News and Comment

Putting patients at the heart of changes to the NHS

Thursday 12 January 2012

By Ewan King, OPM director, and Robin Clarke, OPM fellow.

The mantra ‘no decision about me without me’ that underpins the Health and Social Care Bill is a good one – it tries to draw out in simple language the power and control patients will be afforded when it comes to decisions about their own healthcare. The goal of creating an NHS built upon shared decision making between clinician and patient cuts through many of the planned reforms, from improvements to front-line patient services (e.g. through the creation of patient reported outcomes and shared decision aids) through to much larger structural changes like the creation of clinical commissioning groups. The replacement of LINkS by Healthwatch, locally and nationally, also has the potential to enhance patient empowerment on an individual and collective level. In fact, those seeking to become authorised clinical commissioning groups need to demonstrate that they are successful in engaging meaningfully with patients, carers and their communities.

However, there is strong sense in some quarters that those leading the changes to the NHS are being distracted from the task of placing patients at the centre. Facing enormous financial and political pressures, some PCTs have become overly focused on how structures and the financial need to change at the expense of patient engagement. Some patients have reported that they have failed to be involved in important change to their local NHS.

NHS South West London, although facing pressures as great as many other local areas in England, has decided that patients need to be at the heart of changes to the NHS. As part of its Better Services Better Value review, which is looking at ways to improve the quality of patient care and health services in South West London, NHS South West London commissioned OPM to run a series of events to engage patients, the public and other stakeholders on the challenges facing health services and to explore initial options for change.

What was probably most surprising about these events was the enormous level of understanding the public had of the pressures facing the NHS and the difficult choices that needed to be made. Patients who have recent experiences of the NHS, in particular, understood that the NHS the health system was ‘trying to deal with too many patients, with too few resources’ and that radical changes, including closing some services, may need to be considered.

The report of the events concluded that: ‘People understand we face a genuine challenge if demand for healthcare is going up faster than resources are being made available to respond to it. As such, they are open to discussing quite radical changes to the way healthcare is delivered. People are particularly open to discussing changes to services once they hear that change could improve the quality of care on offer, as well as reduce costs’.

Those leading the NHS are often rightly concerned about taking radical proposals about changes to the NHS – often which contain difficult news about service closures – to the public. They fear a backlash, and the involvement of local politicians, in shutting down the proposals.

However, in our work with patients around difficult changes to the NHS, we have found that the public – once they understand the proposals, the choices that prevail, and the trade offs that need to be made – are willing to consider and discuss considerable reconfiguration options. Moreover, even if they eventually disagree or oppose the changes – the fact that they have been involved in the debate will at least ensure that they feel they were consulted and understood the decision-making process.

If we are to create an NHS that truly embodies the mantra ‘no decision about me without me’,  then it is vital that NHS organisations have the strength of commitment, and take the practical steps necessary, to engage patients in debate and decisions about the future of their NHS.