National Voices News Archives 2013
March
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1 April NHS Changes - Hopes & Fears - This is a not an April Fool’s Joke. There is a big reorganisation of the NHS in England and it launches on Monday 1 April. So will it be better for patients or worse? What are the hopes and fears of patient organisations? Here is National Voices’ round up of the key issues.
To start with, patients are unlikely to see any instant, dramatic changes on 1 April. If we walk into our local hospital or GP surgery we can expect to see the same faces, the same rooms, the same equipment. In the months to come, we may however, start noticing some differences. For example, we might find we have more choice when it comes to who performs our operation and, if we are lucky, we will have some useful information and support in making that choice. But it isn’t yet clear where the NHS will end up: it is going through a massive behind-the-scenes reorganisation and embarking on a whole new way of commissioning – of deciding who will carry out which services.
We don’t have a crystal ball so can’t tell you the future, but we can outline some of the hopes and fears of patient organisations:
Hopes
• Coordinated care. This is at the top of patients’ wish list. We are fed up with having to navigate a confusing system at the most stressful time of our lives and we need support in this. For example we need a key contact – a care coordinator.
The Health & Social Care Act brings new duties on organisations to deliver more integrated care. But legal duties don’t explain how to do it. Patients and service users want the focus to be on coordinating our personal care – not joining up organisations. This is about great management, about keeping all efforts focused on patients and carers and fantastic teamwork across organisations and departments.
National Voices has been working with patients and the new body, the NHS Commissioning Board, to set out what person-centred, coordinated care should look like. See our draft vision for coordinated care.
• Control over decisions Former Health Secretary, Andrew Lansley, borrowed the motto ‘No Decision About Me Without Me’ to spearhead the reforms, saying they would finally give patients more control over decisions about our care and treatment. The Health & Social Care Act brings in new duties on commissioners around this. As with coordinated, care, however, legal duties alone won’t make for sudden change. To give us control over decisions we need clinicians to work in partnership with patients and provide us with good information, including the risks and benefits of all available options. Then it should be down to us – patients, service users, carers and families - to decide what is most appropriate to our circumstances, values and preferences.
• Patients designing services The Act also says patients and the public should be involved in planning services. Many patients are experts in their condition and can bring invaluable insight. This will happen if staff get really good at engagement, involving service users from start to finish to make sure they get it right first time.
• An NHS that listens more broadly The reforms place a great emphasis on good engagement and listening to service user feedback. This was reinforced in Health Secretary Jeremy Hunt’s recent response to the Francis Report, when he said hospitals will be scored on the different services provided, for example, within individual wards and departments.
• Patients will have greater choice of provider We will start more seeing choices, for example, about where to have a hip operation. This is helpful as long as we have clear information on the pros and cons of different care providers and if that information is easily accessible to everyone, no matter what our background or where we live.
• More honesty and transparency On the back of the Francis Report, the Health Secretary has just announced a new, legal duty to be honest with patients. This will mean fewer cover-ups and may also bring with it a more honest, open and accountable culture in the NHS. See more on culture change below.
Fears
• Putting something into the Health & Social Care Act doesn’t necessarily mean it will happen.
• The focus on structures may distract from the end goal The reforms have focused largely on how to structure NHS organisations and there is a danger that this is a distraction from the end goal. Patients don’t mind whether the bit of the NHS that commissions their care is called a ‘PCT’ or a ‘CCG’. We are interested in good care, good treatment, good outcomes, quality of life and a positive experience.
• Lack of clear ways to make it happen While we are optimistic that some of the opportunities will come into being, it isn’t yet clear how this will happen in many cases. For example, while we all agree coordinated care is important, we have yet to see clear action plans for how it will be brought about.
• The new style of commissioning is largely untested. While, in principle, it makes sense to put clinicians at the heart of decisions about services, there may be unintended consequences. We only have two precedents – very small scale clinical (practice-based) commissioning which did not face the same challenges, and Primary Care Trust (PCT) commissioning which was stopped just as it began to improve. Many of the things commissioners should do – involving patients, coordinating our care, redesigning services for better quality, using evidence-based approaches, reducing inequalities – are things we want, but there is little evidence yet to say these will be achieved. And there is a long way to go to demonstrate that people who have often been excluded - homeless people, travelers and sex workers - will get better access to care.
• No clear way of judging the success of commissioning. It is right that we measure NHS success in terms of ‘outcomes’ – but doubtful you can measure commissioning success that way. Outcomes are influenced by factors beyond commissioners’ control, and, even where outcomes improve, it will be difficult to attribute that to commissioning.
• Other reforms, such as benefit reforms, are worrying charities. These could have an impact on people’s health and could put more pressure on health and social care services.
• Culture change Everyone – from patients to staff to politicians – agree we need culture change. All say we need more supportive patient-focused care. However this is a big challenge and there is currently no clear action plan to achieve this across the health and care system.
National Voices is the national coalition of health and social care charities in England. We work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them.
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Contact
For National Voices media enquiries please contact: Jules Acton or Sarah Scadding on 020 3176 0737 / 0738 jules.acton@nationalvoices.org.uk
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