12th December 2014 Written by Ian Wheeler

Head of Research & Evaluation at Skills for Health discusses the impact on the healthcare workforce…

The Stats

Image: Drugs.According to the Health Survey for England 2013, 50% of women and now 43% of men are now regularly taking prescription drugs in England. Commonly prescribed medications included: cholesterol-lowering statins, medications used to treat high blood pressure, such as ACE inhibitors, painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (non-prescription NSAIDs such as ibuprofen were not included in the survey). The cost to the NHS is believed to be in excess of £15bn-a-year.

In an increasingly aging society, where more of us are living longer with a range of health conditions this headline figure of almost half of the population taking prescription drugs might not be so surprising.  For the right people, these drugs they will save and improve the quality of life.  Their use will also save a great deal of money for the NHS and society over all.

The moral / clinical debate

But there will be clinical and moral debates about these figures. We might ask what do they say about us as society.  Many will raise an eyebrow and ask how did it come to this?  How much is this is necessary?  Are too many of us passively receiving these drugs and not questioning if this is what we want? Are we in our modern world simply taking the easy way out?

If we want to reassure ourselves that we are not a nation unnecessarily dependent of prescription drugs the co-creation ‘agenda’ as it’s often referred is a welcome practical step.  Co-creation as a term has been coined to describe a process whereby clinicians work with the service user to work through what their condition means for them.  Importantly the clinicians will bring with them critical knowledge about the medical condition that their client   might have.  What is different about co-creation and moves it beyond our more traditional way of viewing health care is that the users will also be treated as partners in a relationship to decide on what services they might need and of course what drugs might be necessary.

The clients are not therefore simply as people with a condition that needs to be treated. They will be viewed as people who have a range of ‘assets’ at their disposal.  They will have the ability to make considered choices and have view on the life they want to lead.  Of course there will be those who are asset rich with much at their disposal, there will be those with little, or have conditions where they genuinely wish to be ‘looked after’ at least until they have come to terms with their conditions.  But the point is, as this approach becomes more common place then we can begin to assure ourselves that we might be a national of pill poppers, but we are well informed pill poppers.

What change and what skills are required?

To make this work on a large scale there are a range of changes needed to how we structure services in the health sector.  There is already a concerted effort across the UK from groups of GPs and clinicians to do this.  What is recognised is that there is a range of skills that need to be developed to help this co-creation take place.  Many of these skills are often referred to as ‘soft skills’ but their impact is likely to be significant.

Increasingly health professionals acknowledge the need to hone their skills around interviewing and motivating people to look at how they are living and taking treatment.  Such interviewing methods take careful development.  The reward if they are well developed is that clinicians can explore what activates people to take control of how they manage their own treatments.  It may be sensible to prescribe drugs, it is also be sensible for the client to lose weight and stop smoking.  They will need advice and support on how to get there.

For many this will also require a shift in the mindsets.  For most working the in the health sector, they took up their professions to see how they can help others.  Of course a desire to help others is a key compassionate motivation.  However, implied in the co-creation of healthcare will be helping people to take ownership of their care and help them do things to help themselves.

Taking communities on the journey

There will also be skills needed to be developed in terms of clinical leaders in the community.  So far there has been a great deal of debate about leaders within hospitals.  But health and social care workers at all levels will need to help show the way for the communities that they serve, that they will have a role and a responsibility to shape their services.  Such leadership will need to be informed by classic change management skills and backed up by solid communication and negotiation skills.

In the future it is unlikely that our consumption of pills will go down anytime soon.  Indeed, as we innovate and develop, the amount may increase.  But to know that we all an active role in the design of our own care will make us less likely to judge those who take prescription drugs as somehow weaker minded, but as people who have made informed and reasonable choices. And we’ll need to make sure we have the right skillsets and mind-sets to make it happen.