What is it about your job that you feel would surprise the public?
The general public probably won’t have heard of the Richmond Group or National Voices, which is quite clear when I talk to mums and dads at the school gate about my job. But the ‘health policy’ public would probably be surprised at how small the organisational footprint of the Richmond Group and National Voices actually is. We have very small budgets and small numbers of staff – three and six people respectively. The expectation of what we might lead or even comment on far outstrips the resource that we have.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
It seems to me there is much less confidence and optimism across the board now about the impact of any new strategies and plans. When I started in policy it was the New Labour years and money was coming into the NHS, it all felt slightly naively optimistic. But in more recent years, possibly as honest funding hasn’t been attached to some high-profile strategies and plans, there is much more cynicism about the value of very top-level policy-making.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
We need to really take seriously the truism that the NHS and health services are a ‘people business’ – the delivery of health care happens when a health professional and a patient have a conversation. We need to be much more sophisticated when it comes to understanding how people feel and think about that interaction – both for the patient and the staff member. For such a big, expensive service, it is really quite shocking how little we know and think about that.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
The almost naïve questions that he started off with – “why doesn’t the NHS do digital, why are we not talking about prevention, why are NHS staff so unhappy” – were actually quite refreshing. I’m more worried about who he listens to for the answers. If he listens to people trying to sell apps then there is a real risk of inventing solutions for problems that are yet to be found. Some issues may not need AI or a digital solution – they may be solved by something as pedestrian as a consultant giving a patient their phone number.
What do you wish people at the top of the NHS understood?
It’s a people business. We need to take much more seriously the challenge of understanding what makes doctors, nurses and patients behave in a particular way. It would be wonderful if an understanding of why people behave in the way they do informed the making of top-level plans, rather than just decreeing what needs to happen on a structural level.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
Policies that describe transactional changes seem to have a better chance of being implemented. When I first started there was a whole thing about hospitals being dirty and needing a deep clean. Then we had the whole handwashing conversation, which isn’t that long ago, with consultants saying ‘you can’t expect me to wash my hands 50 times a day’. But we insisted and they did. It's easier to insist on such transactional changes.
What policy have you seen fail, or not be as successful as first intended?
Policies that grapple with cultural challenges will struggle if they don’t think about the behavioural changes and skills and resources required. That is perhaps why the IT policy stuff has always been such a miserable failure. I can’t recall how many years now the policy has been to give patients access to their own care record, and yet still only a tiny minority of patients use that access or even know what to do with it.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
As I start my new role at National Voices, I think we need to stay closer to people’s experiences of health and care services when having policy discussions. ‘What does the problem look like for a service user?’ should always be at the start of any policy conversation. As organisations who stand up for patients, we also need to be much smarter between us – National Voices, Richmond Group, Healthwatch and others – in how we can let each other lead on certain issues while at the same time supporting each other. We can get more bandwidth going that way. We’re all small and the challenge is massive.
The NHS is under pressure because...
Because it doesn’t have enough resource. And because it will never have enough resource if it strictly sticks with a very biomedical model, where all suffering is seen as a medical problem and the answer is always more medicine. The answer may in fact be in better work or education, more social support and fewer inequalities.
Charlotte Augst is the new Chief Executive of National Voices.