Richard Taunt: Rethinking medicine—a longer term plan

Change takes time. We need to prepare for the future, not just firefight the present. The recent publication of the NHS Long Term Plan has given commentators an opportunity to wheel out some of health policy’s favourite clichés.

However, the development of Rethinking Medicine—a collaborative improving how medicine supports better health and healthcare in England—has me thinking about how you define “long-term;” and how setting a “long-term” endpoint changes where you begin.

So is “long-term” 5 years, 10 years, 20 years? In working it out you need to consider the scale of change needed, but also quite how embedded the status quo is. The Long Term Plan’s aim to reverse decades of hospital dominance sounds like a task for at least a decade. The plan’s aim to balance the attention given to physical and mental health is likely to be even longer.

Yet what Rethinking Medicine seeks to achieve is longer still. This is partly due to size. Rethinking Medicine tries to change how the art and science of medicine is undertaken across England. 125,000 doctors. 1.4 million healthcare staff. A health service seeing more transactions every day than debit cards. This is behaviour change on shock and awe scale.

But it’s also about the long-arm of history. Central to Rethinking Medicine are healthcare staff, in particular doctors, viewing their role in a completely different way: less about treatment of disease, more about understanding of people; as Victor Montori writes, “less healthcare, more care.” The roads people travel to arrive at these conclusions are varied—concern about overtreatment, desire for shared decision-making, embrace of determinants of health—but all share a discomfort that modern medicine doesn’t have the answers to the questions being asked of it.

Think of it not as junking medicine, but giving it a much needed upgrade. Yet the power the current medical model has is all around us. My 6 year old daughter’s doctors kit is one of her favourite toys. White coat and glasses to look clean and clever? Tick. Bandages and syringe to heal the sick? Tick again. (In a UK twist, every game starts with a spell in the waiting room). I’m yet to try sneaking down in the night and replacing the contents with some decision making aids, a primer in sanitation, or a lecture by Ilyich, but I think I know the reaction I’d get.

Our understanding of what doctors are there to do, and in return how we as patients respond to them is woven into the very fabric of our society. These roots are in part structural—the Royal College of Physicians has existed longer than the Royal College of GPs, the NHS, women’s suffrage, and the abolition of slavery, put together. But its roots are also cultural, based on elemental human fears. Until the 1850s it was more likely that going to see a doctor would harm rather than help you; why did people still go?

To change the daily practice of both the givers and receivers of healthcare is a century long task. We shouldn’t shy away from this. Besides a complete shift in public and professional social attitudes, for Rethinking Medicine to be complete it will also require an overhaul of education, regulation, and service delivery. We don’t have long: while the doctors of 2119 are not yet alive, 5% of their patients are, as well as a larger proportion of their teachers.

Which brings us back to what we do now. Rethinking Medicine is not a normal sort of programme. In fact, it’s less a programme (“a set of related measures or activities”) than a movement (“a group of people working together to advance their shared ideas”). Success for Rethinking Medicine in 2019 is not to execute measures or activities, but to expand what is already a fast growing group of people, sparking a range of conversations and ideas which can travel far further than from any one individual alone.

The public health professor Harry Rutter talks of 20 year plans where, if you move 5% towards your goal every year, you make it. It’s the same for Rethinking: if we get 1% closer this year, and next year, and the year after, eventually we’ll get there.

The NHS Long Term Plan is admirable in making the case for the need to plan further than simply beyond the next crisis. However, to see the real level of healthcare change we want to see, we need to set our sights on longer term goals.

Richard Taunt is part of Kaleidoscope Health & Care.

Conflict on interests: Kaleidoscope is a Community Interest Company which is supporting the development of Rethinking Medicine, a non-commercial collaborative funded by NHS England and the Royal College of GPs.