News and Comment

A difficult conversation now – or mayhem later

Tuesday 4 October 2011

Mike Farrar, chief executive of the NHS Confederation, makes a stark point in an article in the Guardian. Talking about the financial challenges facing the NHS, he says that he doubts whether patients and the public understand how serious the situation was becoming. He went on to say:

‘If we are not clear on this with the public, we will have no mandate for the change necessary.’

Those of us that have spent years immersed in public dialogue are well aware that one of the most sensitive policy areas to discuss is the NHS. If the public hear about a possible reconfiguration they are quick to defend the status quo feeling that change will only result in services suffering.  But it doesn’t have to be this way.

A few years ago a Midlands health authority was planning a service reconfiguration, which would have seen one of its three acute hospitals become a planned care and rehabilitation (PCR) site. Patients groups quickly mobilised and over 100,000 signatures were collected opposing the proposals. The health authority decided to have a final push for making the case for change by bringing together a small group of citizens to examine all the evidence and listen to all views and say what they would do if they had to take the decision. At the end of the dialogue process they said that they felt that the health authority was making the right decision, but disputed which hospital should become the PCR site. Opposition faded away, as the public felt that there had been an open and honest discussion.

If this type of open dialogue had not happened the health authority would probably have felt it lacked the mandate to make the change, and hospital services on their patch would have suffered.

We have been working with NHS South West London to engage the public in a dialogue about its Better Services Better Value review. This review is looking at possible changes across five service delivery areas including the familiar tinderbox of urgent and emergency care. More than 150 participants attended the two public events. As with the previous example, they were presented with the evidence and asked if they felt there was a case for change.

Mike Farrar might be relieved and possibly surprised to hear that the vast majority of the participants at the events led by clinicians from across the NHS in South West London were aware of the pressures affecting health services, and that they are serious and need to be met head-on. They were keen to openly explore the acceptability of different options across five service areas. They also said that the NHS, the public and other stakeholders should maintain a dialogue so that we can find a solution that will actually improve services in a very challenging situation.

If the public and others are engaged at an early stage and NHS bodies are open about the challenges they face, then the detrimental effects of cutting a little here and a little there, or even the NHS going bust can be avoided. This is not a time to hide away and delay the difficult conversations. By having that dialogue now hard decisions will become a little easier to take.