Patients can be part of the solution, we just need to let them in

The idea of consumers being at the centre of services is a simple idea that’s illustrated across retail, travel, finance and many other sectors. However health professionals – clinicians and managers – are still struggling to recognise and unleash the full value that patients, as informed active consumers, can bring to the NHS.

My interim experience on the Health Education England Patient Advisory Forum over the summer left me feeling that the NHS needs to plan its workforce around the broader, medium- to long-term needs of surrounding populations, rather than short-term organisational (and often consultant-led) wants. Most, if not all, of Health Education England’s £5bn spend is dedicated to the people who spend between 5-10 hours a year seeing a ‘typical’ long-term condition patient. Very little, if any, goes on supporting the patients or carers who deal with it for the other nearly 9,000 hours.

And yet in Wanless’ world, a fully engaged public saves some £30bn of public monies. A presentation at the Patient Information Forum (PiF) June Executive Circle by Mark Britnell, Chairman & Partner of KMPG’s Global Health Practice, showed that ‘activated patients’ can save providers between 8-21% of costs. Yes, 8-21%! That’s a bigger intervention than any drug, medical device or even QIPP.

NICE Chair David Haslam, presenting at PiF’s September Executive Circle, supported the linked concepts of ‘activated patients’ being a health care intervention and ‘information being regarded as a therapy’. Plans are gestating to see if we can pull out some key themes from current NICE guidance to support one or both of these concepts.

The engaged patient concept runs through all Department of Health policy, the Mandate, etc. But it seems that the rhetoric is very different from the vast majority of realities (see my last blog).

Clinical commissioning groups (CCGs) and providers, broadly speaking, are still concerned primarily with finance, governance, competition, etc – the 'looking upward not outward', to corrupt a phrase from David Nicholson. If patients are the solution why are they not focusing more attention on patient engagement at the individual level? Could NICE’s CCG Outcome Indicator Set be expanded beyond patient experience to contain some patient engagement measures? QOF too? Clinicians, despite best intentions, find it difficult to get out of the medical model of doing ‘to’, not doing ‘with’ patients (see the RCGP’s Care Planning paper from 2011).

The system needs to fully grasp that patients can be part of the solution and not just the problem. That many patients, when appropriately informed, educated and supported, can become a value to the system, and to wider society, and not just a cost. An asset and not just a deficit.

We fund and provide buildings, people, medicines, devices. But there needs to be proper funding, training, roll-out and measurement for care planning, information prescriptions, structured patient education, access to records and so on. If information (in its broadest sense) is a therapy that improves outcomes, then we need to see this embedded in health care delivery. To not inform nor coach patients to take more responsibility might be akin to withholding treatment.

In health care, we’re continuing to (unwittingly) make ourselves and our patients dependent on a system we increasingly can’t afford to fund. We keep providing the fish when we really need to start teaching people to fish themselves. Will we ever systematically let patients, carers and others in?

Mark is a clinician, management consultant and patient advocate, www.twitter.com/MarkDuman