Culture shift or engagement dressage?

In his first speech as Secretary of State for Health this week, Andrew Lansley backed a “nothing about us, without us” approach to patient engagement.  Sounds good. But here’s the big unknown: is this a genuine culture shift or just clever patient engagement dressage?  That’s what trained horses do of course and we think it’s a good metaphor for formalistic process that is all for show. Caroline’s blog on how things are being done with schools policy shows that any commitment to consultation can so easily be trampled under the hooves of a new government’s cavalry charge  for early achievement.

At an East London event jointly organised by National Voices,  Patients Association and Department of Health,  Lansley fleshed out some of the principles in the new Coalition Government’s plans for healthcare. This included how LINks and Healthwatch would be related – a subject MAC has a great interest in and to which we will return with our views in an upcoming post.

In making the NHS a safe, effective, successful service, his key priority will be “First, that patients must be at the heart of everything we do, not just as beneficiaries of care, but as participants, in shared decision-making. As patients, there should be no decision about us, without us.”

The corollary would be “disempowering the hierarchy:  the bureaucracy, the Primary Care Trusts and the Strategic Health Authorities. I don’t want the whole of the NHS to wait to hear from me. I want it to listen to patients, and to take responsibility for action.”

Caveat – hierarchies don’t usually relinquish power easily and a struggle is usually involved – maybe even with bureaucratic blood on the carpet.  It will take more than speeches to achieve the objective – so watch this space for the promised White Paper on Health in early July and an autumn Health Bill  as foretold in the Queen’s Speech last week.

In the meantime, we intend to take Mr Lansley at his word and judge him and the NHS by their actions.  We also remember the adage “culture eats strategy for breakfast.”  In that spirit we invite readers to consider his speech and give us their comments, warts and all.

To kick this off,  this is what Jeremy Taylor, CEO of National Voices had to say about Mr Lansley’s Bromley by Bow vision:

‘Culture shift is the key challenge for the NHS.   Despite significant improvements in recent years, there has been too much management by fear, too much inertia from professional vested interests, and too little opportunity for patients and families to be heard.  National Voices calls for an open, human, responsive and collaborative culture that puts people first.   Incentives play an important part in this but we need to understand the whole mix of carrots and sticks, and we look forward to seeing more detail from the government.’

We also wonder what this all means for commissioning as a change process driven by public health intelligence and for the role of Third Sector bodies who are trying to influence it locally.   MAC has a particular interest in upping the commissioning game for neurological long term conditions and the profile of organisations that work with the millions of people who have neurological LTCs.  It is hard enough in organisational development terms for Third Sector bodies to focus on 150 English PCTs as commissioners, especially for the less common conditions. It would be ludicrous to expect them to try to engage with the 500-600 GP commissioning consortia which Mr Lansley is describing as part of his vision.

It would be a serious – and we hope unintended – consequence to weaken the potential influence of Third Sector patient-led organisations as players around the health and social care reform table just at the time we need their voices and intelligence the most.  We urge Mr Lansley to think about the consequences of pushing commissioning crudely down to GP level and leaving the PCTs, if they even survive as viable organisations, to pick up the scraps that the GP commissioners can’t be bothered with.  That would be a recipe for fractured services far worse than anything experienced now and would quickly lead to even more yawning health inequalities.  And it is a subject we shall also be returning to in the near future.

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