Personal Resilience: The Big Idea that Can Save the NHS
My Submission to the Government Consultation on a National Resilience Strategy:
How an Ethos of Personal Resilience and Responsibility is the Only Thing that can Save our NHS
· A complete reboot of the NHS is required led by an ethos of personal resilience – i.e. encouraging patients to take more responsibility for healing themselves.
· A personal resilience plan needs to be at the heart of every GP visit and course of treatment.
· Without it, the NHS will face an endless cycle of healthcare hyperinflation, leading to crisis after crisis. As the US has demonstrated, no amount of resources will ever be enough.
· Taking more personal responsibility for our healing and health has many advantages: those that do enjoy faster and fuller recoveries, better mental health, higher self-esteem, better community relationships and greater resilience throughout their lives.
· Acting quickly is critical to personal resilience. A course of personal resilience can spearhead recoveries even when there are waiting lists.
Personal Resilience and the NHS
I spent nearly twenty years in the Finance industry. As well as working as a professional investor, I taught classes and wrote papers on personal resilience. In a high stress industry like asset management with inevitable ups and downs, personal resilience is an essential requirement for success.
I retired in 2020 to pursue a number of personal projects, including launching a brand new public policy think tank with a focus on resourcefulness (Think Tank | Brainfart Policy).
I am very happy to be contacted if you’d like to know more or discuss the findings below.
My personal email is firstname.lastname@example.org, and my mobile is 07525431014.
May I begin by wishing you all the best with this vitally important project.
Resilience: The Science of Mastering Life’s Greatest Challenges, by Steven Southwick & Dennis Charney (Cambridge University Press)
Resilience, by Southwick & Charney, is a highly accessible academic text on personal resilience written by two of the world’s most highly regarded psychologists and neurobiologists.
The book goes through case studies and academic research outlining how individuals who have been through horrific experiences have overcome them to lead happy, active, and socially fulfilling lives. These are really amazing recoveries. Vietnam veterans tortured by the Viet Kong for years, children born with horrific disabilities and debilitating diseases, a police officer left paraplegic after a gunfight, and those who have lost their entire families in tragic circumstances.
The key to personal resilience is what all these incredible people have in common: “All of the resilient people we interviewed accepted responsibility for their own emotional well-being and personal growth...Ultimately, resilience is about understanding the difference between fate and freedom, and learning to take responsibility for one’s own life.”
This is the commonality across all these dozens of stories. After traumatic events, each of these incredible people recounted this moment of epiphany, when they decided to take full responsibility for their recovery.
They do this in many ways: Some throw themselves at a new hobby or intensively challenging physical regime, some go straight back to the place or event where the trauma happened, others reach out for social support, others make radical changes to their lifestyles, while some dive into helping their community.
Crucially, they all reach this moment of epiphany quickly - often within weeks of the tragedy. From then on they are working hard at their recovery plan. What they do not do, however justifiable, is to wallow in their grief for years. They move quickly to readjust and rebuild their lives.
In summary, the secret of personal resilience in the face of a tragedy is to move quickly to take full responsibility for your recovery. Then begin taking action to drive that recovery. In this regard, there are proven tools; such as intensive exercise, community involvement, reaching out for social support, helping others and adopting positive lifestyle choices (sleep routines, healthy diets, etc.).
How Personal Resilience Can Reset the NHS on a Sustainable Course
Since the NHS was founded, the demand for and scope of its services has grown inexorably.
The difficulty the NHS faces is that as soon as anyone uses its services, by necessity they are outsourcing at least a bit of their personal responsibility for their health away from themselves and onto the NHS. Most of the time this is totally necessary, but it does take away some sense of control and resilience. The founders of the NHS believed a national health service would encourage people to take more responsibility for their health. Indeed this was one of the core justifications.
However, the opposite has happened. We can see this particularly in Scotland, where a more comprehensive range of health and social care services has been accompanied by the highest drugs deaths in Europe, the worst rates of heart disease and several cancers in the OECD, the lowest life expectancy in the UK, and over a third of Scottish adults on opioids and painkillers. A similar story has unfolded in the US, where healthcare spending has ballooned to the highest in the world at c. 18% of GDP. Money and resources can never be enough. Thus, the NHS is caught in an ineluctable spiral of health inflation. The more responsibility it shoulders for people’s health, the less they do for themselves. In turn that makes them less resilient and therefore actually less able to recover for themselves, and so ever more reliant.
This is leading to the NHS being overwhelmed by demand. That is clearly a chronic risk to the UK. The Covid pandemic has illustrated how an overwhelmed NHS threatens the resilience and functioning of the entire country. My mother died in 2018 from stomach cancer. The treatment was fantastic. What was disappointing is she kept asking for things she could do for herself – supplements to take, exercises and lifestyle changes. She never got any advice. She got wonderful care and expensive drugs that ultimately did not work, but she never got any self-help ideas. Coronavirus is similar. The Prime minister sent out his letter to all households, with the message, Stay at Home. Save Lives. There was nothing about how to boost immunity and lung resilience to buttress against the disease, or how to tackle obesity. Nor was there much on how to protect your mental health, even though it was widely acknowledged that lockdowns would create a mental health crisis!
Instead, the tone was: you hide away in fear and wait for us to rescue you.
Similarly, millions of people have volunteered to help the NHS. But why do we not consider taking more responsibility to look after your own mental and physical health (thereby saving valuable NHS resources) to be volunteering?
Psychologically, this ethos is hugely damaging. The greatest commonality among depressives versus positive people is that depressives feel their life is out of their control, whereas positive people believe their life is up to them and their actions.
The mental health crisis is well known. If the core contributor to good mental health is a sense of empowerment (i.e. your actions matter), the only way to make inroads is to encourage everyone to take personal responsibility and empower themselves. To fix the NHS, we need to change it to the National Self-Help Service. The whole ethos needs to change. Treatments should always include as much as possible that individuals can do for themselves. Any course of treatment for acute conditions should involve a gradual passing of complete responsibility back to the individual.
Without this, the country will continue to become less resilient at the individual level and more and more dependent on an NHS, which is getting closer and closer to breaking point. An ethos of personal resilience shows how to reverse this catastrophic trend, placing some of the burden back on the individual, and at the same time making them happier, more resilient and quicker to recover – a real win-win.
· Any national resilience strategy needs to address building personal resilience for every citizen.
· A personal resilience strategy is essential to prevent the NHS facing ever deeper crises.
· With an ageing population, constrained government finances and record waiting lists, we need to recognise that more and more people will have to take responsibility for curing themselves.
The more incentives and nudges to do so, the better.
· Almost all treatment plans and GP visits should begin with the staff and patient producing their own self-help plan.
With chronic conditions, we should offer patients as much self-help as they want.
With acute conditions, any course of treatment should gradually pass back complete responsibility. The acceptance of responsibility for recovery and following the prescribed self-help steps should be a quid pro quo of receiving treatment.
· Even where there are waiting lists, a self-help plan needs to be started immediately. This is especially so for mental health conditions. As the research shows, wallowing, however understandable, is highly damaging and will impair recovery. Waiting lists (for e.g. councillors) are a problem, and often people are just left hanging as a result. This is when downward spirals regularly happen.
In these cases, the emphasis needs to be on cycling past the trauma quickly, and getting a plan going straight away - even if that means a rough plan - and even if the specialist is not available. With resilience, speed is often more important than having the best qualified doctor. Waiting is a false economy.
· Consider rebranding the NHS or parts of it to emphasise self-help: e.g. The National Self-Help Service.
· Teach Schoolchildren Personal Resilience. As well as helping the NHS, this would benefit their physical health, their mental health and help them overcome economic traumas, such as job loss. This needs to be more than part of the PSHE curriculum, which is not taken seriously. There needs to be incentives, such as exams, keeping online resilience diaries, or rewards for schoolchildren who learn and understand personal resilience.
· Anyone wishing to volunteer or work for the NHS should be encouraged to take responsibility for their own good health as part of their job.
· For many conditions (such as mental health or dietary problems), access to GPs can be restricted in favour to cheaper life coaches who can spend more time with patients. Many GPs are switching to life coaching because they find it more rewarding, as they feel they can actually have the time and skills to fix problems, as opposed to managing them.
· The NHS should encourage patients to read around their condition and seek out low cost or free alternative treatments, which are safe but may not be clinically proven: For example, St John’s Wort for depression or cold showers for Long Covid. The NHS should set up online and physical communities of patients with the same condition. Here, patients could share their experiences and trial self-help measures with other sufferers.
· Treatments that require effort by the patient should be given priority over treatments that do not (e.g. drugs). The very act of making the effort brings a sense of self-esteem and empowerment to a patient which is likely to aid recovery. The growth of social prescribing to treat mental health problems is a great example of this.