04 / 11 / 2013 8.15am
The move towards framing the language of our health and care system to put patients at the centre of everything we do has been a positive and heartening development. Not only is this better for individuals receiving care – who should always be treated with compassion and respect – but also for the carers who 'hold up half the sky' for our health and social care system.
But the strategic framework that should develop and deliver consistent integrated, person-centred care, both with and for the diversity of people using our services, is still a long way out of reach. Why?
The Francis report spelled out many clear messages for providers, commissioners, regulators, government departments, local partnerships and more. Robert Francis told us that services did not listen to patients, or systematically or flexibly respond to patients and improve services. Nothing significant changed because such messages were ignored or patched over; because system rules demanded attention to other issues.
Subsequent reports from Don Berwick and Sir Bruce Keogh have almost reiterated the same messages – this should tell us there is a problem.
Francis also described a culture focused on doing the system’s business – not that of patients. He drew our attention to an institutional culture that ascribed more weight to positive information about the service than to information capable of signalling cause for concern. And he unearthed issues with standards and methods of measuring compliance that did not focus on how services affect patients. The report screamed "patients first and foremost".
I predict this trend will continue if we as leaders continue to grapple with the system, rather than form alliances to change it.
A lot can be said about the NHS reforms – good and bad – but through the devolution of power, they have provided the opportunity for strong alliances of local people, and local services, to work together to face tough choices and make changes linked to agreed community incentives. Can we seize this opportunity?
Liverpool Primary Care Trust was determined to just this, and used its organisational strategy to successfully manage partnership working, viewing the community as a valued partner. They ensured dedicated commissioning resources for the procurement of relevant local services and successfully tackled health inequalities through a sustained public health approach. Embracing equality and diversity: a decade of achievement (published by Liverpool PCT in March 2013), praised the trust for working to: "ensure it was well informed and that it ha[d] a good understanding of the needs and concerns of the diverse communities it served through effective stakeholder engagement, health needs assessments, patient profiling and equality impact assessments."
Despite successes and challenges, Liverpool demonstrated how it can be done. But are we brave enough to agree to and ensure that fundamental principles, such as integration and equality, are actively incorporated into long-term planning which positively assists our communities? Are we humble enough to admit that we don't know how to do this community engagement 'stuff' and to resource, work with and learn from those who do?
NICE guidance PH9 for example (although in need of updating) points us in the right direction and offers an initial review of the evidence for effective community engagement activities for us to learn from. And Nottinghamshire Healthcare NHS Trust's approach provides a great example for us to consider: the trust has significantly involved service recipients and carers in developing and delivering mental health care services. Ex-service users have been employed at the trust and recruitment has routinely involved service users as members of interview panels for senior roles. Nottinghamshire has involvement centres open to patients, carers and volunteers, and is actively seeking to engage with community members. No model is perfect, but a willingness to resource action plans and build on learning is necessary and welcome.
I’m a big fan of NHS Change Day, the national and soon-to-be global campaign to inspire and motivate people in the NHS. It is not by chance that while 'observed politely' by some commentators in the UK, Change Day recently won a prestigious global Harvard Review leadership challenge. Despite major NHS change, this event managed to inspire nearly one-fifth of the NHS workforce in England.
You never know, such actions, where staff and patients work together to improve care, might just change things for the better.
Joan Saddler is an associate director at the NHS Confederation. Follow the Confederation on Twitter @nhsconfed.