Power to the Patients

Baroness Murphy

Lord Crisp initiated a debate last night on “patient and citizen empowerment” in the NHS, a topic calculated to generate justifiable sighs of despair from patients. He confessed that as NHS chief executive for some years he said that patient empowerment was a top priority but in reality, not a great deal has happened in practice. England is ahead of much of the rest of the world, and we now have technology and science that is literally putting things into patients’ hands in ways that enable them to be more empowered as patients and citizens.
There are many good examples, from personal budgets to expert patients’ programmes, decision making IT programs to help patients choose and the ability to express an opinion publicly as on NHS Choices website. The NHS has been moving, but it has not yet reached a position where this is central to its functioning. The question between the clinician and the patient has often been, “What’s the matter with you?” but the future question should be “What matters to you?”
Lady Pitkeathley spoke about the Centre for Patients Leadership for preparing service users to be skilled and confident representatives. Baroness Brinton, who herself has rheumatoid arthritis spoke of the importance of the patient having knowledge of their own condition, a theme I also spoke on. ‘Knowledge is Power’ and there are superb websites providing accurate information, although people have to be pointed in the direction of the best ones.
BUT there is a structural problem in the NHS caused by the remoteness of the funding. It feels free to patients and feels free to clinical staff too. Staff inevitably behave paternalistically rather than feeling they are providing a personal service. Patients feel disempowered and sometimes infantilized by the system. The question arises of how we get patients to act more like consumers when they often feel very vulnerable. It seems to me possible that a small financial contribution for access would make a difference to how you are likely to perceive your immediate relationship with a doctor or nurse. Most people for example now use private chiropodists; even those who have very little money. They go along to a foot care place run at a supermarkets and even garden centres and get direct treatment. They do not wait for an NHS chiropodist these days: they organise what they need themselves. They get a more responsive service at the time they want it.
I know that any payment raises enormous concerns, it’s a politically unpopular idea but we are now in a minority liberal western democracies that do not make a notional charge at point of access. It would be preferable in my view to prescription charges, another imposed remote charge. A direct small fee would shift the balance of perceived power between those ‘done to’ and those ‘doing’.

5 comments for “Power to the Patients

  1. MilesJSD
    19/06/2014 at 5:46 pm

    The first
    and possibly most radically essential reform needed
    both for building the fundamentally-24/7 effectiveness and response-ability
    [qua democratic-participativity]
    of the citizen

    and for clear further citizen-enablement in daily self-health-improving and long-term sustainworthy wellbeing building skills

    is to introduce a new sine-qua-non foundation of Somatics

    within which the first essential, for all ages of people, should be
    Selverian Self-Sensory Awarenessing.

    So stop conflating and false-economising.

    National ***Health***
    really does need to be seen and addressed quite differently from Diseases, Illnesses, Injuries and Impairments under the most-unfortunately branded National Health Service
    which really has always been a good National Hospitals and Illnesses Sector, but has never succeeded in building both affordable individual health and long-term collectively sustainworthy wellbeing,
    especially in terms of cost-effectiveness of Budgets and upwards trending Life-&-Health Results throughout The People.

    as well as for adequate Enablement

  2. MilesJSD
    20/06/2014 at 11:27 am

    So clarifying a little,
    Enablement must precede Empowerment;
    and will de facto require Levels and Timeframes
    of Learning-and-Competence curves;

    to which end-results must surely be locked or ‘handcuffed’ the appropriate levels or extents of de facto Progressive Empowerment which, one must hasten to NB, would probably have to include “Influence”, “number-of-words” and “right to repeat” or to “nail to the table at (say) the Lowest Participatory-Democracy Level”, limits.
    Charlotte Selver is the saliently emulable and genericly affordable”leader” indicated above;
    so probably that self-awarenessing Enablement-Work would ring more immediately ‘intelligent’ spelled Selveran

    but I think the other descriptive wording should stay,
    ‘Selveran Self-Sensory Awarenessing’ would be my suggestion,

    to be ‘locked-in’ as the ‘New Somatics Foundational, Preliminary, or Pre-requisite, ‘grade’.

  3. maude elwes
    20/06/2014 at 12:20 pm

    I feel one of the first ways to empower the patients in the NHS is to change the atmosphere of betrayal that tells every patient from childhood to old age that this service is a free government ‘benefit.’

    It is not free and it is not a benefit a generous group of politicians are giving us. It is a necessity for a civilised nation that is paid for by the people of that nation, whether that comes from general taxation or National Insurance contributions. So, to start change in attitude it has to, once again and forever, be flagged up that National Insurance is the route for payment of our health service. This will kill many birds with one stone. First, the tax payer will be happy to know their money is going toward what they are told it is for, their right to a health care system free at the point of use. Next, it will hit hard at those working within the system, high or low, that indeed their patients are paying their wages. It will knock on the head the feeling they are giving their hard spent time and efforts to a bunch of welfare abusers, as some of them deep down believe they are doing. Which is why they become nonchalant toward their customer. Think of it this way, do any of you who go to your private health carers get treated as if you had come to them via the referral services of the benefits supervisor? Or, are you treated with the utmost respect, from the minute you step into the reception room to the time you exit from your private hospital, having received the best care possible throughout.


    I’m a person who has experienced both NHS and private healthcare, and as you are well aware, the difference lies in the perception of the customer pays the bill on invoice. We know in truth the actual health care treatment received, private or NHS, is indistinguishable in the long run. The diagnosis, the treatment, prescription and so on, identical whether you pay via your private insurance, out of your own pocket, or through your taxes. It is the perception that differentiates the care you receive. Of course, if you go privately the office will be posher, your doctors rooms will be splendid but the end result of treatment you receive will be equal. In the end it’s the same consultants that treat you whichever route you take. So, the first thing that must be repeatedly shoved down the throats of us all, advertised and thoroughly explained, not only to those who work in this monolithic business but to each and every patient, regardless of appearance, is that he/she is paying through the nose for this service and they have a right to expect the care promised.

    We all know very well the NHS is the best service in the world for any nation to emulate as, at the end of your stay or visit you will not be destitute and you will have received the ultimate health treatment available, regardless of your ability to pay at the time of delivery. It is a collective insurance, and rightly so.

    You cannot introduce a payment at time of delivery because once you fall into that nasty little trap, you accept a notion that it is not prepaid by the patient. And that is a lie, because akin to any insurance policy, it is. This idea of ‘free’ must be eliminated because to do otherwise is the first step in imposing a sense of being undeserving. And when it is perceived as undeserving the idea of that morphs into, ‘these charity cases are not entitled to this care we are freely giving so, they can be abused in whatever way we feel we can get away with, as government will back us when we fall foul of the law.’ Respect goes out the window the minute a notion of undeserving hits the brain. Hence the growing lack of compassion toward the disabled, sick, elderly and infirm. Which our present government doles out on a daily basis as the undeserving poor, creating a division in society that keeps those with means in a position of expecting servitude. And of course this is what it is designed to do. Message to the elite, cap doffing is no longer in vogue and cannot be brought back into fashion, no matter how hard they try. So, a new thinking must prevail.


  4. maude elwes
    22/06/2014 at 11:58 am

    So, this morning, a wise person with some sense of duty to the people, decides to tell us ‘part of the truth’ regarding this government and the previous Blair fraudsters who set up Health Trusts. They have handed our NHS paid for by the tax payer service to the private sector on a plate. No pay back at all to the tax payer but huge profits for the creamers as they lick their whiskers. Fraudulent covert creeps every one of them who did this, without either asking the public for permission before being put in power or advising them of their objectives once there. They ‘must’ face a court as criminals, for they knowingly colluded in a betrayal of the peoples trust. And you wonder why we don’t want to vote for any of you?


    Under this auspices is there any wonder the people who use this service are presented with a mark of charity on their forehead when they shuffle in for treatment. And if you look deep enough, I bet you find the corporations benefiting from this takeover are majority foreign owned. The USA being the big winner, either openly or registered in some ‘off shore don’t look at us we like to remain anonymous front.’ And I wonder how many of these who sold us out have shares or were given bribes of some kind to oil the wheels of the move to privatisation in some way. Insider information being staunchly at the back of their investment opportunity. Their assets should be frozen.


  5. 29/06/2014 at 4:01 pm

    We need less politics and better healthcare, patient power needs to be us as individuals taking responsibility for our own health this is the only way we can tackle obesity, heart disease and the like. Its our health not the governments or any political parties health!

    We are conducting research on this very topic and find that the vast majority of patients want more involvement and control of their healthcare from this comes a self-awareness that can be developed into meaningful changes in life style.

    To contribute your views please got to elephantinroom.com

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