It is often argued that the direction of health policy needs to change. This is only to be expected as times and circumstances change and as our understanding of things evolves. In the affluent health economies that I am focusing on here this is typically expressed in relation to changing population and disease patterns. The UK National Health Service (NHS), for example, is frequently criticised as no longer being suited for a changed world. Richard Smith, a former editor of the BMJ, has expressed this in blunt and forceful terms: ‘When the NHS began in 1948 it made lots of sense. People suffered from infectious diseases that could be diagnosed, treated, and cured. Spending on the NHS meant that some people who would have died or been severely disabled could be returned to full health. There's not much of that now. This is the age of chronic disease, where doctors are patching up not curing, and some people (even, I suggest, many) are kept alive when it might be better for everybody, including themselves, if they were dead’ (Smith, 2015).
Smith – as someone who has spent time close to the heart of medical thinking – is here aligned with those sceptics who are wary of the presumption that an increased level of clinical intervention is necessarily a good thing. On this account it seems that a service designed for wholly good purposes and staffed by conscientious professionals may nonetheless end up doing things that are, in effect, ‘uncaring’, and may not be providing people with either what they want or what might be seen as in their best interests. In essence, what lies behind the more or less continuous calls for ‘person-centred’ reforms is this recognition – that services do not always provide what we think does or should matter to people.
Here I am just using the expression ‘person-centred’ in a very loose way to signal the various respects in which health policies and services might better reflect, benefit and ‘suit’ the people they are intended to serve. (At the end of the chapter I will begin to unpack the idea of person-centredness more fully.) As noted in the last chapter, demands for reform reflect broader social changes, including in public expectations and values, as well as in disease patterns.