On June 26th I attended a “community partners” event in Cheltenham, run by NHS Gloucestershire (the NHS primary care trust) to get feedback on its plans for Gloucestershire’s health economy over the next five years. The event was one of four that brought people together from a variety of organizations involved in health and social care.
The event began with a presentation and ended with group discussions. The results of the discussions are not available yet, but I’ll review them when they are. The introductory presentation gave a view of population and health statistics looking out to 2035, but the reliability of such projections was not discussed.
The themes for the group discussions, however, were not strategic themes but only tactical plans for the period from now to 2017. When I pointed this out, a presenter said that we should focus on strategic solutions, and tried to blame politicians:
It’s quite difficult for the public sector to look more than five years ahead because we’re part of a political process.
Someone else pointed out that:
A lot of people feel abandoned by the NHS.
The response to that was that the event must not be just a talking shop.
Despite these reassurances, the six scenarios that formed the basis for discussion illustrated current issues in public health, not strategic issues, and it seemed to me that strategic thinking in the discussions was discouraged by the facilitators.
The main presenter summed up by telling us to:
Suspend, today, any negativity!
And then he left.
In my group the initial discussion was based on a scenario in which a fictitious Mrs Jones and her two children are all obese. Apparently there is more clinical obesity in Gloucester than in Cheltenham, but no one knows why.
A member of the group described, from personal experience, the antagonism towards obese people from all healthcare services. As a result, obesity causes “diagnostic overshadowing” that results in other conditions not being detected and dealt with. There are knock-on effects on mental health.
Another member of the group suggested that the methods that are proving effective in the management of drug misuse could be applied to obesity too.
Other scenarios that we discussed included a fictitious woman found in the street at 2 a.m. wearing only a nightgown, someone with a learning disability whose carer develops type 2 diabetes, and the complex issues around hospital discharge:
There’s lots of things, but they don’t work.
I thought the discussion brought out many interesting experiences around the table, but the facilitator seemed resistant to strategic or innovative thinking. Time and time again someone would describe from experience how current approaches are not working well, but the official line seemed to be that what’s needed is more of the same approaches.
It will be interesting to see whether the four events achieve anything.