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Patient perspectives on commissioning |
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South Bank University |
Professor Bob Sang |
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What do patients think about commissioning? Are patients even aware what commissioning is? I’d guess that the public are largely unaware what commissioning is and more importantly, of the current threat that the healthcare reform agenda splits between public accountability in the democratic sense and the denial of a real patient-centred approach through the possible adoption of quasi-consumerist, marketised commissioning systems. As to patients, they commission every day - through the agency of their GPs; by self-care and self-referrals etc. Too little attention has been given to learning from this day-to-day experience which, in business terms, impacts on 85% of NHS spending on the 10% of the population with long-term conditions or disabilities. There is a growing movement among such people, including an alliance with those promoting personal care budgets, person-centred planning and crucially, the Wanless Reports’ ‘fully engaged’ scenario to create continually grounded and collaborative approach to commissioning. So what is the way forward to involve patients in commissioning? Until now, public and patient involvement has focused on voice and influence, and not role and capability. This has enabled policy pundits and other vested interests to come up with meaningless proxies for patient involvement (such as the use of surveys, population needs analysis etc.). In other words, the marketers and their public policy adherents have both got it wrong! By enabling people to take on an active role, in personal and community health - building on successes like the Expert Patient Programme, In Control, and the independent living movement; and increasingly initiatives in acute care like the co-design of cancer services and acute mental health services - we have an opportunity to develop genuine ownership of local healthcare plans, while addressing the inevitably contentious business of deciding priorities from the bottom up. After all, this is meant to be a patient-led NHS. Isn’t it? The current local government bill on public involvement in health gives the opportunity for active engagement in health improvement, which explains the marketeers’ desperate attempts to outsource end-to-end commissioning before it is too late. However, criticism of the proposed Local Involvement Networks (LINKs) is valid - see the robust interrogation of the minister responsible in the recent Health Select Committee report on PPI (April 2007 HC 278-1). For commissioning to succeed in the longer run, it must achieve trustworthy patient and public engagement in two respects. Firstly, a much higher order of community governance, using the new Local Area Agreements, linked explicitly to practice-based commissioning. Secondly, through day-to-day active involvement of people with long-term conditions and disabilities in improving the effectiveness of treatment and care, enabling them to enhance their social and economic contributions to the wider health improvement, social inclusion and service improvement. |
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Back Issue - May 2007 |