Posted by: ayrshirehealth | April 10, 2013

Moving Forward by Learning from the Past by @maidenturret

Grateful for my lot

I am very fortunate. I have a rewarding job (in the public sector – not in the ‘real’ world as some of my friends tell me), a decent house and a salary that gives my family and me the opportunity to do most of the stuff we wish to do. While I have noticed some impact of austerity measures on my disposable income, I want for nothing in material terms.

Reality check!

I was in a branch of a well-known store (the one where you choose your purchase from a catalogue and then stand and wait on it being given to you for 20 minutes – never understood the concept!) before Christmas last year, and I overheard a conversation next to me. A mum was choosing a Christmas present for her son, who was with her. imageA bit of an exchange was taking place over what the mum was going to buy with the money she had. The bottom line was that the mum could only afford to buy one item on the list. Her son, who looked about 10 years old, was making his point that he had a list of things that he wanted for Christmas. The mum was clearly distressed.

My heart sank as I heard the interaction between mother and son. I reflected upon the fact that I am able to provide my daughter with all the items on her Christmas list (within reason!), which add up to a considerable amount. I never really give it a thought. How would I cope if I were in a similar position as the mum I overheard? How would I feel? How would my child feel?

Time for a change

Cleary, I don’t know the detail of the individual circumstances of the mum and her son. However, the experience made me reflect on two fundamental issues – inequality and the scourge of ‘isms’

Our society is driven by individualism, consumerism, capitalism, materialism, scientism etc, which raise the question have we pushed modernity too far? While I am not knocking the benefits of modernity (scientific evidence, improved health, material prosperity etc), I would argue that there is a need to reframe our approach to the way we define ourselves and society as a whole (while retaining all that is worthwhile).

The evidence[1] suggests that we need to shift our attention away from increasing material wealth, to the social environment, and the quality of social relationships.

NHS Scotland by board

The social concerns which plague many rich societies are much more common in more unequal societies, such as Scotland.
Countries with smaller income differences between rich and poor are more unified: community life is stronger, levels of trust are higher and there is less violence. The evidence shows that if Scotland had less of a gap between rich and poor that the majority of the population would benefit.

So would I be happy to contribute more in taxes? Yes, if I thought it would be redistributed to close the income gap, rather than disappear into the ‘black hole’ of the national deficit!

What this got to do with healthcare?

While the public services can do little to address income inequality, I believe public services are well placed to take the lead in reframing the current paradigm to take a different approach to the challenges we face. I have been hugely encouraged by the thesis offered by Professor Phil Hanlon and colleagues[2] who describe a more integrative approach for public health. This work draws on a range of ideas including those of Ken Wilber and Plato.

Hanlon recognizes the need to re-integrate the elements of life that have been separated by modernity. He argues that policy development and decision making, service delivery etc would be transformed if we paid equal attention to science, ethics and aesthetics. handshakeI would also argue that this approach would address the ingenuity and innovation gap that currently exists within large public sector institutions, such as the NHS.

For example, can you imagine an option appraisal process for a new community hospital that involved all stakeholders (with equal number of lay representatives and professionals) and paid equal attention to the following:

  • Ethics (the ‘good’) – is this the right thing to do?
  • Science (the ‘true’) – what is the evidence base for this?
  • Aesthetics (the ‘beautiful’) – will it raise our spirits and fire our imagination?

I’ve never had such a conversation in the NHS, have you?

As the impact of welfare reforms kicks in, we face at least another ten years of austerity. As an institution which purpose is to care for the health and wellbeing of citizens, the NHS is well placed to strengthen its contribution towards addressing some of the wicked problems that determine the health and wellbeing of the people we serve (employability, hope/meaning purpose, increasing social capital etc), but doing so in an integrative way.

Plato said The part can never be well unless the whole is well’

This week’s blog was by @maidenturret (Andrew Moore) who is an Assistant Nurse Director in NHS Ayrshire & Arran.

Next week @craigwhitephd returns to ayrshirehealth with his second blog

References used this week:

[1] Wilkenson and Pickett (2010) The Spirit Level: Why Equality is Better for Everyone

[2] Hanlon et al (2012) The Future Public Health Maidenhead Open University Press


  1. I wholeheartedly agree that we need to move away from consumerism and individualism back to community and social relationships, however I think this is fraught with difficulties because people have got used to having more and being comfortable. I’m a full-time carer on £59 a week for over 35hrs care up to 24/7, depending on the needs of the person I care for, who has been labelled and disabled by psychiatry. I’m also a mental health activist and campaigner, using my 30yrs of community development grassroots work to fuel my present passion which is to see a paradigm shift in psychiatric treatment.

    I scribe for my son at sociology classes and recently we viewed ‘The Century of the Self’ series of BBC films, about Freud’s influence on democracy and Bernays’, his American nephew, influence on consumerism, in fact he is credited as the inventor of Public Relations:
    This film series was very informative and helped me make sense of where we are now, in terms of psychiatry and social circumstances. The consumerist society and the obsession with possessions, the ‘big brother’ aspects and the controlling of the masses. Why we have moved from psychoanalysis and psychotherapy to psychiatric drugs as the be and end all, when in fact they are causing disability and more mental ill health than the original diagnosis or label.

    I have found that there are ethical questions being asked in terms of mental health services and have had many conversations about this, being a survivor activist and participating on national MH groups. Prof Phil Barker, architect with his wife Poppy, of the Tidal Model of mental health nursing practice:
    edited a book about Mental Health Ethics:
    with a range of articles to do with services and psychiatric treatment. The use of compulsion and force in psychiatry is a contentious issue with many, especially those of us who have been forcibly treated. It’s never OK, in my opinion, for drugs to be shoved into a person, in the name of psychiatry. I experienced this in 1978 and 1984, the threat of it in 2002, and I really don’t feel happy about it. I want to see mental health treatments that are about the person and not about the system or control. Which means a getting back to the social relationship, as you advocate, and underpinned by science which sociologists would say was more about relationship than truth. For how can we know absolutely that anything is true or right except if it’s right or true for us?

    Chrys Muirhead

    • Chrys, thanks for your comments. I think we are very much on the same page, regarding person centred care. I am hugely troubled by the current governments welfare reforms and I have always felt that carers have had a ‘bum’ deal. There is a growing number of people articulating the need for a change of orthodoxy, which makes me cautiously optimistic. I suppose we need to keep chipping away!

  2. Thanks Andrew – enjoyed the read and found it thought provoking. I always think it’s sad when some people get a warm glow from ‘getting’ or acquiring ‘things’. To me that’s not what life should be about. If you ask people they remember experiences in their life rather than the acquisition of a new car or coat, and it’s those experiences that shape and influence their views and attitudes. A more equal society may seem idealistic but it is achieved in other places such as the Scandinavian countries.
    If we are truly committed to mutuality in the NHS there’s no reason why there can’t be equal representation of lay members and professionals on committees and groups – aspirational but achievable.

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