The bitter public battle now being fought over the future of the NHS looks set to continue. Its future shape uncertain, and the mounting resistance that is so visceral is based upon fear, uncertainty and crucially a genuine lack of trust in those that claim to be guiding us to the best possible future the NHS.

The Lancet in January 2011 agreed that the current system stifles innovation and that although vast sums have been invested in the NHS we have not seen the benefit delivered as valuable frontline services. So we need transformation.

But the question is how do we get to that best possible future? How do we create a more sustainable NHS? Here are a couple of thoughts.

Participatory healthcare for chronic disease

Patients Know Best is a platform, that enables patients and clinicians to engage in individual and collective diagnostic practice, that allows for patient sovereignty and patient empowerment (where patient data sits at the very epicenter) and for clinicians to provide more accurate and dynamic healthcare assessment and advice. Patients can interact in full confidence with the clinical team online, uploading information about their medical history, patients can also read and interact with other clinical information inputs. This means patients are empowered, they are engaged in the process. Appointments can be made online within 24 hours – everyone has full access to all relevant data, which has proven significant benefits for everyone involved. Clinicians now have the right information with the right time to consult, reflect and properly advise. They can discuss with their patients and decide together next best steps.

In this process everyone learns with deep knowledge translating into meaningful action. The insight is that patients know a great deal, they are curators of their personal histories, and all to a lesser or greater degree possess uncommon combinations of common conditions in unique personal circumstances. Clinicians can them combine that unique knowledge with their own knowledge blending together unique and relevant programmes for chronic disease care.

Founder of Patients Know Best Mohammad Al-Ubaydli says it is not only significantly cheaper but a greater degree of comprehensive accuracy is achieved in one to two orders of magnitude.

Participatory leadership in healthcare

Nova Scotia was facing significant challenges in how it was going to evolve its healthcare system. In 2006 the Government asked Nova Scotia’s public health practitioners, to ‘articulate and be guided by a collective vision for the public health system.’ This is a complex challenge, and how does one go about articulating a collective vision?

Large-scale organisational change of the healthcare system that is happening in Nova Scotia, is being enabled through a process described as ‘Participatory Leadership’, whereby it is the participation of the people that are the true actors (nurses, clinicians, patients, etc.) within that healthcare system that are being hosted (guided) into co-designing, and co-creating how they are going to find the answers to their difficult and challenging issues.

In December 2008, a group of practitioners and partners in public health from across the province took on this challenge. They initiated a search to find a process that would bring people together to seek new solutions for the common good. They also knew the process would have to take into account the complexity of public health. And they also felt that any attempt to address the current challenges of public health demands the collective intelligence of all stakeholders. They sought a process that would launch Nova Scotia into a new beginning, an approach that would foster leadership and innovation.

The real insight was that the answer to such a complex problem lay in the minds of the many, that the way forward was held collectively in all the stakeholders that worked in the current system – not in the PowerPoint charts of highly paid specialist management consultants.

The benefits of participatory learning and leadership in healthcare

Patients Know Best and Nova Scotia are stories that are real world – they are serious and they represent two simple ways in which a best possible future for our healthcare service could be delivered, that can cost effectively meet the needs of many millions of people.

They are cost effective because ‘we’, become part of the process, we have co-created it. We begin to build a shared narrative around the people’s NHS. This is entirely different to the ideology and language of markets and privatization.

They are also demonstrative of the agile organization. Agility is related to what Otto Scharmer describes as an evolved geometry that devolves power from hierarchies to evolving networks of relationships, these are organizational models in which people, patients, physicians, clinicians, support services connect with each other in more meaningful ways in which they are all part of the process. So we move from the language of economies of scale to human centered ecologies of scale.

Explicitly, the thing that joins the dots is that Patients Know Best and Nova Scotia are both designed around the needs of humanity. Participatory learning and leadership are both constructed from the understanding that seeking change for the common good calls for involvement, collective intelligence and co-creation to discover and illuminate new solutions and wise actions.

John Berger wrote, ‘what we see is shaped by what we know’, and what we make is shaped by the language we have available to describe a new reality. If that language is lacking or deficient then so will be the outcome. And that is why Andrew Lansley’s Bill is in such disarray, as his framework for reformation is not based upon the language and literacy of social innovation, participatory cultures and leadership, it is based upon a language that has ultimately done so much damage to us.

What is missing is a literacy that defines a new form of leadership relevant to today’s world: the capacity to collectively shape and create our best possible future, and to release us from the cul-de-sac of our ‘industrial free markets are best’ view.

This is extracted from the book No Straight Lines: making sense of our non-linear world

Open Access book available via (this link)

Paperback and Kindle versions via (this link)

Marcin Jakubowski tells us how. In many ways this story is very much part of the story of No Straight Lines that I have been researching, evolving and developing over the last 7 years. You can find out more about No Straight Lines here and pre-register for the free browser book, or indeed lets us know if there are other formats of the project you are interested in.

Marcin’s story is at a very human level, but it also asks big questions about ‘WHAT NEXT’ looks like, economically and, organisationally. His story is about questing for a more sustainable and enduring world, something that Gabriel Branby also talked about.

Marcin asks the What If? question, but he is one of a growing band of people, and these questions are pushing harder and currently deeper into the consciousness of our everyday lives. and I think Marcin is a trailblazer but he is also connecting up to and creating an entirely new eco-system, a ‘human operating system‘ that wants to get stuff done in very different ways.

As Tony Judt argued in Ill Fares the Land, why is it that we struggle to imagine a different world to the one we currently have, when that world could be built upon a philosophy of a more humane sense of the world we live in?

First off less than 2% of Congress totaling 535 members, have professional backgrounds in science, whereas there are 222 lawyers.

When in 1987 the Federal Communications Commission removed the fairness doctrine of how difficult or controversial news was reported it open the door to more extreme punditry, take a bow Rush Limbaugh. And we have witnessed an increasing line of anti-science perspectives from Rick Perry, Sarah Palin, Michele Bachmann, with the whip held by Newt Gringrich.

And Otto argues right now science is under threat by anti-climate change organisations – between 2009 and June 2010 the energy industry spent half a billion dollars fighting climate change legislation. He writes that 96 of the 100 newly elected Republican members of Congress deny outright that climate change is real or are voting against it in one form or another.

That said Otto argues there are complex forces that are shaping the debate on public perceptions towards science, ‘the moral ambiguity createdafter the dropping of the Atom bomb and living in a nuclear MAD world’, or some of the terrible excesses of toxic pollution that killed and maimed ordinary people – coupled with the culpability of government, the effects of postmodernism on the one hand and the rise of fundamentalist religion on the other smashing into each other. A deep distrust arouse around government and science.

This is the volatile cocktail that combines – commerce, science, truth and politics and results says Otto on an assault on American science that is unprecedented. Though the Barack Obama administration does not get away with it scott free

President Obama’s not much better. Running strong on climate change in 2008, he has since totally de-prioritized it, apparently marginalizing his scientist appointees like Chu, Holdren and Lubchenco, all of them outspoken on climate change, and now appears to be moving ahead with offshore oil drilling, lower air pollution standards, poor carbon standards, and the Keystone XL oil pipeline. In a time when the science has only advanced further and the U.S. National Academy of Sciences says anthropogenic global warming should be “regarded as settled facts” — a time when China’s leapfrogging ahead on clean energy investments in the next economy, that’s not going to take America where we need to go.

Finally Otto refers to ScienceDebate2012 as he describes it, ‘a grassroots campaign for a presidential debate on science, technology, health, medicine and the environment’. Which was born out of Science Debate 2008 which was the largest political initiative in the history of American science.

We are on a journey from a linear world to a non-linear one (click here for more information) and we need good science to come with us. To attempt to shout down science, diminishes us all and limits the possibilities of our world.

For more information on Otto’s perspective read New Scientist October 27th 2011 (subscription required) or the Huffington Post- The un-American war on Science.

Shawn Otto has written book called Fool Me Twice: fighting thee assault on science in America

Why Andrew Lansley is not talking to people like Mohammad demonstrates why BIG GOV struggle with designing for a better world. Its not top down with lots of expensive consultants. Designing for transformation is flat, emergent and networked. And the clue is in the name of Mohammad’s company PATIENTS KNOW BEST. Better thinking, better world. Its about blending technologies of cooperation, with data, platforms and people. Designing around people, for people, not inspite of them.

Mohammad’s story is the reason a patient knows best is because they are the only one who goes to all the consultations. So Mohammad has come up with a simple program so a patient can access their health records.

No Straight Lines, argues that we have reached the nadir of the adaptive range of our industrialised world. Now faced with an unsustainable trilemma of social, organisational and economic complexity, we have entered an era in which the rules we have previously organised our lives around no longer apply. Leaving us with both a design problem and a design challenge which we must urgently solve. By describing an entirely new way for true social, economic and organisational innovation to happen, No Straight Lines presents a revolutionary logic and an inspiring plea for a more human-centric world.

We can see that things could be done better – but the question is how. Is it right to use free market thinking as an invasive form of ideology into all aspects of the fabric of British Society? My view is that its a form of toxic creep. Cameron stated he would, and I quote verbatim, ‘that his government would ring-fence the NHS’. It hardly looks like that to me. Also, because of the research conducted over the last 7 years on No Straight Lines, we can see that people like Andrew Lansley and this government, are struggling with complexity, and trying to take an old model which has failed and attempting to apply that to a new paradigm. The fact is there are enough great answers to these problems which in fact are far superior in the service they deliver, at a fraction of the cost but are in Lansley’s view unorthodox, so therefore cannot be looked at seriously. As John Berger wrote in Ways of Seeing, “what you see is defined by what you know.”

Not far from where Andrew Lansley lives is Cambridge, there is some very interesting innovation happening in healthcare in Cambridge. For example Patients Know Best enables people managing long term chronic healthcare to engage in a more meaningful dialogue with clinicians, which can deliver far better, for far less, and avoid wastage in unnecessary hospital visits which happen for a whole host of reasons. in Ontario, through a Participatory Leadership programme, the entire community and healthcare system are engaged as participants in working on evolving a more relevant form of healthcare service – without the need for consultants, with their flip charts and powerpoint decks. (more on this in the No Straight Lines book). This is an entirely different form of innovation, that has an entirely different though common sense approach to solving wicked problems.

In No Straight Lines we look at the problems of a US led style healthcare system, its unfairness and its entire design based upon procedures done to patients (which is how private companies make their money). More procedures = more money. This is what Lansley does see – its machine age thinking, its linear, its not networked, nor design led. Its not human centric, its money centric, and as my Grandfather used to say, “when ready money changes hands some always sticks”.

In a paper I received yesterday entitled: Liberating the NHS: source and destination of the Lansley reform

The authors write, The Financial Times Public Policy Editor has noted of the current NHS reform: 

“what is still missing is a narrative that explains how these changes, carried out in this way at this time, will help the NHS to address its central task – making £20bn of efficiency savings over the next four years in order to meet rising demand within a budget that is flat in real terms. Instead, the opposite is more likely.”

 A narrative for this reform, far more transparent than the double-speak of the White Paper, can indeed be located. It is described in the following pages. It maps a move away from the tax-funded NHS based on the principles of contribution according to ability to pay, and use according to medical need. It takes the NHS towards a US-style arrangement of individual health insurance with access to care based on payment of health insurers at a level based on the insuree’s state of health. In other words it removes the pooling of risk which underlies the post-war social solidarity compact, involving subsidy of health care for poorer and less healthy citizens by richer and healthier compatriots. A plan for the end-state system to be jointly funded by the state and the individual solves the perplexing riddle of how the new system could generate £20 billion of savings, given that it involves more providers, fragmented procurement, more complex administration, the marketing costs involved in market competition, and multiple layers of profit extraction from the NHS budget,. Cost reductions will be achieved through de-skilling and poorer employment terms for medical professionals as the NHS hospitals which employ them are shifted into the private sector.

You can read the rest here – and share it with those that you believe should be reading it.

Liberating the NHS: source and destination of the Lansley reform

In fact the question is: Is online piracy and ubiquitous free content killing our culture? I believe we must always be open to divergent and different perspectives of the world. We must be prepared to see the world from anothers’ perspective. I do think this is at times a good question to ask.

Morozov writes: Levine’s call to arms – “it’s time to ask, seriously, whether the culture business as we know it can survive the digital age”

But then one has to ask the question for example is Fox News culture? meaningful culture, worthwhile culture. Rupert Mordoch famously said he would make Sky News in the UK more like Fox if he had his way. Just have a read about the delightful Roger Ailes that runs Fox. The mainstream media that presents information as truth that plays a key and important role in shaping the debate about our world, has been found wanting. Is this system worth preserving?

But I persisted with the review – some good points raised. However,

In a chapter subtitled “How the internet could kill Mad Men”, Levine frets about the future of cable television, seemingly unaware of the fact that, back in the 1960s, American broadcast networks did their best to wipe out the nascent cable industry, which survived only thanks to a ruling by the US supreme court. Had the judges followed Levine’s conservative logic, a more fitting subtitle would be “How the networks aborted the parents of Mad Men”.

And how many times have incumbents fought bitterly and viciously to stop others. The telegraph versus the telephone for example. Morozov goes on…

Are new technologies really that much of a threat to the culture industry? Google TV – one of the projects Levine lists among the greatest threats to cable television – seems dead on arrival; at the moment, product returns outnumber sales. According to a recent survey by BookStats, in 2011 the publishing industry earned nearly 6% more revenue than in 2008, while selling 4% more books – in part, thanks to ebooks. The global march of streaming services such as Netflix and Spotify has made piracy less appealing.

None of this excites Levine, who complains that the internet has not encouraged innovation. “Like TV, the internet is only as good as what’s on,” he writes. Statements like this underscore the danger of setting internet policy based on the interests of the content industry alone. For those in this group, the internet is merely TV on steroids – its impact on the Arab spring, economic and human development and the future of learning be damned.

I arrived at the conclusion that Levine is representative of a certain form of market fundamentalism – and this fundamentalism is dangerous. Born out of not understanding, not wanting to understand. An arrogance about what is “culture” and who has the right to create it. He sees markets not as cultural but purely economic, he sees people only as consumers. Culture in his view, and people that he represents, see “culture” as a means to extract money from people. Simple. As the economist John Kay wrote,

“Capitalists are capitalism’s worst enemy, and particularly the market fundamentalist tendency which has been in the ascendant for the last 20 years”

For me, and Morozov saves it for last, is that in “Levines opinion James Murdoch was a saviour of Journalism.” The same James Murdoch who may have perjured himself, who along with his father owned a newspaper that in its quest for monetary gain, hacked into the voice mails of dead children, to get “the edge” on their rivals in the tabloid newspaper wars. If that is what Levine thinks is culture, then God help us all.

But the real frenzy isn’t the exposure of the scandal – it’s the scale of corruption, collusion and cover-up between News International, politicians and police that the scandal has revealed. As the cast of hacking victims, blaggers and blackmailers has lengthened, and the details of the incestuous payments and job-swapping between News International, government and Scotland Yard become more complex, it’s easy to lose sight of the bigger picture that is now emerging.

If it were not for the uncovering of this cesspit, the Cameron government would be preparing to nod through the outright takeover of BSkyB by News International, taking its dominance of Britain’s media and political world into Silvio Berlusconi territory. But what has been exposed now goes well beyond the hacking of murder victims and dead soldiers’ families – or even the media itself. The scandal has lifted the lid on how power is really exercised in 21st-century Britain – in which the unreformed City and its bankers play a central part.

What concerns Milne is the moral lassitude that seems to pervade all parts of the systems that are supposed to be edifices of British Life. Read: Barclays Bank The Real Indoor Pirates, or The Problem with Murdoch’s Media.

Is it time to truly Reboot Britain, which is different to playing lip service to it? A far too many people and organisations have done and are doing.  A people will only be free when they can control their own communications. And that fact has been drawn into sharp focus.