http://www.demos.co.uk/projects/healthyconversations/ en-us Copyright 2008 Mon, 07 Jul 2008 00:50:28 -0100 Latest items from Healthy Conversations on http://www.demos.co.uk/ - the thinktank for everyday democracy Mon, 07 Jul 2008 00:50:28 -0100 http://www.demos.co.uk/items/11839 http://www.demos.co.uk/items/11839 The Talking Cure. Faizal and I wrote the pamphlet to try to capture the changing conversations taking place between professionals and patients around health. The discussion at the launch was fascinating and impassioned. Howard Stoate gave us his perspective as the only practising GP in the House of Commons. Richard Horton was as thoughtful and fired up as ever. You can listen to all of the speeches, questions etc. here.

The pamphlet has been picked up by a few publications involved with questions of health, medicine and professionalism. The Pharmaceutical Journal picked up on our discussion of concordance and the changing role of pharmacists. We also have a podcasted discussion, and I have written a piece for Comment is free - attracting the usual agora/crucible backlash.

So please have a look at the pamphlet and let us know what you think.]]> Mon, 19 May 2008 13:44:06 -0100 jack.stilgoe@demos.co.uk ( Jack Stilgoe ) http://www.demos.co.uk/items/11688 http://www.demos.co.uk/items/11688 Dr. Edzard Ernst, a prominent professor of alternative medicine, is interviewed in today’s Independent talking about his new book, Trick or Treatment. From what I gather, it gives alternative medicine a bit of kicking, demonstrating its ineffectiveness when subjected to randomised controlled trials.

Two interesting points strike me about the article.

The first is that whilst Dr. Ernst is very critical about the complementary medicine industry, he doesn’t shy away from criticising mainstream medicine too. In fact he singles out mainstream medicine’s lack of interaction as a large factor driving people to alternative medicine;

"Mainstream medicine is pretty awful, too. Doctors lack empathy and time. There is plenty of evidence that people using alternative medicine don't even expect effective treatment – they are just looking for a therapeutic relationship. They are not getting it from their GP, so they look for it elsewhere."

This relationship is often overlooked in policy conversations and healthcare debates, even though as Dr.Ernst highlights it’s at the heart of good healthcare. Our upcoming report, The Talking Cure (formally Healthy Conversations), examines precisely this issue, looking at the importance of the relationship between health professionals and patients. You can find out more here.

The second point of interest is Dr.Ernst’s findings that complementary therapies can have a strong placebo effect. For example, the interview sites four wheelchair users getting up and walking under the influence of a healer (or so they thought, it was actually an actor/voice recording).
This got me thinking about what we consider to be legitimate effects. Why isn’t a placebo benefit considered a legitimate product of the alternative treatment? We know that placebos work in some circumstances. Yet the essence of a placebo is that you don’t know it’s a placebo. Inherent in this is some form of deception, whether it’s by a doctor or an alternative therapist.  If the narrative of complementary medicine allows people to heal, is not valid? Does it not serve its purpose, if its purpose is to be a necessary disguise for a placebo?
 
If I understand the views of philosophers such as Richard Rorty correctly (and I may well not have), a ‘pragmatic’ philosophical approach argues that a belief is a device for understanding the world, to be shed when no longer useful. Science is not therefore a mirror of a true nature but a language through which to understand the world. If that’s the case how do we manage issues like alternative therapy, which science tells us is false, but still appears to benefit people?
]]> Tue, 22 Apr 2008 15:10:37 -0100 faizal.farook@demos.co.uk ( Faizal Farook ) http://www.demos.co.uk/items/11633 http://www.demos.co.uk/items/11633 Dr. Howard Stoates MP – Member of Health Select Commitee & GP
Richard Horton – Editor, The Lancet
Colette Goldrick – Director of External Affairs, Pfizer UK
Douglas Smallwood – Chief Executive, Diabetes UK
Jack Stilgoe – Senior Researcher, Demos
Catherine Fieschi – Director, Demos (chair)

Launch of a new Demos pamphlet and a discussion on the future of medicine and healthcare.

Approaching its 60th birthday, the NHS faces a flood of chronic illness. Prevention and self-management are increasingly vital but increasingly difficult. Patients are losing their traditional trust in medical experts and gaining access to new sources of information. It is now time to rethink and rebuild relationships between patients, professionals and the public.

With the noise of recent healthcare reforms, the everyday conversations that matter most have been drowned out. In this pamphlet, we look at innovative relationships that are starting to emerge and the barriers to further change. We argue that the future of the NHS lies not in new structures or new technologies, but in new conversations.


You can download recordings of the event here:

1. Colette Goldrick, Pfizer. (3 mb, mp3)
2. Jack Stilgoe, Demos (20 mb, mp3)
3. Dr Howard Stoates MP. (12.5 mb, mp3)
4. Richard Horton, Editor, The Lancet (20 mb, mp3)
5. Q&A Panel discussion. (46 mb, mp3)

Or you can listen to all these recordings at the Archive page.]]> Tue, 15 Apr 2008 15:25:05 -0100 jack.stilgoe@demos.co.uk ( Claire Coulier ) http://www.demos.co.uk/items/10515 http://www.demos.co.uk/items/10515
Last Thursday, we hosted a conversation among various people interested in the changes to the ways that patients talk to doctors and to each other. We were delighted to have Harry Cayton and Angela Coulter to prompt the discussion. They have both been at the heart of debates about patient engagement in health for years - Harry as patient tsar at the Department of Health and formerly head of The Alzheimer's Society and Angela as head of the Picker Institute.

We have recorded their talks for a Demos podcast, You can listen to the podcast...

1. By subscribing via feedburner
2. Listening via the Internet Archive
3. Downloading the file (14.5MB)
4. Listening below on the embedded player (you need quicktime),

It's quite a long one so maybe it's worth having some markers: Harry Cayton starts at 1:33 and Angela Coulter starts at 6:54.

We have also produced a note of the discussion, which is here.

We wrote a discussion paper to get things going. It captures our emerging ideas in the healthy conversations project. Next, we'll be exploring these with patient groups and professionals. And we'll see how the hope of conversational healthcare matches the everyday reality.]]> Thu, 18 Oct 2007 16:59:58 -0100 charlie.tims@demos.co.uk ( Jack Stilgoe ) http://www.demos.co.uk/items/10311 http://www.demos.co.uk/items/10311 papers this morning, it looks like Derek Wanless has thrown the efficiency cat amongst the NHS pigeons. We already knew that a large proportion of extra NHS funding went on staff wages, yet according to Wanless we have seen little increase in productivity.

Improvements in smoking cessation and increased life expectancy are being countered by increasingly poor lifestyles/obesity and rising health inequalities between rich and poor.

According to NHS statistics total staffing (FTE) in the NHS has increased by 3.4% annually between 1997 – 2005, so it is going to be interesting to hear the reasons for why the front line have been unable to make substantial progress in improving health service productivity.

One of the things that strike me as problematic, in terms of efficiency, is the current way that the NHS divides up clinical and financial responsibilities between clinicians and management. Perhaps giving clinical leaders some financial responsibility for their departments would encourage the minimisation of inefficient clinical behaviours.

Of course, a much wider reform of NHS management practices will be also needed. One of the most interesting innovations is the use of Toyota’s lean management techniques, which seems to have already proved successful in Scotland. You can find a really interesting edition of Radio 4’s In Business looking at the NHS' use of ‘lean’ here.

Wanless’ findings also show the increasingly urgent need for a much more engaged, self-managing population, even if we can increase productivity within hospital/clinical contexts. The divisions between public health and acute/primary care will clearly need reconfiguration to tackle the lifestyle/chronic conditions that are an increasing threat to the health outcomes of British people and the viability of the NHS.]]> Tue, 11 Sep 2007 11:25:22 -0100 faizal.farook@demos.co.uk ( Faizal Farook ) http://www.demos.co.uk/items/10298 http://www.demos.co.uk/items/10298 GP’s open surgery out of hours and on weekends.  This has met with some criticism from the BMA, who argue that other professionals don’t have to work weekends, and that out of hours work would mean a reduction of normal hours service.

There are genuine questions to be asked around how to shape our current model of GP care to best suit the healthcare requirements of a 21st century working population, especially within the context of a need for an engaged, self-managing ‘patient’ population. The importance of early intervention and prevention places an emphasis on both access to, and effective relationships with, health professionals.  

Although a recent DH survey showed that most existing patients were satisfied with their GP services, I argued in my letter to the Guardian that healthcare responses will need to work within the reality of our wider population’s social behavior to maximize the opportunities for health conversations.

Obviously, any reconfiguration of GP working practices will need to take account of optimum clinical delivery and GP working conditions but these are not inherently obstacles to accessible, continuous GP care.

We hope to discuss some of these issues further in an upcoming workshop as part of our Healthy Conversations project. If you would like to know more about either the workshop or the project drop me or Jack Stilgoe a line.
]]> Mon, 10 Sep 2007 12:23:28 -0100 faizal.farook@demos.co.uk ( Faizal Farook ) http://www.demos.co.uk/items/10296 http://www.demos.co.uk/items/10296 Guest Speakers:
 
Professor Angela Coulter, Chief Executive, Picker Institute Europe
Harry Cayton OBE, Chief Executive, Council for Healthcare Regulatory Excellence
Dr. David Colin-Thome OBE, National Clinical Director for Primary Care (tbc)
 
A Demos breakfast seminar  on conversational healthcare. 
 
We know that the doctor-patient relationship is changing. Sources of health information have multiplied and the GP’s monopoly on knowledge is wobbling. But as we move from paternalism to ‘patient-centred’ how should we think about professionalism and expertise? What are the advantages and challenges of patients and the public playing a more active role in their own healthcare? As the questions patients ask become more complicated, how do conversations with doctors need to change?
 
At this workshop, we want to tackle these issues and more with interesting, interested people, as part of a new Demos project looking at the everyday aspects of health policy.

This is an invitation only event. If you are interested in attending please contact faizal.farook@demos.co.uk
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