News and Comment

Changing Times with Professor Chris Drinkwater, President of the NHS Alliance

Friday 10 May 2013

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In today’s Changing Times interview we hear from Professor Chris Drinkwater CBE, a GP in Newcastle for 23 years and now emeritus Professor of Primary Care Development at Northumbria University and the President and Public Health Lead for the NHS Alliance.  

If you compare today’s society and the society into which you were born: what’s most strikingly different, and what’s most surprisingly similar?

The thing that is most strikingly different in today’s society is the digital revolution.  I didn’t own a computer until I was in my thirties and but today, like many people, I’m totally dependent on technology and all but addicted.

The more insidious difference is that there has been a gradual shift from collectivism to individualism, which has seen the commodification and outsourcing of public services.

There are two things that I find noticeably similar, though perhaps one is more surprising than the other. The first is that Maslow’s hierarchy of need still holds good: belonging, being valued and the ability to achieve remain the most important human needs.

Secondly that the medicalisation of health (see Ivan Illich 1975 book Medical Nemesis: the expropriation of health) continues at pace. Indeed considering current projections that health will make up 20 percent of the United States GDP by 2012, it’s possible to imagine a situation where it will make up 100 percent of GDP in the not too distant future.

Given difficult choices have to be made, what one public service or source of support do you think we should prioritise most highly, and why?

We should re-build collectivism and social capital through a focus on local co-production of health, which requires greater engagement with both patients and the public.

If you could choose one person to be the Prime Minister’s adviser, who would that person be, and why?

Any adviser should have a greater focus on generalism than is currently common.

Their key competencies should include emotional intelligence, and the ability to think from a whole systems perspective.

The Department of Health for instance, has been dominated by specialists with a vested interest in technical specialist fixes rather than generalists with a broader whole system perspective.

Let’s have more older people and more general practitioners at the top.

Public services rely on voluntary support more than ever: is this to be welcomed?

Yes. This type of voluntary support is the nearest thing we have to a collective approach. There is a perception that the world is dominated by corporate fat cats and self-interested state bureaucrats, and this flies in the face of that.

In the best case scenario, what will public services be like by 2023? What about the worst case scenario?

The best case is a Wanless “fully engaged” scenario, in which there is as much focus on preventing ill health as curing ill health.

The worst case scenario is a fragmented two tier American-style system with multiple providers and co-payments, in which the wealthy get a world class service while the rest get second class treatment.

Previous Changing Times contributors

Matthew Taylor, Chief Executive of the RSA.

Professor Kate Pickett, epidemiologist and author

Carolyn Downs, Chief Executive of the LGA