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Involving patients and the public in healthcare

Lynn Young
Primary Healthcare Adviser for the RCN

This article was written at the height of the conference season. The Lib Dems were very pleased with themselves due to their by-election victory in Brent, West London, and the Labour Party were at odds with themselves over public sector reform - to name but one issue. And the Tories are yet to arrive at their conference venue (although they will have by the time you read this).

But back to the current government and what the PM and Dr John Reid, Secretary of State for Health, have to say about health reform and the road to glorious modernisation.

Well we are not going to have slowdown, although Dr Reid recently called for a safe and secure NHS, which does imply that the turbulence may soon settle. But life is not that simple, and "Czar" Harry Cayton, the new Director of Patient Experience and Public Involvement, has arrived on the scene eager to get cracking and make this genuine and not a token to those who lobby constantly for patient power. We also have patient choice to contend with, but given the constant cries of limited financial resources and staff shortages it is difficult to see how we can manage to achieve it in a meaningful way.

All change should lead to better patient care and improved health, and we need to be mindful of the well- held view that better choice for some could result in reduced care for others. Traditionally patient or consumer choice has been only for the middle and above classes, and there is a risk that the PPI (if imperfectly implemented - which it will be) will further reinforce these inequalities. But good change does not always cost more money; in fact it can sometimes bring improvement and save valuable resources. Patients with chronic conditions tell us they wish to be involved in their care. Self-management programmes for various chronic diseases often improve the person's health simply because they take control of their condition and learn how to manage it themselves.

The Western world is rapidly ageing and so we are becoming a population overwhelmed by chronic disease, which needs to managed with skill, knowledge and compassion. We know that a large number of patients with chronic disease are admitted to hospital on account of a preventable crisis - expert management can usually stop this happening. Nurses need to work with and alongside patients. Major cultural change has to happen if chronic, not acute, care is to be at the heart of the NHS, and if services are to fit around patient needs and wishes, rather than those who provide services. For far too long both the NHS and social services have operated in a way that suited their wishes more than those of the public. Clinicians are seriously challenged as they strive to confront themselves, their practice and honestly question whose needs they are serving.

Before Mr Milburn left the Department of Health he said that "the patient is king". I think this is barmy given that progress is more likely to be achieved through healthy partnerships. Dr Reid has certainly taken choice to his heart and is charging ahead with a reform agenda that ensures the patient is at the centre of the NHS.

Here are a number of questions for you to ponder on, discuss and debate with your colleagues. How do relentless targets fit in with patient-centredness, choice and involvement? Does the public respect league tables? Do these tables really reflect the standards of care provided by the organisation? Will the Patient Experience and Public Involvement agenda help to improve the unacceptable health inequalities within our society? How can it help to ensure that the very poorest within our communities receive the very best care when they need it?

Modernisation is indeed a tricky business, and while we should welcome the fact that at long last the government is taking chronic disease seriously, nurses must also continue to confront the root causes of illness, such as social deprivation and poverty. Consumer choice must work alongside public health, not against it.