July 2014) and that it is a treasure we hold dear as can be seen from the high profile it received during the referendum and the current focus as we lead up to a general election.

What was the original idea behind the NHS and the creation of the welfare state and what is the notion of public service and what, or perhaps who are we here for?

When William Beveridge in 1942 produced the blueprint for the welfare state he had” five giants” that needed to be eradicated, these were ignorance, squalor, want, disease and idleness. This blueprint ultimately led to the creation of the welfare state and the National Health Service that was founded by Aneurin Bevan in 1948.

In tackling these the welfare state grew into something he didn’t predict, an over professionalization of services that relied on high tech equipment, professional knowledge and sophisticated processes, which ultimately created dependence and lack of resilience within the communities it served.

This I think reflected some of the pejorative language we use, terms like our patients, my patients framed a “we know best” approach, but we now see the development of a more personalised approach which identifies personal responsibility and some degree of accountability to be involved in our own healthcare and become partners in collaboration rather than passive participants

A more facilitative partnership approach to delivering health care commonly described as Co-production drives a process to involve people in this sharing and supports the development of community resilience i.e. people helping themselves. This starts to shape our role into “helping people decide not telling people what to do” and was eloquently described by Shaun Maher in his blog titled “Keeping the lights on” (@Shaun4Maher, 22 August 2014) by the difference between asking “What matters to you?” not “What is the matter with you?” This approach is also well established within the Health Improvement work taking place in D + G and by Elaine Lamont blog “Services…but not as we know them” 26 September 2014.

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So how do we know if we are managing to do this effectively and provide high quality health and social care to those whom we serve?

Most commonly in the NHS and Social care a lot of what we do is driven by the need to meet various targets and attain levels of quality by implementing a variety of improvement programmes

Measuring what we do and telling our story of how well we are doing sometimes doesn’t match up, how often you have heard people say “that score or report doesn’t reflect accurately what we do”

It can be easy to become demotivated, frustrated and feel that what you do doesn’t have a positive effect and that you are drowned in form filling, report writing and action planning. A recent (2010) study called “the Bermuda triangle” found that in one hospital there were 515 projects all linked to improvement work, another hospital started a balanced scorecard approach with 4 strategic categories that then developed into 252 performance measures

This created increased workload and meetings which focused people’s attention on compiling reports and action plans to improve results rather than focus on the work that was being done on what you might call the front line

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So peoples behaviours and energies have been shaped by the tools which we have created, or as Marshall McLuhan stated “We become what we behold. We shape our tools, and thereafter our tools shape us.”

Euan 7Has the NHS moved away from its roots and purpose, have we lost something of what we had in our communities that supported and looked after people and helped them to be resilient, to ask questions, to seek solutions to be all they could be.

What are we trying to create with ideas of personalisation, co-production and collaboration and does this truly present us with a new model for a way forward in the NHS given the huge challenges we face, how can we engage the public in a debate about making the NHS better, harnessing the people’s ability to be part of the solution.

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One example of this collaborative approach came following the announcement in June 2014 by the Cabinet Secretary for Health and Wellbeing, Alex Neil MSP, that: “… we must do more to listen to, and promote, the voices of those we care for. We need the voices of our patients, those receiving care and their families, to be heard in a much clearer and stronger way” the Scottish Health Council working in partnership with Scottish Government officials, COSLA officials, and members of the Alliance, have been doing work on the ‘Stronger Voice’. Locally the Scottish Health Council has responded to this by setting up a “people’s database” , a list of people who are willing to be part of public involvement and in a way suited to them eg. Email, focus group, online survey.

(Contact: dumfries.galloway@scottishhealthcouncil.org to get involved!)

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So clearly most would agree that working in the NHS is at times stressful, chaotic, and a complex arena, with no easy answers, we might wonder if we are making a difference, we might think of the old days when things were better or have our own ideas of what needs to be fixed. Sometimes these things may appear outwith our direct control or even our ability to influence, but sometimes just sometimes there may be times when are able to exert control and influence for change.

Euan 9.2A colleague I worked with some time ago would always say “don’t give me problems give me solutions” and one way of looking at solutions has been a key feature of a therapeutic approach called “solution focused therapy”



Euan 9.3The Solution-Focused model emerged from the therapeutic arena of Family Therapy in the 1980s. Since then, its psychological principles have been applied to a wide range of fields, from mental health to organisational change. The model reflects the values of co-production as it affirms collaborative, personalised, strengths–based values and a clear focus on sustainable outcomes.

The aim of a Solution-Focused approach is to help individuals, teams and organisations develop constructive, customised solutions. It is therefore solution-focused rather than problem-focused. So the term indicates where we look: forwards, towards solutions, rather than backwards, by studying problems.

The approach commonly begins with the miracle question:

So my thought for you is this:

In amongst all the things we have to do, the daily grind of serving and caring when things can sometimes be a bit of a bother, the things that irk, whatever it is that bothers you about working in the NHS here’s a miracle question for you

Suppose….You finish your day, go home, go to bed and eventually you fall asleep

….And while you are asleep a miracle happens

….And this problem has vanished or things are how you want them to be

…..But, you’ve been asleep so you don’t know the miracle has happened. As you

wake up – in the middle of the miracle – what’s the first sign you notice that tells you

things are now as you would like them to be?

What do others notice that is different?

What are you doing?

What are others doing?

What else is happening?

How are people responding?

What is the positive impact of this for you and other people involved?

What else do you notice?

Who else notices what is happening?

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Feel free to share this with colleagues and allow yourself the opportunity to begin looking forward and not backwards

Euan McLeod is the Senior Project Officer for the National Bed Planning Toolkit

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