Reaction to the NHS Future Forum reports

As I sat yesterday afternoon ensconced in the Department of Health boardroom, reading the NHS Future Forum reports for the first time, what was my immediate reaction?

Clearly, a great deal of work and thought has gone into them. Steve Field is to be congratulated for retaining focus on a relatively small set of important issues, and successfully resisting the temptation of commenting on everything that might be wrong with healthcare in England.

What caught my eye first was the radicalism of vision for information. Owned by the patient, there to improve quality and to foster shared decision making and self management. Music to my ears. What the Health Foundation has argued for consistently over the last few years. 

But then I spotted the recommendations in this section. Good to see there was one saying that the government must now make it clear exactly how it will realise its commitment to give patients access to their health records held by GPs, given that this has the potential to revolutionise the relationship between clinicians and their patients.

However, while recognising that information without good communication is of little value, there was a disappointing absence of detailed recommendations as to how such effective communication will be achieved. Fine to have the aspiration that every patient with a long-term condition should have easy access to a named person who can act as a co-ordinator of their care. But that does not get to the heart of the one-on-one relationship between patient and clinician in the privacy of the consulting room.

And there lay my biggest disappointment. 

The information report rightly says that ‘many people want to be more involved in decisions about their care’ and want ‘a partnership with their health professional and greater support to manage their health and conditions more independently’. But its sister report, devoted to education and training, makes no reference whatever to how clinicians will be trained to make this happen.

Unless clinicians are helped to understand that this means a fundamentally different approach to the consultation, using techniques such as motivational interviewing, little real change at the level of the doctor-patient interface will actually happen. Yet the education and training report is all about the process of establishing the new structural arrangements, with virtually nothing on the actual content of that education and training.

So, good as far as it goes, and at its heart a radical vision. But are the recommendations on the need for information plus support for both patients and clinicians strong enough? When we read the government's response published later today, will we see a practical course plotted towards realisation of that vision? Let's wait and see.

Stephen is Chief Executive of the Health Foundation.