Published by David Prior on 4 December 2014
- Our Work
- The Reformer Blog
9 December 2014
Over a decade in the struggle for NHS reform has taught me a number of lessons. One of the most significant is to be most afraid that nothing will really change in the NHS when everyone appears to agree about the direction of the change that needs to happen.
No one really argues against a “patient centred NHS”. Indeed for many people in the NHS, they think it is already here. And for others it just needs a few tweaks in how we tell patients how to behave to bring about the changes that will put patients at the centre of the NHS.
And, as some point out, when you look at the patient satisfaction scores of many patients’ experiences of the NHS, you see scores that would make Apple very jealous.
So what’s the problem? And why will this decade see radical change when the previous six have not?
In 2014, the problem of the lack of patient-centredness has moved from a moral problem of “Why won’t the NHS organise itself around my life rather than its own organisational needs?” to an economic one: “Because the NHS excludes us from our own healthcare, it can’t afford to treat all the new sick people”.
This change has happened for two main reasons. First and foremost, the nature and the extent of the illnesses that the NHS has to work with has changed. Most resources are spent on long term conditions and the number of people with those long term conditions will increase in line with the ageing population. Second, whilst the extent of NHS resources will stay about the same, the number of sick people to treat will go up. Therefore the amount spent per sick person will decline.
This means that the NHS can no longer afford to exclude patients from playing a significant and efficient role in their own healthcare. Given that patients need to do more of their own caring, it is inevitable that patients need to be more central in the way in which the NHS cares for them. Or the old model NHS goes bust.
The fact that most NHS resource is spent on people with long term conditions means that most NHS effort is spent with sick people who have their sickness for a long time. Most people with arthritis, diabetes, heart and lung problems have had, and will have, these conditions for decades.
In any other service or industry, if the consumer of the service had decades of experience of a particular activity, the provider of the service would see this as a large resource to be worked with. They would be asking themselves the same question over and over again: “How can I turn this vast consumer knowledge and experience into an asset to help me deliver value within the service?”
To make any of that real, the service provider needs to recognise that the use of the consumers’ knowledge and experience as an asset will only be fully realised if we make sure that the service is delivered in the way that is most convenient to the user. To get them to add the greatest value they can, we must wrap the service round their lives.
One of the oddest things to hear the introduce this patient to the idea of self-management”. This is absurd because patients with long term conditions do self-manage. For nearly all of their lives the NHS is absent. The NHS is in their clinic or hospital and the person with the long term condition is in their home.
For nearly all of the time, there is no doctor or nurse sitting at their bedside when they run out of breath or they are in chronic pain from their condition. For 5,800 waking hours a year, people with long term conditions face their condition with the family, their carer and their friends and on their own.
Patients self-care nearly all the time. They just don’t do it as well as they might. If the NHS could use the little time we have with patients to invest in improvements in their capacity to self-care, this would transform the outcomes of “healthcare”. Poor self-care leads to exacerbations which lead to emergency admissions into hospital beds. Very good self-care leads to fewer exacerbations which leads to fewer emergency admissions.
Recognising that patients are at the centre of their own healthcare, and moving them to the centre of NHS care, will change the value proposition for the NHS. Failing to do so will endanger its future.
Professor Paul Corrigan CBE, Former Health Adviser to Prime Minister Tony Blair
This blog was taken from an article written for the brochure that accompanied Reform’s major health conference on the 2 December 2014.