By Jim Phillips

In the UK last winter hospitals were at full capacity, patients were left waiting on trolleys in corridors and waiting targets were missed.

At the same time GP surgeries were full and people were waiting weeks to get an appointment to see their GP of choice.

Who got the blame?

As usual the media largely focused on money and lack of doctors and nurses; fuelled often by lively and heated debate in parliament.

Other parts of the media pointed the finger elsewhere- patients were the problem:

• Bed blockers – people who are fit to leave hospital but don’t have the support at home to leave.
• People using A&E when they didn’t need to.
• People wanting GP appointments for common self-limiting ailments that the pharmacist could have helped with.

Against this back drop a quiet revolution in health and social care has been taking hold across Europe- The idea of empowerment.

It takes many forms and names- health literacy, patient activation, self-care, self-management, asset based approaches.

They all though have one thing in common- that for health and social care to be sustainable people and communities need to work collectively with health and social care services to develop services that are sustainable and support people how to manage their health and wellbeing- including appropriate use of services. So that people can make informed decisions about the care they want and know what their role is in staying well.

Because it is not the patient’s fault that they are in the hospital or in the GP’s waiting room seeking answers to health problems that the clinician is all too often not able to provide.

Modern medicine has promised much but for many of todays health issues it falls well short of providing a cure.

Studies have estimated that only 20% of health outcomes are due to clinical interventions. The majority are down to lifestyle and choices we make about lifestyle and the opportunity to make healthier choices.

To have sustainable and affordable health care we need to fundamentally change the conversation between health care services and the public in the industrialised countries. There needs to be a shift from (to borrow a phrase) “what can health care do for me” to “what can I do to care for my health and those close to me”.

Initiatives such as social prescribing- used as a way of reducing a social isolation and connecting people with community support perhaps reflect the rise in social isolation and fragmentation of communities. In well connected communities people know who is alone or needs help, who needs meals cooking or shopping done after coming out of hospital.

So perhaps issues such as bed blocking caused because people have no nearby family to support them are a symptom of a increasingly fragmented society. A society that is strong on individual rights but unwilling to take on the responsibilities that need to go with them.