Patients could be told the 'actual value' of the health services they are using in a bid to make them use the NHS more responsibly and relieve pressure on staff.

Health minister Andy Burnham last week put forward the idea as part of his strategy to encourage NHS staff to engage better with the government's reforms.

In a letter to health secretary Patricia Hewitt, Mr Burnham acknowledged that increasing demands from patients were putting pressure on staff. 'Rising expectations are changing the work environment for NHS staff and placing them under more pressure,' he said. 'This changing behaviour could also have... [an effect on the] long-term viability of a service free at the point of use.'

He called for a 'clear set of principles to encourage patient responsibility, in particular by informing the public of the actual value of the NHS services they are using'.

Although Mr Burnham did not specify financial value, NHS Confederation chief executive Dr Gill Morgan said: 'I would not be averse to telling people how much their current treatment has cost or what different choices would cost. People might suddenly realise what good value the NHS is.'

Mr Burnham's proposals were developed at the request of prime minister Tony Blair and Ms Hewitt. He spent seven days shadowing NHS staff to prepare his strategy.

Among his proposals to get NHS staff back on side in the increasingly acrimonious debate over NHS reform, he argues for:

  • short-term employment guarantees for midwives, newly-qualified nurses and allied professionals;
  • help for staff moving from secondary to primary care;
  • an annual report to ministers on Agenda for Change;
  • better integration of cleaning and portering staff into ward teams;
  • unions, strategic health authorities and local employers to replicate tripartite national structures for dialogue at local and regional level;
  • a campaign to engage staff with the drive to bring waits down to 18 weeks;
  • improving the democratic legitimacy and accountability of primary care trusts;
  • a formal constitution for the health service.

Dr Morgan said: 'There is a sense of reality about this. There is a disconnect between the technocratic thing we are trying to deliver, and which is owned by the centre, and what people's lives are like in the NHS. This is a good attempt to understand that gap and come up with practical solutions.'

NHS Employers deputy director Alistair Henderson welcomed the idea of an annual report on Agenda for Change. 'We would be happy for the NHS Staff Council to do this, although some of the things Mr Burnham mentions such as an equality review are already underway.' Mr Henderson also welcomed the notion of tripartite working at regional level.