Government response to Francis: engaged patients still not in the mainstream

The government’s initial response to the Mid Staffordshire NHS Foundation Trust Public Inquiry, published earlier today, is entitled, Patients First and Foremost. But while it contains many sensible proposals which I am sure, when taken together, will lessen the chances of a repeat of the terrible things that happened to patients at that hospital, it does not, to my mind, put patients first and foremost. Indeed, patients barely get a mention at any serious level of detail until page 50 and, even then, the government misses the point.

So while the response does say that ‘the care system requires a genuine shift to placing patients at the centre, shaping services around people and their preferences’, patients still remain passive recipients of that care.

In my earlier critique of the Francis report itself, I noted that nowhere had he said that patients should be involved in decisions about their care and treatment; nowhere had he made clear that it was the patients who should be in control; and nowhere had he advocated encouraging supported self management. I went on to argue that this had been a missed opportunity to promote a step change in the way in which care was delivered in the NHS.

The government’s response to Francis represents a missed opportunity to put this right. Yes, it argues that patients should be involved at the stages of needs assessment, commissioning and service design. But thereafter? What about involvement in actual delivery of care? What about supporting people to self manage their care? What about enabling people to genuinely share the key decisions that need to be made about their care and treatment? What about involving carers in some of those key decisions too? There is no mention of any of this, simply the suggestion that, after the event, patients should be offered an opportunity to give feedback.

Many of us successfully argued for changes to the Health and Social Care Act – as it was going through parliament – that placed a duty on commissioners to promote patient engagement. We also successfully argued for changes to the wording of the Mandate between the Department of Health and the NHS Commissioning Board, which now speaks of ‘the NHS needing to become dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment.’

We also spent many an hour in meetings of the Future Forum NHS Constitution Review Group, arguing that activated patient engagement should be recognised. In that context it is gratifying to see that the revised version of the NHS Constitution, also published today, offers the pledge that the NHS ‘will enable you to participate fully in your own healthcare decisions and to support you in making choices.’

Yet why is none of this reflected in today's government response?

I can only hazard a guess. It is that there is still no deep, top-of-the-office commitment to the fully engaged patient. It is still not in the DH/NHS Commissioning Board DNA to think of the patient sharing control with their clinician. It is still something only for the interested enthusiast to dabble in, not yet in the mainstream.

Stephen is Chief Executive of the Health Foundation