Saturday, 22 September 2012

A brief history of patient involvement in NHS

The new Health and Social care Act 2012 was sold to us as putting the patient at the centre of everything the NHS (in England) does.

I have spent many years collecting information on patient and public involvement and I would like to share some of the things I have filed in boxes and piles of paper.

Way back in 1974 the Community Health Councils (CHC) were created to give the patient a chance to have a say about the way the NHS was run.  Later other groups replaced the CHCs and as part of the HASCA Local Healthwatch will take over that role (in April 2013).

I started to collect quotes when I joined our local CHC in 1992.

Here are a few:

"A consumer responsive NHS will treat its consumers with respect and will enable individuals and communities to influence the health service purchased and provided on their behalf"
A Regional Strategic Framework - Towards 2000.

"The government recognises that...involving people more at both strategic and operational levels in discussions and decisions about options and priorities.... will help them achieve their objectives"
The Health of the Nation June 1991

"Patients and the public must have a say in health service decision making"
Purchasing for Health July 1993

Zooming on a bit

The NHS must be more open and truly accountable to the public.
- involving the public in decision making and monitoring process
- involving patients in service planning, development and implementation
A First Class Service. Quality in the new NHS 1998

"Duty to involve and consult patients and the public in service planning and operation and in the development of proposals for change"
Health and Social Care Act 2001 Section 11.

Its all sounding a bit familiar isn't it?
So moving quickly on....

Section 14U.
"Each Clinical  Commissioning Group (CCG)... promote the involvement of patients and their carers in decisions which relate to;
- prevention or diagnosis of illness in patients
- or their care and treatment."
Section 14Z2
"CCGs must make arrangement to secure that individuals.. are involved in
- the planning of the commissioning arrangements by the group
- the development and consideration of proposals by the group for change in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which services are delivered or the range of services available."
Health and Social Care Act 2012

So what, you say!

My point is that various governments over the last 20 years have said a lot about the need for patients and the public to be involved in decision making at various levels in the NHS.  The fact that they are still saying it suggest that it has not yet happened across the country in a meaningful way.

Will the embryonic CCGs really involve us patients in commissioning decisions?

Is it all rhetoric?

Do patients really want to be involved at a strategic level in decision making about health services?

What do we mean by 'involvement' and what do the CCGs mean?

Involvement, to me, is an active thing, it means that patients and the public participate in the development of new patient pathways and how services are changed. It is about involving the public in decisions about which services to commission and which services not to commission.  It is about asking us for our opinions on setting priorities. It is not just asking us for our opinions after the changes have been developed or priorities set.

The question remains though,  how many patients want to be involved in such difficult decisions?

Added in Sept 2017

The latest version of patient participation is Co-Production. This is an idea that originated in the States where whole communities got together with the authorities to develop facilities or services.

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