Was it conspiracy or just more of the usual cock-up (the predominant explanation for most things that go wrong in public life)? Whatever the explanation, Government certainly seems to have got things seriously wrong in its latest consultation about “shared decision making”, which is supposed to be a main strand in the “No decision about me without me” policy thrust of Mr Lansley’s reforms.
Here’s the problem: what the document is really about is patient choice of provider. This is important, certainly, but by no stretch is it a synonym for shared decision making (SDM). The NHS Alliance bluntly pointed this gaffe out in a recent letter to Lord Howe from its Patient and Public Involvement Group.
… the government is eliding the meaning of the term “shared decision-making” into choice of provider. This carries the risk of entirely excluding the idea of shared decision-making from CCGs’ responsibility. This is not good for patients, for clinicians, nor for the NHS.
Three changes needed
MAC is part of the Alliance’s PPI Group and we fully concur with the Alliance’s position on this consultation. In short we want three things:
- the current consultation paper either be withdrawn or renamed, as it does not fulfil its shared decision-making remit;
- the section on Shared Decision-Making is given the same weight and focus as provider choice;
- another consultation paper be written that does, indeed, focus on shared decision-making as defined above. It could explore evidence, good practice and ways of making it real for Clinical Commissioning Groups and local offices, so that they feel engaged by the concept and the supporting evidence.
Dr Brian Fisher, convenor of the Alliance’s PPI Group, said
“Shared decision-making is a process that brings clinicians and patients together to select tests, treatments, management or support packages, based on clinical evidence and patients’ informed preferences. It improves outcomes and lowers health service costs. Ignoring this vital intimate work in the patient consultation threatens to exclude shared decision-making from NHS focus. This is bad for patients, clinicians, or the NHS.”
Individual involvement leads to SDM
Individual involvement is about changing relationships so that power is shared more equally between patient and clinician. The shared decision making and better self-care through evidence-based techniques which this can release also extends to patient record access, harnessing the power of information, use of decision aids and agenda-setting. The evidence is that shared decision making improves outcomes and lowers health service costs.
This individual involvement is distinct from but synergistic with the collective dimension of patient and public involvement. It is essential that none of this gets muddled up and truncated into a tick box compliance process about “choice of provider”. If that is allowed to happen, we predict that CCGs will wiggle through it without making the fundamental changes in how the NHS and its thousands of clinicians relate to its customers.
Shambles or rescue?
Government’s response to the Alliance’s positive criticism will be a good indicator of whether it is going to rescue shared decision making from the shambles it seems to have fallen into. We look forward to Lord Howe’s response.
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