Expert Patients

25 February 2015

For the NHS, the next Parliament is a challenge and an opportunity. To close the funding gap the NHS must find a productivity growth rate of up to 3 per cent, more than the UK has ever seen before. Simon Stevens has set out his vision to achieve that. The next government will support his efforts to deliver.

One of Stevens’ big ideas is to use prevention and patient engagement to turn patients into an asset to the health service, not a cost. Stevens follows in the footsteps of Sir Derek Wanless who in his landmark 2002 review argued that involving patients in their care will be the only route to sustainable healthcare. Under the “fully engaged” scenario, where there is the greatest public and patient engagement, the NHS could save £30 billion between 2002 and 2022.

More than a decade later and the NHS is a long way off the “fully engaged scenario.” As the Five Year Forward View acknowledges, improvements in public health remain marginal and in some areas, such as obesity, are in decline. Self care, shared decision-making and patient activation are in their infancy in the NHS at large.

A wealth of evidence now shows that Stevens and Wanless were right in their convictions.  Involving patients in their care both improves outcomes and use of resources. Reform’s new research found patient engagement could save the NHS £2 billion by 2020.

Delivering on these productivity gains will require the NHS to tap into the hidden human capital of patients and communities. New technology can allow patients to do jobs previously carried out by clinicians, from monitoring their condition to administering elements of care. Diabetics already measure their blood sugar levels and administer insulin injections, not a practice nurse. Treatments such as renal dialysis, once confined to hospitals, are now possible in the home. Digital communication, such as skype GP consultations or online appointment booking, could strip back the need for back office staff. Shared decision-making can allow patients to work in partnership with professionals to make better decisions about their care that patients are more likely to adhere to.

The good news is that patients want to do more, and in many cases already are. National patient surveys show that half of hospital inpatients and one in three people using GP services were not as involved in decisions about their care as they wanted to be. Technology and consumer expectations are transforming healthcare, with nearly nine out of ten people consulting diagnostic information online and 60 per cent of patients saying they would monitor their chronic condition using a mobile app. Citizens already invest more in their health and wellbeing than ever before and the value of informal care is rising faster than the NHS budget. In social care it exceeds the care budget five times over, according to the National Audit Office.

However this emerging “expert patient” is developing more quickly outside the NHS than within it. Private and third sector organisations are going direct to the consumer with services not provided by the NHS. “Virtual” primary care offers an alternative to lengthy waits to see a GP and inconvenient opening hours. A new app called Babylon allows patients to skype a doctor through their smart phone. Patients can order prescriptions online, to be delivered to their front door, via DrThom. Social networking sites, such as PatientsLikeMe and iWantGreatCare, are giving patients a forum to learn from each other, track their conditions, and provide feedback on services.

Despite a number of efforts to engage patients within the NHS, the impact has been limited so far. Enshrining patient rights in the NHS Constitution does little good when the document remains ill understood by the majority of patients. Patient choice has great potential yet only 51 per cent of patients are aware of their right to choice. Recent focus on gathering patient feedback has not changed citizens’ reluctance to complain about the NHS relative to other sectors. Digital services are key to giving consumers control yet while 97 per cent of consumers would like to access their electronic record, 67 per cent remain unable to do so.

The challenge for the NHS is that patient-centred care is more than the sum of individual initiatives. Well intentioned reforms, from the Friends and Family Test to personal health budgets, continue to act as “bolt ons” to the status quo without engendering the underlying cultural change required. Without all elements of the system aligned in the interest of patients, not providers, the high value healthcare Stevens seeks will be extremely hard to achieve.

Cathy Corrie is Senior Researcher at Reform

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