How to put patients in the driving seat

Article by John Baron MP, Shadow Health Minister, from the current issue of the CMS Bulletin

Delivering ‘patient-centred care’ is one of the great ambitions of today’s NHS, but this important goal cannot be achieved without an effective system of patient and public engagement.

Putting patients in control of their care as much as possible has become a familiar mantra of the modern NHS. However, for patient-centred care to be a reality, patients and the public need a much stronger voice in the design of services – and in holding the NHS to account. That is why Conservatives in Parliament have been putting the spotlight on patient and public engagement.
Of course, successful engagement should not be seen as confrontation between the public and medical professionals. Patients and NHS staff often have an intuitive understanding of each other’s needs and concerns. Where patient and public engagement is most successful, doctors and nurses see patients’ groups as a partner against the regional health service management charged with implementing Patricia Hewitt’s agenda of targets, initiatives and reconfiguration – or cuts.

It is therefore little surprise that Labour has repeatedly failed to give patients the powerful mechanisms for engagement they deserve. Ministers abolished successful community health councils (or ‘CHCs’) only four years ago, replacing them with a myriad of fragmentary new bodies. The cornerstone of the new system was patients’ forums, but these were inadequately supported, which is why they did not have the best of starts – despite the hard work and dedication of members.

The Government is now pushing through legislation to abolish patients’ forums and replace them with new local involvement networks (or ‘LINks’) but these plans have spectacularly failed to engage the respect or enthusiasm of existing volunteers – a situation not helped by the legislation not having the word ‘patient’ in the title, while being tagged onto the end of the local government Bill, almost as an afterthought. Many volunteers intend to walk away from the NHS, disgusted that forums are being replaced after all the hard work committed to them. I am therefore concerned that another tier of expertise in the health service is about to be lost.
Our objections to the new proposals are numerous, ranging from the loss of expertise to the lack of independence and statutory powers. For one thing, the specialist knowledge and skills of patients’ forums attached to mental health and ambulance services risk being lost.

Secondly, for any system of engagement to be credible, it must be independent. However, I am concerned that local authorities will have an undue influence over the new arrangements. LINks will be financially accountable to the council, and yet will be expected to hold to account some of the services provided or commissioned by it. Money for these LINks will not be ring-fenced, and so is liable to be top-sliced by cash-strapped local councils – hence the conflict of interest.

Thirdly, where patients’ forums have been successful, the power to enter and inspect NHS premises has often been key. However, the Government’s Bill contains only a watered-down version of that power. The words ‘inspect’ and ‘inspection’ do not appear. I fear that, without strong powers, there will be little incentive for volunteers to serve.

The Government’s proposals also fail to create a national voice for patients, or even the capability for regional networking of LINks. Nor does the Bill give patients a direct role in the regulation of health and social care.

That is why we have already consulted on proposals for ‘HealthWatch’ – an independent, national voice for patients, which would combine the traditional investigative and representative functions of patient engagement with those of a modern, consumer-style public services watchdog.

HealthWatch would be a voice for patients on all NHS issues and would provide a mechanism through which informed public opinion can influence the regulation of healthcare. It would have the power to make visits and acquire information, and would pursue and refer individual or collective patient complaints.

HealthWatch would be a national body – a strong, independent brand – but with a local presence and significant bottom-up elements. Until the Government joins us in embracing this concept, patient and public engagement in the NHS will continue to suffer from a poverty of ambition, and patient-centred care will remain an elusive dream.