A change in what “choice” represents in policy has great potential for patients. Now that change needs to be backed with a firm will to implement it, writes Health Foundation chief executive Stephen Thornton.
Cynics have suggested that the recommendations of the NHS Future Forum and the government’s proposed changes to the NHS reforms are merely a way of “pimping a policy” that was looking tired. This is still subject to debate.
However, in one important respect, the proposals do much more than freshen up an existing policy. Until the listening exercise got under way, “no decision about me without me” was a policy chassis without an engine. Now it has real drive and commitment from the top.
Even before publication of the forum’s recommendations, there were signs of a change for the better. In early June, the prime minister advocated “real patient power”, pledging that patients “will be able to decide what will be the best service, best package of care that will allow [them]… to lead independent lives”.
The Health Foundation has welcomed this shift in the way David Cameron speaks about patient choice, from defining choice only as choice of provider to a broader definition that encompasses choice of treatment and care.
In its evidence to the listening exercise, the Health Foundation stressed that for the NHS to be a first-class health service, we need people to be given the right support so they can be in control of their own health and healthcare decisions.
These choices in healthcare need to be explicitly described in terms of choices to support healthy living, choice of provider and the way in which care is provided and choice of treatment including self-management support.
In order to embed the principle of “No decision about me without me” in the daily experience of patients and their families, an essential first step will be certain changes to the Health Bill. We welcome the government’s amendments to commissioners’ duties to involve patients and carers, as well as their duty to promote choice – although we do continue to advocate a clear definition of choice on the face of the bill. And we look forward to the opportunity to engage in the government’s consultation on the secretary of state’s choice mandate.
Will to implement
But there is a need to think beyond the bill. Here the forum suggested that “examination of arrangements for shared decision making in commissioning should be included in the authorisation process for commissioning consortia”.
The Future Forum recognised that a cultural change is required in the NHS to make “no decision about me without me” a reality and suggested that this is the responsibility of leaders throughout the system – professional regulators, professional organisations, commissioning authorities and leaders of clinical teams and provider organisations.
Again, the Health Foundation has argued this case. Shared decision making will only become a reality if its implementation is incentivised and if those with responsibility to deliver it are held accountable. Clinical commissioners, the NHS Commissioning Board, the National Institute for Health and Clinical Excellence, professional and organisational regulatory bodies and patient organisations all have a role to play. The government must ensure aligned action by all.
In our submission to the NHS Future Forum we showed the ample evidence that shared decision making and supported self-management actually work, together with practical measures that can be implemented to support it. They listened. “We were struck by the arguments that shared decision making is a fundamental aspect of quality,” the forum’s report said.
“Early evidence shows promising benefits of shared decision making at the individual level, on patient participation and communication and health outcomes, particularly in relation to the care of people with long term conditions.”
But, on the basis of “what gets measured gets done”, the service needs to introduce standard and agreed measures to assess the degree of patients’ involvement in decisions about their care, their confidence to self-manage and whether they were treated with dignity and respect.
The tools are available. We have the prime minister’s political support and a groundswell of commitment from the NHS Future Forum – let us hope there will now be the will to implement them.