Partners in care

The Prime Minister’s recent speech on the NHS marked a clear shift in the Government’s attitude to the role of patients in their healthcare. Passive, dependent patients are out; active and empowered patients are in. Gordon Brown’s new NHS is one which supports patients to take a more direct role in managing their own healthcare. If delivered, this would not only change our health services unrecognisably – it would improve the lives of millions of people.

A health service that actively supported people with long-term conditions to improve their healthcare would be a radical departure from Beveridge’s 1942 NHS, underpinned by dependence and a “one size fits all” ethos.

But not everyone agrees that it’s time to move on. A recent Daily Telegraph article, published before the Prime Minister’s speech, portrayed this shift as a money-saving exercise that would damage the health of vulnerable people, abandoning them to treat themselves. This is misguided at best and scaremongering at worst.

Encouraging people with long-term conditions to actively manage their condition is important because what they do in their day-to-day life can have as great an impact on their health as the treatments prescribed by their doctors and nurses. Far from driving people away from health services, this approach brings them closer to their clinicians. Having recognised that patients bring expert knowledge of their own condition; clinicians are able to take a partnership approach, shaping their advice to reflect individual needs and lifestyles so that it is of maximum effectiveness. Its benefits not only include improved patient experience of healthcare, but crucially, improved health for patients. 

Given the clear evidence that this is a change that the public strongly supports, the case for change becomes even more compelling. And as Society Guardian’s editor, Patrick Butler, recently pointed out the idea of harnessing the knowledge and resourcefulness of patients is not new. So why is it still not happening across the NHS?

Part of the problem is that there is very little practical experience within the UK of how health systems can best support people with long-term conditions. There is widespread support for the Prime Minister’s vision, but a distinct lack of understanding of how to make the vision a reality.

To bridge this gap, The Health Foundation has invested over £5 million in a new programme, Co-creating Health. This is a three year, ambitious and large-scale attempt to bring patient self-management into the reality of what the NHS does on a daily basis. To do this, eight healthcare teams from across the UK will look to transform one area of local care - diabetes, chronic obstructive pulmonary disease (COPD), depression or persistent pain. 

Reliable delivery of this type of support will not happen simply because the Prime Minister has given it a welcome endorsement. Like safe healthcare, it can only be achieved through a systematic approach. Something so important cannot be dependent on the personal philosophy or commitment of individual clinicians.

This approach is far more than a one-off Expert Patient Programme course, although such programmes are effective at building patients’ confidence and skills. Similarly, providing people with more information about their condition or about treatment options is not enough by itself to help them make difficult lifestyle changes and choices. We all know that we should eat more healthily and take more exercise, but it’s not a lack of information that’s preventing us from changing our ways. A genuine transformation requires a full system change. Health professionals, clinical services, systems and environments all need to be geared to empower and support patients.

As the NHS approaches its 60th birthday, the Darzi review on the future of the service puts clinical engagement at the heart of reform. No question will engage clinicians more than the challenge of redefining medicine for the 21st century. Central to change will be the extent to which the service successfully supports patients in feeling that they are partners in their own care. It’s a change that could not only add life to years, but also years to life.

Dr Peter (Alf) Douglas Collins is a consultant in pain management with Taunton and Somerset NHS trust and an adviser to The Health Foundation's co-creating health initiative national support team; Natalie Grazin is assistant director of the Health Foundation.