Patient involvement is still a minority sport in the NHS

Patient involvement is still a minority sport in the NHS It gives people a voice and saves money – so including patients in treatment decisions should not be an optional extra, says Richard Vize.

With increasing numbers of NHS trusts destined to slide into the financial mire this year and next, there is one resource of which hard pushed hospitals enjoy a plentiful but underused supply – patients. They are the best hope for cutting demand and transforming services.

"Coproduction" is up there with "integration" and "transformation" in the NHS lexicon of abused words. It is intended to signify clinical staff involving patients in deciding the best course of treatment. As health secretary, Andrew Lansley pitched this as "no decision about me without me".

While this was certainly one of the more intelligible parts of his reform package, it conveys slightly the wrong idea about why patient involvement is so important. That slogan creates the impression that it is simply a right to be respected – but it is so much more powerful than that.

Patient involvement leads to better treatment, and often less of it. It is a simple way to save money and keep people out of hospital.

This week's announcement by the National Institute for Health and Care Excellence of new guidelines for treating prostate cancer is a powerful example of where helping patients understand the risks and benefits of treatment can avoid interventions that are unnecessary, distressing and costly.

The guidance is focused on giving men the information and support to decide whether living with prostate cancer and monitoring it is preferable to surgery. Choosing to live with cancer shows how patients are willing and able to make sophisticated, difficult decisions about their healthcare needs.

Involving people in care decisions means patients taking more responsibility for their own health. In many areas of of our lives, four years of austerity have opened up the debate about the balance between personal and state responsibility.

But while students are contributing to the cost of their university education and families and communities are increasingly being expected to take on more of the burden of social care, the NHS is still too diffident when it comes to pushing personal responsibility.

The shortage of cash means this will have to change. Patients will need to be supported in addressing the underlying causes of lifestyle-induced illnesses, while education and community support are now essential tools in reducing emergency admissions among patients with long-term conditions. There is convincing evidence that good self-management cuts A&E visits. At the other end of the scale, significant savings can be made simply by giving patients more flexibility over when to come back for a check-up.

The best hospitals are using patient insights to change their care pathways – coordinating services more effectively, giving patients better information with which to make choices, and encouraging clinicians to focus on the whole patient rather than the condition. Northumbria Healthcare NHS Foundation Trust is one that is embedding the patient voice into the way it thinks and acts. Yet despite the urgency of the need to save money and the proven effectiveness of patient involvement, it is still a minority sport in the NHS.

As the King's Fund has found, the institutional barriers to giving patients a voice are numerous and entrenched. Some doctors fear losing power, others lack the training, and too many have limited understanding of what it feels like to be a patient. I vividly remember a senior doctor admitting that it wasn't until he found himself in the position of a patient that he realised how astonishingly disempowering it was, even for him.

Amid the frantic activity of a typical NHS day there doesn't seem to be the time to involve patients in decisions about their care. In too many cases, patient involvement takes the form of projects and pilots rather than systemic change in the way care is provided. This needs to change.

It has to be seen not as a desirable extra, but the centrepiece of strategies to raise quality, improve the patient experience and cut costs. Listening to patients improves effectiveness and can save money – lots of it. Guardian Professional.