SDHI in collaboration with NHS Fife, the Scottish Improvement Science Collaborating Centre (SISCC) and the International Futures Forum (IFF) hosted an interprofessional and interdisciplinary seminar and workshop with 20 participants to envision the future of a healthcare system currently under strain. Dr Margaret Hannah, Consultant and Deputy Director of Public Health in the NHS Fife and author of ‘Humanising Healthcare: Patterns of Hope for a System under Strain’ and Graham Leicester, Director of the International Futures Forum (IFF) facilitated the afternoon with SDHI Co-Director Thilo Kroll.
Healthcare systems are under ever increasing performance pressures and exposed to massive rises in expenditures. At the same time criticism of the way we deliver health care grows highlighting the lack of compassion and a detachment of people’s life priorities and choices. Inequalities in health care access, treatment use and outcomes are not being tackled adequately. The research that supposedly generates the evidence base for effective therapies and interventions is selective, exclusionary, de-contextualised and for many long-term conditions flawed. Faced with a growing number of people who manage not one but multiple long-term conditions outside institutions in diverse community settings health care systems lack co-ordinated, integrated quality practice models that are centred around people’s lives and not primary their health conditions.
So, what are the alternatives to the status quo? What can we learn from the past? Perhaps, very timely 2015 saw a re-publication of the book ‘A Fortunate Man: The Story of a Country Doctor’ by John Berger and Jean Mohr. The book had originally been written in 1967 and was based on the sensitive portrait of John Sassall, a GP in the Forest of Dean. It illustrates his relationships with the diverse residents of this rural community and his approach to understanding the delivery of health care in the context of the social and environmental fabric of rural living. A quote from the book illustrates this very well
“Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place. For those who, with the inhabitants, are behind the curtain, landmarks are no longer only geographic but also biographical and personal.” (pp 18-21)
Margaret Hannah describes in her book the way our current healthcare arrangements are costly, guideline driven and dis-ease and disorder focused. Hope lies in adopting a salutogenic, asset-based approach that works with (not for) individuals and communities as co-creators of health. The workshop identified opportunities for transformational change in the way we deliver healthcare through co-creation approaches and participatory action research. It also requires the collaboration with non-traditional partners in health, i.e. community organisations, local authorities.
We are currently working on a briefing paper based on the workshop, which we will make available for reflection and discussion shortly.