A behaviour change programme minus the behaviour change: What happens when health services are run as businesses?
In austere times, outsourcing health services to private providers is becoming more common. To ensure service-users aren’t short changed and public spending isn’t wasted, commissioners need to take a much more hands-on approach
Changing eating habits is often an element of a behaviour change programme
Recently, I spent a period working as a clinical psychologist in a health and well-being service, commissioned by a local authority in response to the UK’s obesity rate. The service is run by a small private organisation and was set up to promote healthy lifestyle behaviours. One of its aims is to support people to achieve a healthy weight to reduce the risk of preventable weight-related diseases and the human and economic costs associated with these. It does this with programmes designed to change people’s behaviours around food and eating and increase their physical activity.
Aspects of the service were very encouraging. The team deployed creative ways of engaging local communities, statutory services and charities, ensuring a steady stream of suitable people referred to the service. It had established a strong presence in the community by taking part in health and wellbeing campaigns. The programmes were delivered by an enthusiastic though overstretched team that strongly abided by the “code” of the healthy lifestyle behaviours they promoted. A particularly exciting aspect of the service was that commissioners had recognised the role psychological and psychosocial factors play in the development and maintenance of obesity and behaviour change – hence the opening for a psychologist. I was excited to get stuck into my role, supporting this already vibrant service by integrating psychological theory and practice into the service delivery.
Alas, my enthusiasm was short-lived. As I gained insights into how the service functioned, a nagging sense of unease took hold. A feeling, I now think, that stemmed from a tension created by the outsourcing of public services to private providers. It is hard to believe that the consequences of this tension are limited to this particular service - after all, in current economic times, this model of service procurement is becoming the norm. In fact, while writing this article, I had numerous conversations with colleagues working within the public and education sectors who found my experiences resonated with their own. This further convinced me to share my experiences as I hope they will stir up a further discussion.
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