There is a pressing need to create a post of chief psychologist to advise ministers on behavioural perspectives to key health issues
I firstly beg forgiveness for the tongue in cheek title of this article. The job of health secretary is one that most politicians have to be either very brave or very foolish to take on; such financial pressures and political constraints are seldom found in other Cabinet posts, and the role inevitably leads to some unpopularity.
‘The Downing Street Behavioural Insights Team is credited with gaining millions of pounds by simple changes to tax forms’
In my view, the current health secretary has, in those issues where he has had some control such as the Mid Staffordshire scandal and whistleblowing, shown great courage and leadership.
The field of psychology as applied to health and wellbeing has made major strides over the past few decades, with numerous books and articles attesting to the value of using psychological principles and evidence in the formulation and implementation of healthcare policies. It is my view that creating a new advisory role would allow the secretary to benefit from these insights.
Growing role of psychologists in world policymaking
Psychologists have played a key role in patient safety research (Vincent, 2010; Croskerry et al, 2009). The Veterans Health Administration in the US, which has a lot in common with the NHS, now has a psychologist as head of the Mental Health Policy Office, Dr Antonette Zeiss – a post previously held by medical practitioners; and the chief of staff at the VA, Lisa Thomas, is also a psychologist.
Human behaviour is the basis of most everyday decisions and also key decisions by policy leaders. The field of economics has been revolutionised by the application of psychological principles, leading to the award of the Nobel Prize in Economics twice to psychologists, in 1978 to Professor Herbert Simon and again in 2002 to Professor Daniel Kahneman.
At the seventh annual Psychology Day, held in April at the UN, Dr Maya Shankar, a psychologist who is senior advisor to the deputy director at the White House Office of Science and Technology Policy, and who is also leader of the Social and Behavioural Sciences Initiative, described a wide range of ways in which applied psychology has brought benefits to healthcare and wellbeing.
These ranged from better adherence to medication to raising awareness of climate change.
The Downing Street Behavioural Insights Team is credited with gaining the Treasury millions of pounds by simple changes to tax return forms. Psychological operations – or “PsyOps” – have a critical role in human warfare, and the psychological sciences have played an important part in helping victims of warfare cope with the after-effects of taking part in war, whether it be physical injury or psychological injury.
The formation of the Clinical Human Factors Group in the UK, with its key recognition by the Department of Health, has highlighted the importance of one aspect of human psychology related to man-machine interaction.
But there are many other areas of human behaviour, ranging from compassion to clinical decision making, that do not readily come under ‘human factors’ that are critical to patient safety and to the quality of healthcare delivery.
Understanding poor care
In the instance of the Mid Staffordshire scandal, the field of psychology has been shown to illuminate many important issues.
‘The chief health psychologist would provide the latest evidence-based advice to the secretary of state for health’
Jeremy Hunt recently noted in a speech that hospitals are wasting up to £2.5bn a year of the NHS’s budget through poor care and medical errors, such as giving patients the wrong drug, and that there is a clear link between poor care and higher cost.
He cited a new report, commissioned by the DH, which found that poor care costs the NHS at least £1bn a year, and possibly as much as £2.5bn.
The cross-departmental post of chief social scientist was abolished by the government in 2010, and there are moves to reinstate it. Although a DH chief health psychologist would liaise closely with a chief social scientist, if both posts were in place, the DH post I envisage would be quite different and specific to health issues.
New role for psychology
There is a pressing need for a post of chief psychologist to advise the health secretary on behavioural perspectives to key health issues of the day. Such a post would parallel that of the chief medical officer, with similar levels of support staff.
The post would be separate from, but where appropriate liaise with, the chief allied professions officer. The chief health psychologist would provide the latest evidence-based advice to the secretary of state for health on a wide range of health issues where human behaviour or mental status plays a key role. This could include issues such as:
- Patient safety in hospitals to help prevent adverse clinical events.
- Reducing misdiagnosis in general practice settings, since cognitive factors are often at play in this type of costly mistake.
- Public health campaigns to promote healthier living in domains such as obesity and smoking.
- Achieving higher levels of organ donation and blood donation.
- Clinical and research priorities in the field of dementia.
- The psychology of whistleblowing and of raising concerns in healthcare settings.
- The value of talking therapies for mental health conditions.
- How the science of compassion can be brought to bear on the behaviour of healthcare staff.
- Psychological perspectives in the management of long term conditions.
- Psychological aspects of the design of care homes for the elderly.
The chief health psychologist could advise not only on the content of policy decisions, but also on the manner in which they are delivered, since there is now a major scientific base to the psychology of human communication.
As in the case of the Cabinet Office Behavioural Insights Team, it is anticipated that the work of the chief health psychologist might also pay for itself many times over by, for example, saving money for the NHS through improved patient safety – essentially achieving two goals at the same time.
Professor Narinder Kapur is consultant neuropsychologist at Imperial College Healthcare Trust and visiting professor of neuropsychology at University College London