From god to guide: can patient-centred care become a reality in the NHS?: Most parts of the NHS are only paying lip service to patient engagement, recently hailed as the 'next blockbuster drug'
As healthcare systems the world over continue to groan under the weight of rising expectations, ageing populations and squeezed finances, the search for viable long-term solutions shows no sign of slowing.
For many, the focus remains on system reform – finding new ways to make the money go further by redesigning services to be more efficient. But, increasingly, attention is turning to the people who use healthcare services as the potential saviour of them.
As Maureen Bisognano, president of the influential US-based Institute for Health Improvement, told the International Forum on Quality and Safety in Health in London in April: "Patient engagement is the next blockbuster drug."
Patient engagement is certainly not a new concept but, in truth, most parts of the NHS are still only paying lip service to it. The default position for many health professionals is still to think in terms of, "What's the matter with you?" rather than, "What matters to you?"
It's easy to see why. Most systems, our own included, are heavily geared towards the five hours a year that, on average, we each consume healthcare. However, ccording to a new report by KPMG, called Something to Teach, Something to Learn: Global perspectives on healthcare, the real gains are being made by health systems that understand the importance of the 8,760 hours a year when we are not officially classed as patients.
Technological advances, such as smartphone apps which can speed a patient's hospital discharge by allowing them to measure ECGs at home, or telemedicine systems, which deliver multidisciplinary virtual clinics, offer a partial solution to empowering patients.
But the reason these breakthroughs have not revolutionised care in the way we thought they might 10 years ago is that a more fundamental issue is being missed – that of understanding a patient's needs beyond treating the condition with which they have been diagnosed. Too often, our systems encourage the health professional to treat the illness, not the person. We chase narrow biomedical indicators, which, while important, don't capture all that matters to the patient.
There's now a great deal of evidence which shows that when patients are asked what they really want, they often choose a different (and in many cases less expensive) course of action to the one their doctor or nurse might have recommended. For example, most patients do not want to spend their last hours in hospital, yet the majority do.
Educating patients so that they can make informed choices, not just about their care but about their overall lifestyles, is vital. But it is also only half the battle. The key is listening to, and acting on, those choices – only then do patients become truly empowered.
And that's where system change comes in. The emerging evidence from around the world, as highlighted in Something to Teach, Something to Learn, is that to thrive in the challenging years ahead, healthcare systems will need to reorient themselves around the needs of patients.
Hospitals will have to look beyond their four walls, bridging the gap with primary care and transforming to become part of health systems, taking responsibility for entire pathways of care.
Primary care will need to become more accessible and more time will need to be given to understanding the needs and expectations of the 3% of patients that drive 50% of NHS costs every year.
These patients, often with multiple conditions, need continuity and access to integrated services which combine primary care, supported by specialists and the effective use of telephone and web-based tools and support. For this to work, health system funding also needs to be reshaped. There are already signs, from around the world, that payers – be they private insurers or governments – are becoming more active.
They are gaining a better understanding of what constitutes quality in the eyes of patients and designing new types of contracts that reward "value" rather than "volume".
ParkinsonNet, a ground-breaking patient-led education programme in the Netherlands, is a great example. It has shifted perceptions about what constitutes value for Parkinson's patients and, as a result, has radically changed practitioner behaviour. The programme has already halved the number of hip fractures suffered by this patient group and delivered savings of £13m.
In a system designed around the patient, clinicians need to move from god to guide, focusing their skills on the provision of information and support to help patients make effective choices and manage their own health and wellbeing.
True patient empowerment is not a bolt-on; it should be the centrepiece of the healthcare jigsaw.
This partnership is pivotal and central to an NHS which delivers both high quality healthcare and value too. Is it possible? With our greatest asset – the hundreds of thousands of front-line NHS staff who work with patients every day – yes, absolutely.
Mark Britnell is chairman of KPMG's global healthcare practice. Guardian Professional.
As healthcare systems the world over continue to groan under the weight of rising expectations, ageing populations and squeezed finances, the search for viable long-term solutions shows no sign of slowing.
For many, the focus remains on system reform – finding new ways to make the money go further by redesigning services to be more efficient. But, increasingly, attention is turning to the people who use healthcare services as the potential saviour of them.
As Maureen Bisognano, president of the influential US-based Institute for Health Improvement, told the International Forum on Quality and Safety in Health in London in April: "Patient engagement is the next blockbuster drug."
Patient engagement is certainly not a new concept but, in truth, most parts of the NHS are still only paying lip service to it. The default position for many health professionals is still to think in terms of, "What's the matter with you?" rather than, "What matters to you?"
It's easy to see why. Most systems, our own included, are heavily geared towards the five hours a year that, on average, we each consume healthcare. However, ccording to a new report by KPMG, called Something to Teach, Something to Learn: Global perspectives on healthcare, the real gains are being made by health systems that understand the importance of the 8,760 hours a year when we are not officially classed as patients.
Technological advances, such as smartphone apps which can speed a patient's hospital discharge by allowing them to measure ECGs at home, or telemedicine systems, which deliver multidisciplinary virtual clinics, offer a partial solution to empowering patients.
But the reason these breakthroughs have not revolutionised care in the way we thought they might 10 years ago is that a more fundamental issue is being missed – that of understanding a patient's needs beyond treating the condition with which they have been diagnosed. Too often, our systems encourage the health professional to treat the illness, not the person. We chase narrow biomedical indicators, which, while important, don't capture all that matters to the patient.
There's now a great deal of evidence which shows that when patients are asked what they really want, they often choose a different (and in many cases less expensive) course of action to the one their doctor or nurse might have recommended. For example, most patients do not want to spend their last hours in hospital, yet the majority do.
Educating patients so that they can make informed choices, not just about their care but about their overall lifestyles, is vital. But it is also only half the battle. The key is listening to, and acting on, those choices – only then do patients become truly empowered.
And that's where system change comes in. The emerging evidence from around the world, as highlighted in Something to Teach, Something to Learn, is that to thrive in the challenging years ahead, healthcare systems will need to reorient themselves around the needs of patients.
Hospitals will have to look beyond their four walls, bridging the gap with primary care and transforming to become part of health systems, taking responsibility for entire pathways of care.
Primary care will need to become more accessible and more time will need to be given to understanding the needs and expectations of the 3% of patients that drive 50% of NHS costs every year.
These patients, often with multiple conditions, need continuity and access to integrated services which combine primary care, supported by specialists and the effective use of telephone and web-based tools and support. For this to work, health system funding also needs to be reshaped. There are already signs, from around the world, that payers – be they private insurers or governments – are becoming more active.
They are gaining a better understanding of what constitutes quality in the eyes of patients and designing new types of contracts that reward "value" rather than "volume".
ParkinsonNet, a ground-breaking patient-led education programme in the Netherlands, is a great example. It has shifted perceptions about what constitutes value for Parkinson's patients and, as a result, has radically changed practitioner behaviour. The programme has already halved the number of hip fractures suffered by this patient group and delivered savings of £13m.
In a system designed around the patient, clinicians need to move from god to guide, focusing their skills on the provision of information and support to help patients make effective choices and manage their own health and wellbeing.
True patient empowerment is not a bolt-on; it should be the centrepiece of the healthcare jigsaw.
This partnership is pivotal and central to an NHS which delivers both high quality healthcare and value too. Is it possible? With our greatest asset – the hundreds of thousands of front-line NHS staff who work with patients every day – yes, absolutely.
Mark Britnell is chairman of KPMG's global healthcare practice. Guardian Professional.
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