Collaborative Care amounts to 'more diffuse' and the NHS struggles with that.

Fiona Godlee, editor of the British Medical Journal, has recently written a piece called 'Are you ready for “collaborative health”?' at:

http://www.bmj.com/content/358/bmj.j3257

Fiona starts her article with:

'“A reform is a correction of abuses; a revolution is a transfer of power.” So said the Victorian essayist Edward Bulwer-Lytton. Patient centred care began as a correction of abuses, says our essayist Michael Millenson (doi:10.1136/bmj.j3048), a response to patients being treated like “imbeciles and inventory.” It is now a mix of partnership and paternalism, he says, and the real transfer of power is yet to come. He calls this result “collaborative health” and says it will shape 21st century medicine. So we’d better be ready.'

The discussion of this 'collaboration' between doctors and patients, is usually framed in terms of patients looking for sources of information and help beyond the traditional 'asking my GP', but I have written a response to Fiona Godlee's paper which links it to my own observations about end-of-life behaviour:

http://www.bmj.com/content/358/bmj.j3257/rr-4

The important sentence in that response is:

'This is a deeply difficult transition for 'the NHS' to come to terms with: because to a significant extent, 'shared' equals 'diffuse', and 'diffuse' means that things such as clarity of decision-maker, hierarchy and 'easy descriptions of decisions' are no longer available'.

The NHS loves to try and guide and co-ordinate behaviour, by means of creating 'protocols' which define actions and decision-making: 'collaborative' in reality tends to destroy things such as 'hierarchy' and to introduce complexity around issues such as 'is there a definable decision-maker, and is there a single valid decision ?' - which makes it hugely more difficult, to create the sort of protocols which the NHS appears to be so dependent upon.

Any views on this welcome.