Select Committee on Health Written Evidence

39. Evidence submitted by the Health Foundation (PPI 117)


  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.


  2.1  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.


  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]


  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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