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Patient power is the next step, but will it be a healthy option? THE UNIVERSITY COLUMN Professor Marcus Longley, University of Glamorgan.

CAN the Coalition Government in Westminster wake the sleeping giant of patient power? And will the Welsh counterpart wake up too? One of the perennial problems in health policy is how to get the health service to do the right thing - improve quality and efficiency, and focus on those who need it most.

Because it's not easy - painful decisions have to be made, and there are winners and losers.

Over the years we've tried it in two different ways. For a while, we trusted the professionals to get on with it and when we didn't like the results, ministers started trying to run the show from Whitehall, or from Cathays Park in Cardiff.

Andrew Lansley, the Secretary of State for Health, is looking for the third way - although he probably wouldn't thank you for calling it that. He published a White Paper in July called Equity and Excellence: Liberating the NHS.

Although most of the discussion in the past two months has been about the structural changes, which it heralds - GP consortia responsible for spending pounds 80bn of public money - these are only means to an end.

Mr Lansley really wants to wake up the sleeping giant of patient power.

His argument, in effect, is that New Labour was on the right track, but didn't go far enough.

There are two arms to his new approach. On the demand side, patients will be encouraged to work out what services they like and dislike and then be helped to vote with their feet.

There will be lots of information (outcome measures for hospitals, patient-determined league tables, control over their own medical records). And there will be formal mechanisms, nationally and locally, to give patients a collective voice.

Interestingly, local government will lead the local voice. On the supply side, ministers will back off from micro-managing the NHS and a national commissioning board will take over.

Local decisions will be made by between 300 and 500 GP consortia. Commercial providers will be invited in and staff will be encouraged to take over their workplaces.

The White Paper states: "We aim to create the largest social enterprise sector in the world." All NHS trusts will become foundation trusts with new freedoms.

There are many doubts about both the practicality and advisability of all this. But if it is to work, it is essential that patients really do make their voice heard and the system has no choice but to respond.

And what about Wales? Although we have somewhat similar goals - we talk about being "citizen centred" rather than having patient choice - the means to those ends are very different. We prefer "partnership" to "choice" - not so much sleeping giant as untapped resource.

There are promising green shoots of genuine patient-professional partnership already in each of the new health boards in Wales. But the key question is: will they survive the impending Arctic blast of expenditure cuts? Patient-professional partnership should actually be about saving money by getting services right. The temptation, though, will be to dismiss them as an expensive luxury and apply the weed killer of neglect. A useful test for the maturity of the Welsh NHS.

Marcus Longley is professor of applied health policy and director of the Welsh Institute for Health and Social Care, at the University of Glamorgan
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Publication:Western Mail (Cardiff, Wales)
Article Type:Column
Date:Sep 27, 2010
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