39. Evidence submitted by the Health Foundation
(PPI 117)
1. INTRODUCTION
1.1 The Health Foundation is an independent
charitable foundation working to improve the quality of healthcare
across the UK. Our endowment enables us to spend at least £20
million annually to develop leaders in healthcare, test new ways
of improving the quality of health services and disseminate evidence
for changing health policy and practice. We welcome the opportunity
to respond to the Health Committee's inquiry on patient and public
involvement in the NHS.
1.2 We believe that patient engagement should
be at the heart of any debate on patient and public involvement.
We welcome attempts to ensure the NHS involves patients and the
public in decisions about how services are delivered locally through
Patient and Public Forums, public consultation and by the development
of LINks. However, in our view sustainable improvements will only
be achieved by improving the patient-clinician relationship so
that patients are as engaged as they want to be in their own care.
1.3 If this is to be effective, something
of a cultural shift amongst health professionals is also required.
We know from experience that the majority of people working in
healthcare want to improve quality and are most engaged when they
can see how changes have a direct, positive impact upon the care
they are delivering. This applies as much to patient engagement
as any other form of system change.
1.4 This submission outlines the rationale
for improving patient engagement within health services and the
argument for enhanced self-care. It also gives an overview of
our new £5 million demonstration project, Co-creating Health,
which is aiming to provide both patients and clinicians with the
skills and knowledge they need to work in partnership for improved
health outcomes.
2. ENGAGING PATIENTS
IN THEIR
OWN HEALTHCARE
2.1 As the first Wanless review concluded,
high-quality care, and the most productive use of resources, depends
on the population's full engagement in health. [23]In
addition to other emergent approaches that can and do address
some of the problems in healthcare, such as improving patient
safety and engaging healthcare practitioners in quality improvement
methodologies, we believe that healthcare services could be revolutionised
if patients, particularly those with long-term conditions, become
more engaged in their own care.
2.2 The rationale for ensuring that patients'
and their carers' views are routinely made available to service
providers (both managers and clinicians) is clear. Firstly, an
accurate assessment of the effectiveness of care cannot be made
without the patient's unique expertise about their own condition,
its impact and the outcomes of the treatment they received.
2.3 Similarly, the insights patients can
provide from an external perspective often identify issues which
may not be apparent to those working within the system. For example,
they may be best placed to recognise weaknesses in the system
that may prejudice core outcomes and safety, such as complex transfers
of patient information and long, unintended waits.
2.4 However, as outlined in the introduction,
there are cultural barriers within the healthcare professions
which need to be overcome if patient engagement is to become systematic
and effective.
2.5 Our new Co-creating Health initiative,
which is described in detail below, has been developed to help
tackle these challenges for people with long-term conditions.
The following section explains why we have opted for this focus,
though other solutions may need to be developed for different
areas.
THE CASE
FOR SELF-CARE
2.6 An estimated 17 million people in the
UK live with at least one long-term condition, [24]with
the incidence of chronic disease amongst over-65s expected to
more than double by 2030.
2.7 People with chronic illness are frequent
and long-term users of healthcare services, with around 80% of
GP consultations and 60% of hospital bed days related to chronic
conditions. [25]However,
day-to-day management of these conditions is largely carried out
by the patients themselves, along with their families, making
self-care an inevitable characteristic of chronic illness. As
research published by The Health Foundation has found, a hierarchical
model, in which the patient is the passive recipient of care services,
is therefore impractical. [26]
2.8 Similarly, the national patient surveys
carried out among patients in NHS organisations in England consistently
reveal gaps between patients' desire for involvement in decisions
about their treatment, and their experience. Further research
also suggests the UK is lagging behind other developed countries
in terms of patient experience. [27]
CO -CREATING
HEALTH
2.9 To help identify the best means of improving
patient engagement, we have recently announced plans to invest
£5 million in a new self-management initiative, "Co-creating
Health". We believe this scheme has the potential to radically
transform healthcare for people with long-term conditions.
2.10 Providing responsive, effective services
to support people with long-term conditions presents significant
challenges for health services, which healthcare professionals
cannot address on their own. Many people want to take a more active
role in their own care, but clinicians and their patients need
to work in partnership to achieve lasting improvements in health.
This is what we mean by "co-creating health".
2.11 To take a more active role in their
healthcare, people need self-management skills and easier access
to information about their conditions. Our initiative will include
a support programme for patients, providing people with long-term
conditions with the skills needed in both the day-to-day management
of treatment, as well as those needed to work in partnership with
their clinicians and navigate services more effectively.
2.12 Patients also need skilled support
and motivation from their clinicians, so our initiative will also
provide clinicians with the knowledge, attitudes and skills to
become effective in supporting their patients to self-manage.
Clinicians and patients will also be encouraged to identify aspects
of the health system that hinder patients from self-management
(eg out-patient appointment systems), so that new services can
be designed to facilitate better self-management.
2.13 While the initiative involves work
in three distinct areas, the interventions are designed to be
mutually-reinforcing and ultimately support the achievement of
long-standing improved outcomes. We believe that this is the first
time that all three elements have been brought together to support
patient engagement.
2.14 The lessons we learn from this demonstration
project will be used to inform our future work in this area and
we will share our experiences widely.
The Health Foundation
10 January 2007
23 Wanless, D, 2002, Securing our Future Health:
Taking a Long-Term View, HM Treasury. Back
24
Department of Health, 2005, Supporting people with long-tem
conditions. An NHS and social care model to support local innovation
and integration, London. Back
25
Department of Health, 2004, Improving chronic disease management,
London. Back
26
Coulter, A, and Ellins, J, 2006, Patient-focused interventions:
a review of the evidence, The Health Foundation and Picker
Institute Europe. Back
27
The Commonwealth Fund, 2004, International Health Policy Survey
of Adults' Experiences with Primary Care, New York. Back
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