Change takes time. We need to prepare for the future not just firefight the present. It's a popular time to wheel out some of health policy's favourite clichés. But how do you define long term? And how does knowing a realistic end point affect what you do now?
Let's start with what you're trying to achieve. You need to consider the scale of change needed, but also quite how embedded the status quo is. Trying to reverse decades of hospital dominance sounds like a task for at least a decade. Balancing the attention given to physical and mental health is likely to be even longer.
However, what Rethinking Medicine – an initiative improving how medicine supports better health and healthcare in England – seeks to achieve is longer still. This is partly due to size; Rethinking Medicine tries to change how the art and science of medicine is undertaken across England. 125,000 doctors. 1.4 million healthcare staff. A health service seeing more transactions every day than debit cards. This is behaviour change on shock and awe scale. But it's also about the long-arm of history. Central to Rethinking Medicine is healthcare staff, in particular doctors, viewing their role in a completely different way: less about treatment of disease, more about understanding of people; as Victor Montori writes, "less healthcare, more care". The roads people travel to arrive at these conclusions are varied - concern about overtreatment, desire for shared decision-making, embrace of determinants of health – but all share a discomfort that modern medicine doesn't have the answers to the questions being asked of it.
If we get 1% closer this year, and next year, and the year after, eventually we'll get there.
Think of it not as junking medicine – anyone like to dispense with anaesthesia? – but giving it a much needed upgrade. Yet the power the current medical model has is all around us. My 6-year-old daughter's doctor's kit is one of her favourite toys. White coat and glasses to look clean and clever? Tick. Bandages and syringe to heal the sick? Tick again. (In a UK twist, every game starts with a spell in the waiting room.) I'm yet to try sneaking down in the night and replacing the contents with some decision making aids, a primer in sanitation, or a lecture by Ilyich, but I think I know the reaction I'd get.
Our understanding of what doctors are there to do, and in return how we as patients respond to them, is woven into the very fabric of our society. These roots are in part structural – the Royal College of Physicians has existed longer than the Royal College of GPs, the NHS, women's suffrage, and the abolition of slavery, put together. But its roots are also cultural, based on elemental human fears. Until the 1850s it was more likely that going to see a doctor would harm rather than help you; why did people still go?
To change the daily practice of both the givers and receivers of healthcare is a century long task. We shouldn't shy away from this. Besides a complete shift in public and professional social attitudes, for Rethinking Medicine to be complete it will also require an overhaul of education, regulation and service delivery. We don't have long: while the doctors of 2119 are not yet alive, 5% of their patients are, as well as a larger proportion of their teachers.
Which brings us back to what we do now. Rethinking Medicine is not a normal sort of programme. In fact, it's less a programme ("a set of related measures or activities") than a movement ("a group of people working together to advance their shared ideas"). Success for Rethinking Medicine in 2019 is not to execute measures or activities, but to expand what is already a fast growing group of people, sparking a range of conversations and ideas that can travel far further than from any one individual alone.
The public health professor Harry Rutter talks of 20 year plans where, if you move 5% towards your goal every year, you make it. It's the same for Rethinking: if we get 1% closer this year, and next year, and the year after, eventually we'll get there. We hope you'll join us for the ride.