The Changing NHS

I had an interesting chat with a clinical psychologist the other day. We were talking about what a really successful NHS might look like in 10 years time. A lot of the conversation was about the need for people to accept more responsibility for their own health status in general and for the NHS to become much better at helping people make specific changes in relation to diet, exercise, drinking, other risky behaviours etc.

In passing the clinical psychologist said…” the trouble is the NHS has 1.3 million staff but only about 25,000 know how to change people’s behaviour.”

Do you think this is anywhere near true? And, if it is, how many of the 1.3 million ought to be competent at helping people to change their behaviour?

• All GPs, District Nurses and Health Visitors – well yes, obviously
• What about all the therapists – again almost certainly
• Well what about Ward based nurses - again yes
• Doctors? Certainly all the medics. What about surgeons, do they need to know how to change people’s behaviour? - quite possibly
• Managers? - steady on their old chap. Next thing you know managers will be dispensing drugs and ordering tests!

The model I’m most familiar with is called The Stage of Change Model. At its’ simplest, this model suggests that people could be at one of five stages in relation to changing their behaviour (and then hopefully, their attitudes).

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

The basic idea is to first identify what stage a person is at in relation to making an important change in behaviour and then to help them move through to the next stage. Each stage requires particular support and intervention. Eventually, hopefully, they'll make it through to and remain in the final stage. There’s a bit more to it and you can learn more about this model here – but that’s the gist of it.

Hopefully, whatever the number is, over the next few years many more people will get much better at helping people change their behavior. Otherwise I guess we could ask a Government to ban every unhealthy behaviour we can think of. That might just do it!

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