Individuals’ responsibility for their own health and use of the NHS has been underemphasised and should be made more visible by NHS England, the organisation’s patient experience director has told HSJ.

Neil Churchill said the health service had largely avoided the focus on responsibility, which has been seen in recent years in other public services such as welfare where entitlement has been cut. However, he said the NHS should not limit entitlement to free services or extend charges, for example by fining patients for missed appointments, and that such moves were unlikely to be effective.

Instead, Mr Churchill said the NHS should experiment with “nudge techniques”, such as encouraging healthy behaviour and making the best use of services. He highlighted the large proportion of medicines wasted and said patients should be more involved in discussions about the value of services.

One possibility is for them to be told how much their medicines and wider care cost the NHS. Mr Churchill called for experimentation and ideas to be suggested for possible inclusion in a strategy being developed by NHS England.

“We’ve been pretty timid about talking the language of responsibility with patients,” he said, adding: “As commissioners we have to… make sure both rights and the responsibilities we expect of people are more visible than they have been.”

Mr Churchill also said people were becoming more aware of their rights under the NHS constitution but they needed more “teeth”. He said: “The constitution doesn’t have a great deal of traction.”

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