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In this guest blog, the Director of Policy for National Voices throws his support behind NHS England’s refreshed statutory guidance on the importance of involving patients and the public in commissioning:
In January 2012, as the Health and Social Care Bill was being finalised, over 40 charities who were members of National Voices placed a letter in The Times calling for the legislation better to reflect the priority of ‘no decision about us, without us’.
We were acting both on the basis of an already well developed research literature, which has only grown since – see the tools and resources for commissioners produced by Realising the Value.
But equally importantly, we were driven by that other source of evidence – the things that people with a need for health services, especially those with long term conditions who now use the majority of NHS resources, had been telling us for years.
In short – that the benefits of patient engagement create a ‘win-win’ for people and for services.
The letter was the last leg of an 18 month campaign that resulted in a new NHS duty in the Act. This requires both NHS England and clinical commissioning groups to “promote involvement of each individual, their carer and (should there be any) their representatives in decisions relating to the prevention or diagnosis of illness, or their care or treatment”.
Five years and many reform initiatives later, NHS England, whose commissioners also share the duty, has produced a welcome new version of the guidance on what this means.
Our Times letter referred to shared decisions about treatments, personalised care planning, and support for self-management, noting that these approaches “are proven to create better health outcomes, with more appropriate treatment, a better experience of care, and better use of healthcare resources”.
The ‘Involving People in their own care’ guidance reinforces this, crisply outlining each intervention and its benefits, and linking to useful resources such as NHS England’s handbook for care and support planning.
The ‘refresh’ also adds new resources that have appeared since 2012, notably the availability of personal budgets as a key tool to put commissioning power in the hands of people and enable them to tailor their own care and support.
While there are now more enthusiasts around the system than ever for designing person centred care, it sometimes feels that we take two steps forward, and one and a half back.
The progressive initiatives taken in recent years by pioneers and vanguards are at constant risk of being reduced to merely instrumental programmes to reduce hospital usage.
Commissioners can play a key role in resisting these pressures. We would urge you to be fully confident in pressing ahead, using all the tools and resources now available. The guidance offers ten practical ways to advance policies and practice that fulfil the duty, with case studies.
The evidence from both research and from people themselves tells us one thing very clearly. If you can put in place known approaches that effectively engage people in health-related decisions, you will directly create better health and wellbeing — more so than much of the routine provision of reactive medical treatments.