In an overkill 70 page missive to his colleagues in the Lords about the merits of the “reformed reforms” in the Health and Social Care Bill, Earl Howe helpfully restated that the user and public involvement duties of Section 242 of the NHS Act will not be – in his phrase – “diluted”. That’s helpful news in the same week that NHS England CEO David Nicholson updated his plans for the National Commissioning Board. One of the nine permanent executive directors will be a “National Director: Patient and Public Engagement, Insight and Informatics.” But we need to know if the role will do what it says on the tin?
Customer Insight for Business Foresight
We’re pleased to see the “insight” word in this NCB Director’s title. MAC has banged on for years that without customer insight, no primary care commissioner or provider – or any other healthcare business for that matter – can have the business foresight necessary for success.
The new Director with the longest title in the NCB will have his or her work cut out. Too bad that it will take until 2013 for the NCB to be fully up and running. We need it now before the hundreds of Clinical Commissioning Groups (CCGs) – some clearly not large enough to be viable – start dashing off madly with little central guidance and not giving community engagement much of a thought. Remember the old proverb: “If I wanted to get to there, I wouldn’t start from here”.
Choice and integration cannot both be masters
One of the paradoxes which is emerging as we dodge the potholes along the reform route is the tension arising between the emphasis on the patient’s choice of provider when they need elective procedures and the desire of commissioners – with the strong encouragement from Nicholson and soon from the NCB – to have integrated services and common pathways for everything one can think of from urgent care to long term conditions. The fact is you can’t have both in equal measure: a balance has to be struck that is acceptable to users and carers and makes sense in terms of clinical efficiency. Choice and integration cannot both be masters if the English NHS is to lay any claim to affordability and coherence.
Some people contend that patients don’t want choice about where and who treats them, but want to “choose” better local services. Of course they do: good, safe, responsive, effective AND local is the ideal. But we are far from being there and even if we were, it does not mean that choice, in the sense of the Patient Choice initiative, is misplaced. Far from it according to the results of a English survey released last month by the Department of Health: Public Wants More Choice in NHS Care.
Where, when and by whom really matter
The new survey of 5,000 people revealed that over 80 per cent of patients want more choice over how and where they are treated in the NHS and nearly three quarters of patients wanted more choice in who provides their hospital care. Women and older people in particular want to see more patient choice in the NHS. Nine out of 10 people over the age of 55 want to have a greater say in how and where they are treated.
More choice and control for patients must not come at the price of less integration and uniformity and hence ability to control costs for commissioners. This is a challenge for Clinical Commissioning Groups and they will need excellent support from the NCB and, above all, positive and progressive dialogue with their local populations to negotiate it.
Integration difficult but “do-able”
Things that should be simple – talking to people about hard choices in healthcare – often seem so difficult. They don’t have to be. That is what effective patient and public involvement is all about.
Our colleague David Gilbert, InHealth Associates, had a leading role in the NHS Confederation’s latest offering to commissioners on what patient and public engagement means and how to do it effectively in the new commissioning arrangements. David describes his current work with the Southend Estuary CCG as an example.
It’s sound, short and practical: three excellent virtues in the current climate. Now if we could only get CCGs to read, believe and do these things, life would be much easier.
Affordable, deliverable and acceptable
MAC believes that a a good place to start applying this practical advice would be the principles of integrated services which National Voices has just published. Designed “to put patients, service users and carers at the heart of care”, these 12 principles
- be organised around the needs of individuals (person-centred)
- focus always on the goal of benefiting service users
- be evaluated by its outcomes, especially those which service users themselves report
- include community and voluntary sector contributions
- be fully inclusive of all communities in the locality
- be designed together with the users of services and their carers
- deliver a new deal for people with long term conditions
- respond to carers as well as the people they are caring for
- be driven forwards by the commissioners
- be encouraged through incentives
- aim to achieve public and social value, not just to save money
- last over time and be allowed to experiment
are an excellent place to start the dialogue about integrated services (pathways etc) that are affordable by commissioners, deliverable by providers and, above all, acceptable to users and carers.
It’s do-able, but only if CCGs start the process now and don’t wait to be told what to do by the NCB in 2013.