What power do you want over your health?

The Westminster Coalition Government’s White Paper on health in England is more radical than most people expected. There is much to debate in the proposals but it is striking how big a role is given to patient power.

Look at what David Nicholson, Chief Executive of the NHS, told a recent conference of managers. Patients, he said, needed to be given much ‘more clout’ in the health service. Too little has changed to date and a step change is now needed.

One way we will be given more power is through the provision of much more information. In future, we will be able to see the outcomes achieved not just by different hospitals but also by different wards and different doctors. It will, however, be a challenge to make this information useful for patients, not only because there is very little data on primary care but also because doctors who appear to have poor results might simply be taking on the most challenging cases. Asthma UK will, I suspect, need to play a role in publicising good NHS data and making it genuinely useful but ultimately the qualitative information on places like the Asthma UK forums could be just as useful in determining our choices over place of treatment.

But there are other ways that patients could be given more power.

For example, if patients agree care plans with their doctor then those care plans should be observed in all parts of the NHS. Many people have told me that carefully agreed plans have been ignored when they come into contact with other parts of the NHS, especially in urgent care settings. This is a shame, because most care plans are written in order to specify what should happen when asthma deteriorates. Care plans could also give patients more control over their medicines, making it easier to step up to a higher dose in winter, for example, or possible for patients to keep antibiotics at home. They are a good example of shared decision making in practice and it is disappointing that only around 12% of people with asthma have a personal asthma action plan.

Our recent report Fighting for Breath indicated ways in which people with severe asthma wanted more control – for example, in managing appointment times with several different consultants to fit better with work, family or school commitments, or in equipping patients to share relevant medical history with health professionals, especially during an asthma attack when you are short of breath.

Patients could also get the power to manage more of our health on-line. Granted that will not suit everyone, but if an asthma review can be undertaken over the telephone (which many GP practices offer appropriate patients) then there is no reason why it could not be done on-line, supported with a peak-flow diary and a call from a nurse if answers to questions suggest problems. This could even be linked into repeat prescription management tools being offered by some pharmacies.

More radical power could see patients being able to take their QOF points (which influences how parts of the NHS are paid) and take them to different providers, perhaps near their place of work.

The consultation is now open. Patients are being offered more power. What power do you want?
 

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