I’m on a train to Bristol. I’m going to the Festival of the Future City. To be honest, I’m not so interested in the event. I’ve just agreed to host a Q&A with the CEO of NHS England as a favour to a friend. His idea was I might ask some good questions.
I probably won’t. Not because I don’t have any, and not because I’ve not done my preparation. But because it’s basically impossible to get time with someone like him to properly prepare what you might cover and why. In the end, I fear I’ll participate in the usual bland nonsense that fills the air and column inches but makes no difference to anything, anywhere.
The original idea was that I’d bring some of my work into the questions. I certainly have lots of ideas for how to do that but, to be frank, I’d be blind siding the interviewee. Very, very few people in health understand the importance of agency, and the fact that it’s sat squarely in the research that is now packaged as the social determinants of health. To ask the CEO of NHS England of his views on agency without having sensitised him to the work first would be unfair.
Some people tell me this is a “good opportunity”. I guess their view is that I get to chat to The Top Dog and hence may be able to promote my work. I don’t feel inclined to do that. Being the CEO of NHS England is likely a thankless task, part execution, part politics. I suspect he spends his day lurching from short-term crisis to short-term crisis, while trying hard to hold some kind of long-term vision. I’m sure there are things that he’s working on that have never even occurred to me as issues in health.
(As an aside, someone once told me that the top brass of NHS England have a crisis of real estate on their hands. They own a lot but it’s crumbling and there’s few good solutions as to what to do. That’s an issue that would never occur to me. Nor would it interest me.)
I have little sympathy to the idea that the NHS should get into city planning. I’m equally unimpressed with calls for city planners to put health at the centre of their aims, something the The Lancet has said (amongst the myriad of things it demands every single week, exhaustingly). At some point, somehow, we need to reframe the aim of our publicly-funded systems from dealing with proscribed problems to trying to help people lead the lives that they value. Both health care systems and city planning need that reframing if they’re to be fit for purpose into the middle of this century.
The very helpful people in the CEO’s office have suggested that I ask about NHS England’s involvement in developing dementia-friendly places, the use of fitness trackers to collect data to aid city planning, and engaging parents – through schools – to promote better diets, more exercise, and (this interests me) inter-generational activities. The parenthesis withstanding, I can’t help but be bored by all of that.
I’m interested in how NHS England might re-imagine its role as a series of anchor institutes, as wonderfully described by The Democracy Collaborative. I’m interested in how NHS England might promote true accountability to communities, not the watered-down, politically-sullied nonsense of Health and Wellbeing Boards. I’m interested in how NHS England might reimagine its real estate as civic spaces, able to bring back a sense of community and belonging. And I’m interested in whether NHS England has targets designed to reduce its size, made possible by how it has promoted health, rather than the daily headlines of this department, or that specialty, or this service needing more funding. These are the questions that I’d want to ask.
But I won’t. I’ll have to play along with the form, please my hosts, ask questions about rapid urbanisation, the NHS’ Healthy New Towns thing, how we can design spaces to make (yes, “make”) people exercise more, and whether we need to have doctors working with city planning. The audience will nod along, we’ll continue to be complicit with the inadequacies of the bio-medical model, and the people that desperately need things to change will see nothing new.
And I’ll be part of the problem.