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We don’t talk nearly enough about…the art of being a good guest 

Anna Lewis calls for more discussion about the fine balance between institutional support and patient independence, and how they impact individuals' health and wellbeing. The art of being a good guest is knowing when to leave.

Early hours of Saturday morning. A glorious evening with friends – sharing food, wine, stories, life. Reconnecting over experiences, shared, remembered and retold, much to our mutual delight and appreciation. That is, for the first five hours. By hour seven, my introvert battery was hovering precariously between the last sliver of the red bar and total shutdown. The epitome of diminishing returns.

The art of being a good guest is knowing when to leave.

How about if the host is a patient and the guest is the NHS? If indeed we are guests in patients’ lives (as people as varied as Don Berwick and Cormac Russell remind us), how good are we at knowing when to leave? How do we judge that sweet spot between hospitality shared and a welcome outstayed?

What if the prolonged presence of the NHS actually hinders the strengthening of communities, and thus better health?

We all know that the NHS has to change to survive. The contemporary shorthand for this is ‘The Long Term Plan’. How we do things needs to change. We are realising that health services have little to do with health. Unsurprisingly, the NHS has excelled in assembling, or appropriating, an impressive language to accompany this revelation. Think social models of health, social prescribing, self management, personal budgets. Cast around for a consensus on its meaning or application, and things look decidedly less clear.

Some fear it’s a thin veil for shrinking services, leaving those least well served high and dry. Others say the NHS just isn’t wired to find the humility and curiosity to work together with the people who use it. Others say there’s too much cynicism around, and of course we can do collaboration and have been for years. Truth in all three perhaps?

In these and many other scenarios, I wonder if it’s our underlying assumptions that we need to challenge first. For example, if we proceed on the assumption that health can be transacted and consumed between provider and patient, albeit through different care delivery modes and collaborations, we are continuing to emphasise the individual above the collective; the NHS above the community; needs above assets.

We have a vital role to play in patients’ lives, but not an unbounded one.

Institutions are not designed for community building, so what’s the case for the NHS to reinvent itself in this space? What if the prolonged presence of the NHS actually hinders the strengthening of communities, and thus better health? What if the nature of iatrogenesis is not only medical, but also social and cultural? What if the best thing we can do is to know when it’s time to leave?

We have a vital role to play in patients’ lives, but not an unbounded one. Shift power, resources, control, and most of all, mindset, as a route to improving health and enabling the NHS to thrive at what it does best. Is this the time neither to lead nor follow, but simply to get out of the way?

I’m sure we don’t talk nearly enough about the art of being a good guest in patients’ lives. Fancy changing that with me? Join us at the Super Melting Pot.


Anna Lewis has over 16 years’ experience in NHS mental health and social care at director and board levels. She is currently the managing director of collaborative consultancy TogetherBetter.

This topic will be discussed at our Super Melting Pot on 16-17 January, where we will be exploring the things that we don’t talk nearly enough about.


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Anna Lewis18 December 2019

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