Outcomes for children generate emotional engagement; those for adults are dull in their worthiness
Why don't we have the same expectations for adults as we do for children? Then we might start to design and deliver services we want, rather than those that are 'good enough'.
The 2003 publication of Every Child Matters was a radical act. For the first time we had a policy document focused on the desired outcomes for children, rather than seeking to define a set of service interventions and processes.
The outcomes required are deceptively simple, and powerful because they are what we would all want for our own children: be healthy; stay safe; enjoy and achieve; make a positive contribution; achieve economic well-being.
If this is so obvious, why does it seem so radical? And why not apply the same principles to adult services? Because in we have tended to focus on the exceptional rather than the universal, and created all kinds of barriers to limit demand and cost; we require people to establish their illness; their awful and limiting disabilities. In parallel, we maximise access to resources for service providers where they can show how poor, ill or excluded their populations are, causing us to compete in disadvantage.
While there are good economic arguments for this approach, the sociological and psychological consequences are a culture where, almost by definition, to be a 'patient' is to be needy and inadequate; and to work in the service is to have an air of Mother Teresa; holy but tainted by disadvantage.
Every Child Matters starts with the child, and the outcomes are an attempt to describe the key facets of living. This approach instantly requires both universalism - it has to make sense for every child- and development, because children change rapidly in short bursts of time (and have exams to pass).
At a recent workshop of directors of adult services, it became obvious this approach provides a powerful framework to drive activity for children, but also opens up a vacuum for our work with adults.
Our Health, Our Care, Our Say makes several attempts to describe a vision and goals. In summary: remain healthy, seek independent prevention and earlier intervention; real choices, voice and greater access to services; more services, closer to home; integrated services, promoting independence and choice; tackling inequalities of access and care.
The goal are longer than those in Every Child Matters, assume problems must be managed, and are boring. The outcomes for children generate emotional engagement in their simplicity; those for adults are dull in their worthiness.
'Be healthy' for adults would drive investment in minimising the onset of disease, supporting people to make healthy choices and lobbying to ensure we have access to parks and leisure facilities, safe streets, good air quality, affordable fresh food and so on.
It would drive quality in medical management of long-term conditions, and the assertive identification of those at risk of disease with early intervention and systematic input.
'Stay safe' would require us to pay attention to the local environment in relation to pollution, road safety and violent crime. At an individual level, we would have to take seriously domestic violence, loose carpet on the stairs and poor heating. We would have to get better at responding effectively to those with anxiety and depression.
In health services we know we should be doing all of the above, even if money gets driven in the opposite direction. Of this year's new investments 60 per cent has gone into specialised and acute services, with 20 per cent going into cancer alone (thank you Herceptin et al), around 30 per cent into primary care, mental health, learning disability and community services and 10 per cent into health promotion.
'Enjoy and achieve' would be a real challenge for us, and create endless fodder for Daily Mail reporters on the nanny state lookout.
'Make a contribution' would be interesting because we would have to recognise that colleagues have something to offer as well as needs to meet. This would be a seismic shift, with huge resource benefits in responsible self-care and service use, not to mention engaging with the broader social capital of our areas.
'Achieving economic well-being' would align us with local employers, learning and skills councils, economic development and local job centres. Often the major employers in our local economies build skills, create job opportunities and career paths, and crucially seek to return to work those who have been off sick.
Essentially we would become concerned with happiness, not just of the vulnerable, but of all of us, because once we are happy, we are much less likely to be sick.
The 'science' of happiness is a relatively new claim. Psychologist Ed Diener seeks to measure happiness because there is increasingly strong evidence that it leads to long life, health, resilience and good performance; exactly the kind of outcomes we would want.
If we were going to concern ourselves with creating happiness to improve health, we would promote relationships and support people in identifying a purpose in life and developing personal goals .
Friendship seems to have a bigger effect on average happiness than income, and marriage seems to add seven years to life for a man and four for a woman. Developing a sense of self and goals goes to the core of 'achievement' and 'making a contribution'.
Every Child Matters is not perfect; a universal approach always requires close attention to minimising the risk of inequality. And while the five outcomes are ambitious and radical, the associated targets are much more mundane. However it does challenge us to agree the core outcomes we all aspire to in our daily lives as adults and to think about what that would mean for services.
Sophia Christie is chief executive of Birmingham East and north PCT.