Thursday, 17 January 2013

A bigger say in the NHS for patients

A bigger say in the NHS for patients: Greater patient involvement in the health service could lead to better quality care and more efficiency savings.

A truly patient-led NHS has been an aspiration in the health service for well over a decade. The motivation is born out of the realisation that improving patient involvement could lead to better services, higher standards of care and greater efficiency savings. Furthermore, high profile failings, such as those at Mid Staffordshire NHS trust, have highlighted just how bad patient care can be and show what happens when patient experience and engagement is not treated as a priority. The government has built on 15 years of initiatives aimed at putting patients both at the heart of decision making and as arbiters of quality.
For instance, forums such as the local involvement networks have been incorporated into Healthwatch and given greater powers to challenge local decisions. From April, NHS patients and staff in England will be encouraged to take the "friends and family" test in which they state whether they'd recommend services they've experienced to their loved ones.
Nice (the National Institute for Health and Clinical Excellence) has also published new guidance on good patient experience that provides a strong framework on which to build good engagement practice. There has also been a greater emphasis on "shared decision making" – that is, the extent to which patients feel they have come to a joint decision with their doctor about their care.
While each of these initiatives is to be commended, the goal of shifting power from civil servants and managers to clinicians and patients requires innovative engagement approaches across the board.
At the sub-regional level, where the NHS is seeking to secure massive savings by centralising acute services in fewer sites and pushing more health services into community settings, it is crucial that patients are kept abreast of the reason for changes and are able to make informed decisions.
Often described as "acute service reconfigurations", these reviews can lead to proposals for hospital closures and the redirection of patients from hospitals they know and love to elsewhere. For those leading such changes, it is vital to involve patients significantly and extensively as the risk of political and judicial challenges is very real. At the Office for Public Management, we've seen how giving people information about the reasons behind the proposals can help build commitment for some of the hard choices that follow.
For the new clinical commissioning groups, it is crucial to involve the public in defining the local population's health needs, from which commissioning decisions are made. While engagement will largely take place in member practices, the commissioning group will be expected to lead and encourage innovation.
This poses a real challenge to many commissioning groups, who may not possess the skills inhouse to engage with patients continuously or meaningfully. This challenge is particularly evident when dealing with hard to reach or vulnerable patient groups, who are less likely to respond via the traditional means of feedback surveys or take part in patient forums.
To circumvent these problems, Wirral clinical commissioning group recruited 200 people who broadly reflect the area's population, including those from marginalised groups, into an online community. These people consider subjects as diverse and detailed as a self-care mentor programme, mental health services redesign and the possible impact of shared decision-making on self-care outcomes, before submitting a monthly report to the clinical commissioning group divisional board.
But it is at the level of patient engagement with clinical and other staff where patients have most potential to influence the care they receive. We've seen first hand that seeking to embed shared decision making in clinical practice has the capacity to enable patients to make more informed choices, transforming their role from passive recipients of care to active contributors. What's more, in a culture where patients are encouraged to take much more direct control over their health, the decisions they make tend to be better and the costs on the NHS therefore less.
NHS Wirral commissioned two perception polls last year to assist its successor clinical commissioning groups. A telephone poll in November found a high level of acceptance of shared decision making but few examples of its use.
There is much good patient engagement practice both continuing and emerging. However, what separates now from any other time in is the extent and pace of change the health service requires; and, as such, the type of patient engagement called for is much more profound and evidence based.
Ewan King is a director of the Office for Public Management and Andy Mills is head of involvement and patient experience for NHS Cheshire, Warrington and Wirral Guardian Professional. 

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