20th May 2013 

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The smoke alarm            
News and Comment from Roy Lilley

My local Fire Station is just up the road.  Once a year I go and get my car hosed down; at their charity carwash weekend.  Other than that I don't have much to do with them.  I hope I never do.  However, if anyone suggested they close the Fire Station I'd be the first to chain myself to the Town Hall in protest.  I like the reassuring presence of the boys and girls of Blue Watch on the doorstep.


Enter stage-left, the wicked Sir Ken Knight, ex-head-fire-honcho, recently retired as the government's chief fire and rescue adviser.  He's written a report about the Nation's fire services and decided there are variations in costs, outcomes and thinks closures and a radical shake-up is needed.  Sound familiar?  Do you think there's a secret, 'Generic Whitehall Template' that can be applied to all public services; health, prisons, schools, fire and ambulance?  They all 'need a shake-up'?   


I was struck by two of Wicked Ken's points; he said "When I was a fire-fighter, fire deaths in the home were 700 and 800 a year. Now, they're 180."  And, he tells us; "... the number of fires has gone down by 40%".  Guess what?  It's the same in the US.  In case you're interested the UK data is here.  All the 'fire-numbers' are heading in the right direction.


Forty percent is a huge decrease.  Why?  Design, the law and awareness.  Things like; apartment blocks with fire doors and fire lobbies, sofas stuffed with stuff that doesn't burn, health and safety legislation.


Is there anything the NHS can learn from all this?  Designing-out fall hazards?  Taking the stuff out of food that makes us fat and put some stuffing into the law?  Crash helmets, seat belts, smoking in the work-place - all laws that worked.  The law changes habits, protects us but erodes our freedoms.  It's a trade-off.


The mischievous side of me is itching to type; 'Subcontract public health to the Fire Brigade. A&Es are running around trying to put fires out and Blue Watch is running around trying to find some fires to put out....'  But I won't!


I wonder if there is a deeper psychology at play here?  Is the fear of fire greater than the fear of illness?  Is fire-causing behaviour a more immediate and recognisable concern than illness causing behaviour?


One of the biggest self-help fire-factors has been smoke alarms.  People fit them.  Smoke alarms save lives and the public seems to know it.  The proportion of households with a smoke alarm increased from 8% in 1988 to 86% in 2008.


The whole business of people helping themselves, taking care of themselves and being responsible for themselves is obvious; hence the sale of smoke alarms.  The absence of people taking care of themselves and being responsible for themselves is probably at the heart of the latest NHS hiatus; the use of A&E. 


What is the NHS equivalent of the smoke alarm?  Fifteen million (and rising) people with long-term conditions are the most frequent users of primary care.  They are projected to swamp services unless people look after themselves.  They already consume 70% of the primary care budget.  A&E will become unmanageable if a generation of people know no different than to go to A&E with trivia.


Is self-care the smoke-alarm we are looking for?  If more people were more responsible and took more care of themselves the NHS wouldn't have to.  In 2007 'self-care' was one of the key pillars of the NHS Improvement Plan and a couple of years ago one of the King's Fund 10 Top Priorities for Commissioners.


Why is it, such an obvious no-brainer as self-care has not become the smoke-alarm, turning point, tipping point, fulcrum point for healthcare?  What's your view?   


Please take a moment to take part in our Managers Network 5 question Quick-Survey.  Just five questions; how do we turn self-care into the NHS' smoke-alarm moment?  


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