As ministers keep telling us, Labour’s second term is all about delivering public services. The NHS is at the top of the agenda for reform. The debate has so far focused on what managers and doctors, whether in the private or public sector, can do to deliver quicker, more convenient services and to improve patient choice. But, in contrast to education and welfare reform, nobody discusses what patients’ roles or responsibilities might be.
It is true that many patients have to put up with appalling waits for treatment and inflexible services. Confidence in health professionals has been rocked by cases of criminal and negligent doctors. When so much has to be done to modernise outdated services and raise standards of care, promoting the concept of “the responsible patient” seems way off the mark.
But in pursuing an almost entirely consumerist agenda in the NHS, the government is simply piling up trouble for the future. The NHS already faces difficult trade-offs between the needs of individual patients and those of the wider community. An explosion of costly new technologies, particularly those emerging from the human genome project, will further widen the gap between what patients want and what they get. Encouraging patients to expect the NHS to be like a Tesco supermarket- providing a never-ending choice of products on demand, 24 hours a day – will increase their dissatisfaction. The danger is that the more advantaged and articulate patients will opt out, leaving the poor and vulnerable behind. Reforms must acknowledge that the NHS is not just another consumer organisation: it is a public service with wider public goals.
There is a second reason to abandon the consumerist health agenda. Recent research shows that empowering patients with chronic and long-term diseases to help manage their conditions can improve their health and reduce inappropriate use of services. Programmes that involve patients in decisions about their treatments and medicines reduce anxiety and depression and improve satisfaction. The greater availability of “over the counter” drugs, and new technologies such as portable heart monitors, will allow patients to take on more responsibility.
The government must choose between the consumerist model of health services, where the rights of the individual are all-powerful, and the citizenship model, where patients have rights but also responsibilities. The NHS must be transformed from a service that does things to or for patients to one that actively empowers them, reduces dependency and promotes greater self-reliance.
How? First, we need to reform professionals’ training to create a more equal relationship between doctors and patients, ending the old paternalistic attitudes. Second, improving patient information – from the leaflets in medicine packets to hospital and primary care league tables – must be a core health service issue, not an optional extra. Third, a new patient support service should be established to link patients to help and advice – for example, after they’ve received a diagnosis. Fourth, the government should promote self-care – through, for example, teaching schoolchildren about minor ailments or using new technologies such as telemedicine to give greater patient independence. Finally, patients and the wider public must be involved in decisions about how local services are run. The government has at long last started to tackle the democratic deficit in the NHS, proposing independent local advisory forums and patients’ forums. But these must be genuinely representative and have real influence.
To hijack a famous phrase, we must ask not just what the NHS can do for patients, but what patients can do for themselves.
The writer, a senior research fellow at the Institute for Public Policy Research, is author of The Future Patient, available from Central Books (tel: 020 8986 5488)
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