Comment

• Bringing healthcare closer to the people

Publication

• Patient and public experience in the NHS

Demonstration project

• Co-creating Health

Case study

• Developing resources for people with insomnia

Feature

• Creating health in everyday life

Bringing healthcare closer to the people

Stephen Thornton, Chief Executive, The Health Foundation

There is increasingly a political consensus that NHS reform should focus on putting patients at the heart of their own care. Most recently, Health Minister Professor Ara Darzi’s report, Our NHS, Our Future, outlines a vision of a more personalised NHS, with new services for people with long term conditions and new measures to increase GP access. In social care, meanwhile, he proposes personalised budgets giving people who use services choice and control over their support.

These are all good ideas but recent history shows there is a gap between the rhetoric of patient engagement and what has actually happened in practice. Before it considers the next wave of NHS reform, the Government needs to consider how to better implement its existing pledges on patient engagement.

The problem is highlighted in a new Health Foundation report, Patient and Public Experience in the NHS: A Quality Chartbook by Sheila Leatherman and Kim Sutherland, which analyses publicly available data on the quality of care offered by the English healthcare system. The report shows that, while there have been areas of real success such as the dramatic improvement in access to care, there are also areas where improvements are still needed. Patient engagement in decision making and self care is one of these areas.

Drawing on the Healthcare Commission’s large-scale surveys in England, Leatherman and Sutherland show that only half of inpatients and 40 percent of people with mental health problems were fully involved in decisions about their care. Fewer than half of the inpatients surveyed indicated that danger signals and medication side effects were explained to them before discharge.

In diabetic care, even though improved self care is seen as a key intervention to help improve good glycaemic control, only 10 percent of people with diabetes indicated that they had participated in education and training programmes. Of those who had not participated, the vast majority had not been offered the opportunity to do so.

One model of the way forward is provided by a new Health Foundation initiative called Co-creating Health. This will support eight teams from across the UK to create new models of healthcare that embed self-management within mainstream health services. Two teams will focus on each of the following long-term conditions: musculoskeletal pain, COPD, diabetes and depression.

Co-creating Health uniquely combines an advanced development programme for clinicians designed to improve their skills in supporting their patients to self-manage, with a self-management course for people with long term conditions and the re-design of services to make it easier for patients to take a more active role in managing their health. At the centre of the initiative is a radical shift in the relationship between patients and clinicians, towards the creation of a more equal partnership.

As policy makers and NHS managers consider the way forward in making the health service more responsive to patients, I hope that the evidence uncovered in the Quality Chartbook and the practical experience of the Co-creating Health teams will act as beacons to guide them through this complex area of healthcare.

Respond to author

Publication

Patient and public experience in the NHS

This report brings together, for the first time, the scattered evidence on patient views of the NHS. The report uses over 40 different charts to give a comprehensive assessment of the Government’s efforts to create a patient-led NHS.

Demonstration project

Co-creating Health

Hundreds of studies have shown that supporting self-management can lead to dramatically improved outcomes for patients. Despite this, it remains at the periphery of most health services. This self-management initiative aims to transform healthcare for people with long-term conditions.

Case study

Developing resources for people with insomnia

Around one in ten people suffer chronic insomnia, which occurs on a regular basis or over a long period of time. This project aims to improve treatment for people with insomnia by promoting a range of treatment options beyond sleeping pills, which carry the risk of side effects and addiction.

Feature

Creating health in everyday life

In recent years there has been great interest supported self-management for people with long-term conditions. Harry Cayton, National Director for Patients and the Public, at the Department of Health, discusses patient engagement.