Government turns up the heat on patient power

The government has set out its vision for the future shape of public services, which includes giving patients greater choice and control over their care and more opportunities to input their own experiences.

In a white paper published today, Working Together- Public Services On Your Side , the prime minister Gordon Brown says he aims to put power in the hands of those who use public services, with more personalised services and greater choice, underpinned by an information revolution.

On health and health care the white paper highlights progress on a range of existing initiatives such as progress on the 18 week referral to treatment target, the setting up of 115 NHS Foundation trusts and the take-up of extended access by GPs, now offered by more than 70% of practices.

It says 25 new NHS Foundation Trusts could be set up in 2009, subject to Monitor approval, giving hospitals more control over day to day management and says the nurse-led productive ward programme, which aims to free nurses from bureaucracy, will also spread rapidly across trusts and wards in 2009.

NHS Choices will be expanded to enable patients to comment on the services offered by GP practices and the amount of hospital payments linked to Patient Reported Outcome Measures (PROMs) will be increased year-on-year.

The white paper also announces that the government will set up a commission on the future of nursing and midwifery and says standards such as the two week cancer standard for cancer patients and the 18 week RTT target must become the guarantors of high quality care for all.

This summer NHS Choices will be developed to enable patients to give direct feedback on all GP surgeries, extending the existing service which allows patients to log comments about their hospital. The white paper says around 10,000 comments have been posted since NHS Choices was launched in 2007.

In his foreword to the white paper Gordon Brown said the government had been much too slow to make use of the “democratising power of information”.

He added: “People take it for granted that they will access other people’s reviews and ratings before buying something on e-bay or Amazon, and yet we do not yet have systematic access to other people’s experiences when choosing a GP practice or nursery. We have clearly got the balance wrong when online businesses have higher standards of transparency than the public services we pay for and support.”

However, the BMA said that although doctors welcomed feedback on their services it was concerned about the government’s proposals.

Dr Hamish Meldrum, BMA Council chairman, said: “The consumerist approach being advocated by the government is not well-suited to the NHS. Patients are not supermarket customers, and doctors are doing more than providing an easily rated commodity.

“Healthcare is complex – it’s about partnership. The suggestion that your treatment in the NHS can be as easily rated as a stay in a hotel is simplistic. There is a risk that this exercise could reduce NHS care to a meaningless popularity contest, encouraging perverse behaviours and an emphasis on the superficial.”

On PROMs, which will be used for hip replacements, hernia surgery and varicose vein surgery from April , the white paper says the quantity of the payment linked to outcomes will increase year-on-year as quality measurement improves and commissioners focus on ever higher outcomes.

The white paper highlights patients’ rights as enshrined in the NHS Constitution, including patients’ right to make choices about NHS care.

In an interview with the Sunday Telegraph at the weekend health minister Ben Bradshaw indicated that the renewed emphasis on choice could see GPs’ contracts terminated if they did not offer a choice of hospitals to patients who need specialist care. Latest Department of Health choice survey figures show less than half of patients (46%) remembered being offered a choice of hospital for their first outpatient appointment.

This week a Department of Health spokesperson told EHI Primary Care: “Patient choice is about to be made a legal right through the NHS Constitution. It is no longer acceptable for patients in some areas to be less likely to be offered a choice, than in others. We expect all PCTs to make sure that patients are aware of their right to choose and have the necessary support and information to do so.

"We are considering how we might further ensure that GPs make offering choice a priority. We are in the early stages of exploring a range of options, including whether we could reinforce this through the GP contract. Once we have done so, we will be discussing this with the profession."

The white paper says developments in technology are enabling more treatments to be delivered outside healthcare environments at similar cost to providing the care in a clinical setting. It adds: “Increasingly services as varied as maternity and cancer care will be offered to patients in their homes, at their convenience.”

The white paper also underlines the pledge to provide personal care plans to 15m patients withlong term conditions by 2010, as well as the plan to offer avascular health check to all patients aged between 40 and 74.