Our thinking

The social contract

27 March, 2020

‘Normal life’ feels like a distant memory and, as we all adapt to new ways of living, our relationship with and role in society is changing as well.  

Talking amongst the team, we realise that we are taking on more responsibility than before, and in new ways. We have been trusted to self-diagnose medical conditions so that we can be sent prescription medicines without seeing a doctor. We have submitted basic health monitoring information about our pets to keep them healthy without going to the vets. Early reports show lower A&E admissions since the COVID-19 outbreak, suggesting that we are thinking twice about using emergency services. Just a few examples of ways in which we are all being trusted to make good decisions and smart choices to free up resource and protect others.  

Our NHS is built upon a social contract, whereby we are provided with free high–quality healthcare so long as we all take personal responsibility for looking after our own health, that of the elderly, and protect the finite resources of the NHS as best as we can. These principles have been around for a while, but have never felt so relevant as they do today. And, arguably, our part in this social contract has been set aside over the years as we’ve come to see the NHS as a provider of unlimited resources.  

A good example of this is how people treat their NHS appointments. We did some research a few years ago and came to understand the scale of the issue: eight million missed hospital appointments costing the NHS £1 billion per year. People didn’t add up the staggering collective cost of their individual actions. But simple behavioural nudges, such as including the cost of a single missed appointment in a text reminder could prompt positive behaviour change and make sure appointments are either attended or cancelled in advance, and had the potential to free–up precious NHS resources for those that need it.   

The social contract is back in the spotlight as we are all asked to make sacrifices to protect others. As the NHS creaks and strains, we trust it not to break if we do what we need to do to keep it that way.