‘Putting individuals at the centre of health care means something different’

Dean Fathers didn’t train in psychology, but during his discussion with Ian Florance it became clear that he has a clear vision of the role of psychologists and, more widely, of health provision within society.

Dean Fathers recalls the moment he realised he needed to move away from having one job. ‘I stood up to someone in higher authority and realised I was potentially going to lose my job. My brother invited me to a dinner that evening and I sat next to someone who offered me a new job the next day! But I realised that the insecurity of having a single employer was something I wanted to avoid.’

Among a number of roles he is Chair of GreenKite Associates, a non-executive director at both the Parliamentary and Health Service Ombudsman and Diagnostic Healthcare. He is also Chair of the Health and Enterprise Committee at the Greater Lincolnshire Enterprise Council and Professor of Resilience at the University of Lincoln. He was Chair of Nottinghamshire NHS Foundation Trust, among other NHS roles. Dean tells me one principle from the NHS runs through all that work. ‘Any role I take on has to “add years to life and life to years”. I work a lot in the health care sector and I also do a lot of pro bono work, mentoring others, particularly around diversity.’ This theme underpins a range of issues: age for instance. ‘In certain areas of the country where there are large older populations, enabling over 65s to remain economically active not only adds value to the economy but also improves their lives and health outcomes.’

‘My values are public sector ones’
Dean sees these attitudes and interests as stemming from his background. ‘My father was a soldier. I was born in the Middle East and lived as a child in Malaysia, Singapore, Germany and all four corners of England. I therefore had a much more diverse world-view right from the start of my life compared to my peers. My father instilled two important beliefs into me: “all people are important”, and “society creates a twin dynamic, with rights come responsibilities”.’

Dean’s further education – a degree in Organisational Studies and a Master’s in Organisation Development – and his many non-executive directorships suggest a typical private sector leader. Yet ‘my values align strongly to the public sector ones around health, education, defence and the law. So, I think you can typify me as a person with private sector skills who commits strongly to the delivery of my public sector responsibilities.’ Some public sector employees are very suspicious of people who work in their area but come from a private sector background. ‘I think there’s a failure to distinguish between two sorts of private sector leaders: one sort looks to get maximum returns by exploiting resources until they’re used up; the other seeks to strengthen and maintain valuable resources, making them sustainable for the benefit of future generations. I see myself as the latter sort of leader, intending to leave the world in a better place when I depart from it than it was in when I joined it. For instance, my NHS Trust was cited at the UN for its sustainability practices and in 2015 we won the Stonewall Best Company Award.’

Dean’s interests and experiences give him a good perspective on a vision for mental and physical health in society.

‘The NHS must change its approach’
‘Presently many organisations concentrate on too narrow a data field, principally financial- and performance-related. Technology is enabling us to shift that focus onto new dimensions, illuminated by our ability to use big data systems to see, analyse and transform information into intelligence. For instance, technology enables us to look more closely at humanity (e.g. genomic sequencing) as well as much more widely (e.g. the social influences on and determinants of health). To me, this implies a different meaning to “putting individuals at the centre of healthcare”.’

it’s obvious that valuing individuals is critical to Dean. From 2014–2017 he was chair of the research steering group evaluating Schwartz Centre rounds at King’s College London. The Schwartz Centre for Compassionate Healthcare promotes compassionate relationships between staff and patients. ‘The key here is listening and engagement to enable well-being.’

Dean returns to big data in this context. ‘It is particularly important in healthcare. Humanity’s ability to handle and communicate data is growing exponentially, with 5G and beyond. We need technology to enable us to look up and down the health chain. Human differences and our full complexity and diversity will be more accurately informed by more abundant data as well as artificial intelligence applications. At the moment health provision is very fragmentary. The average citizen is looked after by many agencies that each address different aspects of health. This situation often ignores that our health is part of a system which is itself part of an increasingly fragmented society. Many organisations would benefit from a change in approach: they should use data-driven intelligence to integrate services, challenge current paradigms and belief systems and change their narrative about what it means by “putting the patient/customer at the centre of their decision-making”.’

Dean says we have learned from the recent world health crisis that prevention and health education have been sorely missing from many board agendas. ‘They have been focused on sickness regimes to improve financial and performant targets and not wellness as a means of ensuring resilient individuals, organisations and societies.’

The four simple objectives for planetary health as Dean sees them are:

  • Help people to be born well.
  • Help them stay well as long as possible.
  • If they can’t stay well, help them recover to a place of their choice as soon as possible.
  • If they can’t recover to that desired place, ensure they live with dignity or if their condition is terminal to die with dignity.

I asked if he thought this was possible. ‘It’s a long journey but this is a societal problem. Failing to get this right is a huge cost to humanity, not just to the healthcare system and individuals, but to those that care for them.’

‘I knew something academically about psychology; they practised it’
How does psychology fit into this vision? ‘First, we need to create a narrative in all organisation’s boards, where mental health can be discussed openly and transparently. Mental health must be given parity with other agenda items, and the current mental health deficit model replaced with one that views it as a virtuous asset. For too many years mental health has been misrepresented and ignored. Investment in it has been comparatively low. Theory and practice have advanced but it is still often viewed as a side issue. Mental health needs to be integrated as part of a whole system approach to improving productivity and performance.’

The incidence of psychological conditions seems to have increased greatly over the past few decades. Does this mean a huge increase in the number of psychologists? ‘The trend would suggest that we will need more psychologists but I would like to repurpose them. I’d love to see more psychologists working with directors in the public and private sectors, developing them to understand mental health from a different perspective, one where they enable people to achieve their optimum capability, enhance their resilience to the uncertainties, complexities and ambiguities of today’s world. In fact understanding a wider range of social sciences – sociology, anthropology etc – at board level is critical if we’re going to achieve the sort of healthy society I’ve described. This is not just an issue for initial education. Occupational psychology was a key part of my university courses and I’ve worked with many psychologists. I grew to understand psychology in action from an early stage in my career when I was with TNT. They paid for me to train with TUC shop stewards at Congress House. I learned that they were leaders, I wasn’t. I knew something academically about psychology; they practised it. So psychologists – and other social scientists – have a role to communicate accurate information to inform everything from business leadership and parenthood, through books, newspapers, digital media, the TV.’ Does this mean getting PR training? ‘Not necessarily. I don’t use a PR agency. You need to say what you mean clearly.’

Many of Dean’s views have policy and political implications. Has he thought about going into politics? ‘It’s been suggested to me that I should but, in the end, politics is about power: that doesn’t motivate me.’

One quotation from my discussion with Dean really stuck with me: ‘Taking care of someone is not just about sickness.’ Psychology, in this vision, has a huge role to play. As Dean puts it, ‘psychology can help defragment health provision’.

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