Patients as customers Prof Field?

Just spent a frustrating couple of hours watching a live Q&A session on the NHS reforms and possible changes to the Health and Social Care Bill with Prof Steve Field (who started off by being an hour late arriving at the Guardian office venue).   How depressing to hear him more or less dismiss patient and public involvement as just something that Health Watch will do along with the Council-dominated Health and Wellbeing Boards.   And it does not bode well that in Mr Cameron’s big “I love the NHS” speech today in Ealing, he somehow didn’t mention patient and public involvement either. His view is that doctors and nurses know best what patients need and they can be trusted to act accordingly.

We disagree.  No one group has a monopoly on knowledge or wisdom about healthcare for individuals or communities: it must be about shared decision making from the consultation room up to the board room.  Have they all forgotten the rubric which has been parroted all through these reforms: “Nothing about me without me”?

Here’s the question we fired off to the Guardian website in response to Field’s simplistic view.

If Steve Field or anyone else thinks that patient and public involvement can or even should all be done by Health Watch and its local off-shoots, it shows they have no real understanding or practical experience of what involvement, engagement and consultation with service users and the public are about. Don’t leave it all to Health Watch. That is NOT what “Nothing about me without me” means.

Local Health Watch is intended to be much more than LINks rebranded. As a statutory body, LHW will probably have a seat on the top level governance group – whether or not it is called a “board” – of the GP commissioning consortium and be able to make reports to the wider community following each meeting. It will also sit on the Council’s Health and Well Being Board.That is welcome. But there is a high risk transition phase to be navigated first, in which funding is not secure and much can happen to thwart objectives. Local authorities are abandoning their legal duty to involve as well.

It is essential that people working in the NHS and social care don’t by default see Local Health Watch as a synonym for patient and public involvement and therefore someone else’s job.

There must be integration between viable Local Health Watch and many other types of involvement and engagement at the grass roots of clinical commissioning structures and local providers. The MOST important part of this is patient participation in each practice and Foundation Trust members who really have a voice through their governors.

To be successful businesses, GP practices and commissioning consortia need many direct “listening relationships” with their own patients. If they saw patients as customers, this would be a lot clearer to them. Why are they so frightened of this concept? What does Prof Field say to this?

Andrew Craig
MAC Partnership LLP

Did we get an answer?  No, but we are prepared to wait. In the meantime, lots of hints about what the answer should be have been given by the Kings Fund in their latest briefing Ten Priorities for Commissioners .   They argue that the empowerment of patients – patients being the greatest untapped resource within the NHS  - and their active engagement in commissioning  must be a common thread in all priorities facing the new commissioning system.

Simple isn’t it? So just do it.

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing.  Feel free to contact us to discuss the opportunities.

 

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