Wednesday 23 February 2011

NHS reforms: Patient choice may have positive side-effects

Patient choice is a key element behind Lansley's reforms. The idea is that choice will help health services will improve without the need for central management. Patients will "vote with their feet" and only use good services, leaving those NHS providers who aren't good at what they do to either improve or close down.

I'm not too sure what I'd feel if I was one of the poor patients who had to suffer bad treatment before the rest of us all cottoned on and ran screaming from the hospital, but that aside, this idea of patient choice may actual have the knock-on effect of being beneficial for our health.

To help manage my Cystic Fibrosis, I constantly self-monitor my health. Off by heart I know my hospital number, weight to 0.1 of a kg, height, average pulse rate, average oxygen saturation in my blood, and all my lung function stats. I actually know when I'm more ill than my lung function stats would suggest and I get to have a big say in what treatment I have. For example, my hospital constantly tell me to put on weight so I've just asked them to send me a clinical study of the long-term health benefits for CF patients if they are over a BMI of 19.

It may seem weird that I like to know the medical facts and figures behind everything, but the more I understand the importance of my medicine the more likely I am to make the extra effort to take it all - and believe me, there is a lot to take.

So it made me realise that the idea of informed choice behind the NHS reforms might actually improve our individual health as well as the performance of health providers. If we feel actively involved in our own treatment we may be more likely to take our drugs and take note of all the other bits and pieces we can all do to help our treatment work more quickly: eat better, exercise more and sleep regularly.

Moreover, if we feel like we are in control of our treatment it might make us feel more positive about coping while ill and motivate us to get better as soon as possible.

Working out how to get us to self-manage our health better is definitely a shift that the whole of society needs to make. With obesity levels and alcohol abuse on the rise, the whole country needs to recognise that good health starts with us. Any NHS system that advocates public health awareness but simultaneously fails to provide a choice in treatment of specific health-problems is sending out mixed messages to us all.

Patient choice may not prove effective at deciding which companies should provide our NHS care but the drive to provide greater information and choice to patients could be an interesting way to get us to think again about our own responsibility towards our individual health.

Wednesday 2 February 2011

Time to rethink the approach to NHS reforms

The first debate of the NHS reforms took place on Monday, and the second reading of the bill was passed with 321 MPs voting for and 235 voting against. It followed six hours of debating.

But while MPs are battling each other in the House of Commons, they are also trying to win over the public to their plans. So wide-reaching are the reforms, it has taken a while for health journalists to fully realise the implications, let alone the general public who have very little understanding of the NHS machinations at work behind their GP surgery.

This week has been full of statistics and surveys aimed at influencing the direction of the debate. While the reforms are focused on giving power to the GPs over the way NHS money is spent, it is the MPs who will decide whether the reforms are happening. So GPs, powerless in the face of empowerment, are using the media to bang on the doors of the Commons. A snapshot survey of the Royal College of General Practitioners, found that of 1,800 responses, 70% disagreed or strongly disagreed that patient outcomes would improve by opening up the NHS to private companies. 50% also felt GP commissioning would not give more power to patients.

And the MPs themselves have resorted to throwing statistics at the press in the hope of making their opinion the dominant story in the papers. Shadow health secretary John Healey claimed that 3 out of every 4 GPs disagreed that NHS reforms would improve patient changes. (The excellent blog Factcheck questioned the veracity of this stat though).

The Tories have hit back at Labour claiming these reforms were begun in part by Blair's Government. I'm currently reading Andrew Rawnsley's brilliant book 'End of the Party' about the last two terms of the Labour Government. He continually highlights Blair's frustration at being unable to make great public service reforms. In a 2002 interview with Rawnsley, Blair said: "We will not maintain public services and the welfare state unless we radically recast them" (pg76). He wanted to introduce choice to the users of the NHS and diversity of providers, hoping the third sector and private companies would tender for contracts. His reforms were watered down due to party opposition, but it is clear that parts of New Labour were of the same mind as the Tories now are.

So the questions is, why can't we all have a sensible conversation about it?

If the parties are both thinking the same thing - that the NHS must change before it starts to fall-apart - then perhaps an honest conversation with the British public is required. In which the case for change is explained and a realistic time-frame is established for such measures. Perhaps the first step is to start on the path to GP commissioning, but in a more balanced, state-managed way rather then the piecemeal free-for-all that is currently being considered. Once commissioning is up and running then the next step might be to consider what benefit, if any, private companies can bring to the NHS.

In contrast, it is clear to me that the current state of affairs in which GPs are fighting to be heard and the public haven't even been asked their opinion will just result in chaos. The BMA today even said a strike over NHS reforms is a possibility.

As plans currently stand reforms could result in a wildly variant health-service - with some GPs succeeding with commissioning while others fail, and private companies taking advantage of the mess to take over services that undermine the viability of NHS hospitals.

The first step of reforms must be to accept that the NHS, which has been developing for 60 years, cannot be recast in just 60 months. And if reforms cannot be implemented before a general election, and a possible change-over of power, perhaps the fate of much-loved British institution is deserving of the parties to come together and work towards strong, effective and safe reforms for the NHS, which override party politics.

MPs that spend less time fighting each other could then spend more time listening to the opinion of those affected: medics, nurses and us, the service user.