Nurses could learn a lot from Lucozade. Way back when, you no doubt recall that Lucozade was only given to you when you were sick. Nowadays Lucozade has been rebranded as a health and energy drink. You choose to drink it today to keep you strong rather than have it given to you when you are poorly.
Likewise, the NHS is either something to be given to you when you are sick or indeed to prevent you from being sick. I believe that the image of the NHS has to flex. It still needs to keep the yellow cellophane-wrapped version, which tips its drink into the glass half empty. This is the NHS working as a deficit-focused, needs-based organisation. It is the deficit-focused needs-based paradigm. The health service is much needed when people are sick, or to prevent illness via immunisation, screening, lifestyle advice or health protection, which are all illness-avoiding concepts.
But nurses' knowledge of the alternative paradigm, one of a glass half full, an asset and strengths-based view, one that understands what creates health and wellbeing (a theory called salutogenesis) is wholly underdeveloped, wholly under-researched and wholly under-resourced. Some health and wellbeing boards have started to embrace the concept, but within nursing it is still relatively unknown.
We have now reached a stage where three whole generations have grown to adulthood only knowing the NHS. They have not had to fend for themselves healthwise or pay for care. If you look at the behaviour of different generations, you see increasingly that many people today are becoming consumers: passive recipients of care, rather than actively engaged in their own health and wellbeing, as they felt they once had to be. The NHS is becoming a victim of its own success. Free at the point of delivery, it is always there for us and increasingly it is being abused.
Efficiency and effectiveness predominate current management thinking, with something akin to a nuclear arms race in technical innovation. Yet perversely the demand for new sickness solutions via the development of drugs, techniques and equipment accelerates costs and activity. The end point is prioritisation via NICE guidance and restrictions on access, with a public hue and cry.
But what of social innovation – seeing residents themselves as able to improve their own health and wellbeing? Take one look at a men's shed, to give purpose and meaning to the lives of retired men, or a choir for people with dementia and their carers, and tell me that it is not protective of their wellbeing. Is this efficient and effective too? The shocking answer is that we haven't given it enough attention yet to really know. Blogger Andrew Seif at the excellent innovation charity NESTA argues that this is because people are less controllable and thus more difficult to work with than machines or drugs. But nurses and patients start from a position of mutual respect and so I believe we, nurses, should be in the vanguard of co-production methodologies.
I argue that, to halt the rise in consumerism, our residents, patients and carers need access to two bottles of Lucozade. To prevent illness or for those who are actually unwell we need the cellophane wrapped version – we as nurses care for them using all the healthcare means at our disposal. But for those whose happiness and wellbeing is compromised: the isolated, the poor, the socially excluded, the bereaved, the redundant – they need Lucozade as an energy drink. We need more bottles of this and while keeping the numbers of cellophaned bottles the same.
The passive need our help to become active and this requires a metamorphosis in nurses at every level. We must to look to the fire service and the police, who have moved away from wholly heroic, fire and crime-fighting models and now work closely with residents to avoid crimes and fires in the first place. The simple act of a Merseyside fire prevention officer reminding one neighbour to call on an isolated elderly neighbour that he has lost touch with, to help with shopping, can be replicated by us all.
This might seem like heresy to say, but we nurses too should recognise when our addiction to caring, bred into our genes, is turning our population into passive consumers of health. The evidence for wellbeing suggests that people need a purpose and to feel more in control of their own lives. In addition, to feel good you have to do good and nurses are not the only ones who can benefit from this feeling. The sooner we see residents, careers and patients as truly equal partners, the better for the nation's health.
With thanks to Chris Dabbs, Director of Innovation at Unlimited Potential, a Salford social enterprise, for his thoughts.
Heather Henry is co-vice chair of the NHS Alliance and an independent Queen's Nurse