The final instalment of our series on the government's NHS modernisation plans looks at the two patient teams: empowerment and access. Essentially, this is about shifting the balance of power from the NHS towards patients, making sure they can get 'fast a

For the sceptic there is something deliciously bogus about the phrase 'patient empowerment': it sounds slick, abstract and faddish.

'Terms such as empowerment and partnership try to mean everything but mean nothing most of the time, ' says Patients Association assistant director Simon Williams.

Indeed, so sceptical was the association of the government's commitment to a patient-centred NHS that it snubbed an offer to come aboard the modernisation action team. 'From our discussions, it seemed like a rubber-stamping exercise, ' says Mr Williams.

Not so, says team member Lesley Stirling-Baxter, chief officer of Bradford community health council: 'I started off feeling a little bit cynical, but that has disappeared as I have seen items we have discussed in the meetings appear in final drafts of our report.'

Issues discussed include complaint handling, patient-held medical records and staff communication skills.

One of the key themes is helping patients, especially those with chronic diseases, regain control of their lives.

Judy Wilson, director of the Longterm Medical Conditions Alliance, wants courses for patients in life management, relaxation, pain control and drug management. This would reduce dependency on the NHS, says Ms Wilson.

A proposal that everyone agrees will be in the final plan is the patient-held record. But there is dispute about the method. There is strong backing for a secure website for medical records, but this creates problems for poorer patients - the group with the highest health needs. How will the team avoid setting up a system which benefits only the middle classes who can afford the cost of Internet access?

There doesn't seem to be an answer yet - but there is strong backing for helping patients to track their own progress.

'It would encourage people to look after themselves, ' says Ms Stirling Baxter.

The patient experience is also crucial to the access team. In its response to this team, the NHS Confederation identifies three main problems: long waits for treatment; geographical barriers to access; and confusion - the sense that in a complex system they are 'somehow in the wrong place'.

The confederation wants to see NHS entry points - whether GP surgery or accident and emergency reception - redesigned to enable patients to be properly assessed and directed to appropriate care. It wants to see more services provided in the community as hospitals becoming increasingly centralised and remote.

But all of this requires investment in recruiting and training staff and changing the way they work.

The British Medical Association's frosty response to the confederation's idea of elective centres providing high-volume elective surgery suggests that patient access is crucially linked to the outcome of the work emerging on the future of the professions.

A key theme for the empowerment team is the relationship of the public to the NHS, the generally poor communication between professionals and patients, and the failure of health services to respond to feedback.

The Patients Association wants to see a serious review of the complaints system, with an independent body set up to provide advocacy for patients.

'We do not like the stories we get of medical notes that go missing when complaints come in, or of complainants being struck off their GPs' list, ' says Mr Williams.

Ms Wilson wants to extend user involvement in planning and commissioning. 'You need to find effective ways of involving carers and users in defining good services and defining what changes the commissioners of services could do to achieve that.

'The private sector has for decades seen that if you want to improve the quality of your product you go to the consumer.'

Mr Williams warns against 'lazy' ways of supposedly involving lay people in NHS institutions such as appointing local councillors. 'Is that councillor going to stand up and say, 'We need to shut this hospital' even if he knows it need closing? No, because he's reliant on people's votes.'

Lord (Toby) Harris of Haringey, former director of the Association of Community Health Councils for England and Wales, says that CHCs could be the ideal organisation to mediate the patient-NHS relationship, acting as an 'information broker' between the two.

But potential conflicts of interest need to be resolved. CHCs need to stop drawing half their members from local authorities, which are increasingly working jointly with the NHS, and remove retired health professional members.

But can the NHS adapt? Probably not, says Mr Williams: 'I do not think the NHS is amenable to releasing power to patients.'

'Yes, ' says Ms Stirling-Baxter: 'I have seen staff apprehensive about involving the public, and yet when they have done it they have enthused about how satisfying it is. The culture of the NHS is that staff want to do a good job.'

Time for act ion When it found itself in one of the first health action zones, Bradford CHC was asked to review the way it worked.

To its shock it found not only was it 'not fit for purpose' but that its weakest area was public involvement.

'We decided to put our resources at the disposal of the public by cutting the number of meetings and by delegating our hospital visiting rights to patients, ' says chief officer Lesley Stirling-Baxter.

An investigation into patients' experience found that roughly a third of complaints involved poor communication by health professionals.

'We recommended to the health authority that NHS staff in Bradford should have an NVQ1 in customer care so that they understand what customer satisfaction is, ' says Ms Stirling-Baxter.

Other 'actions' resulting from the patient feedback, include a tightening up of the performance of contract taxi drivers, and the placing of emergency chemist numbers in the window of every pharmacy.