Patient must be at heart of healthcare debate


OPINION:THE PROVISION of healthcare is one of the most sensitive and emotive areas of our social fabric. It is also one of the most opaque areas of professional provision. Of all of the services to which we have access, it is the one that has the least usable data for the consumer. Historically the patient/client has been expected to follow blindly the doctor’s advice with little input or participation in his/her treatment, writes KEN ANDERSON

The ability of patients to act as consumers and therefore participate in their own treatment has been severely hampered by medical secrecy and arrogance.

The patient, on the whole, was not seen as having the training or intellect to understand complex medical issues and was therefore treated as a passenger and not a participant in their treatment. This lack of participation by the patient was caused in large part by a lack of appropriate information on which to make informed decisions.

To argue that patients are too unsophisticated to engage with health professions allows health providers to change little, if any, of their work practices, to protect incomes, avoid scrutiny and remain safe in the knowledge that sub-optimal performance or even malpractice can go unnoticed throughout an entire career.

The almost universal access to the internet has turned a bright light into what had been relatively dark corners. Patients, armed with useful non-jargon information, are becoming consumers of healthcare.

They are insisting on doctors being measured, the publishing of meaningful outcome data, and access to healthcare based on their needs and not services based around what the health workers want.

The Labour Party in England, led by Tony Blair, understood that if the NHS didn’t make a 180 degree turn, it would no longer exist. These new consumers who were well travelled, had experience of other health systems that were modern, clean and user- friendly, would vote with their feet and begin to leave the NHS for consumer-focused private healthcare.

Blair could see the NHS turning into a poor service for the poorest people.

The reforms initiated by the Labour Party in 2001 were market-based. For almost five years the new government had listened to the nursing and doctors’ unions, left them to their own devices and pumped ever-increasing amounts of money into the system. In return, they received a significant drop in productivity and a massive increase in the number of people on surgical waiting lists.

It was clear that the special interests were looking after themselves and ignoring the people who paid their salaries, the patients.

In 2001 Labour launched into wholescale market-based reforms centred on patients’ needs and not the health service employees’ wants. They immediately injected foreign doctors into the areas with the worst waiting lists and purchased hundreds of millions of pounds of contracts directly from private providers.

The result was that, in the first instance, cataract waiting lists were decimated, declining from over 24 months to effectively zero in eight months. The English-based surgeons immediately took credit for the eradication of the waiting lists, as they should.

However, they failed to point out that until competition had been injected into the system – and there was a fear on their part that they might lose their jobs – they were perfectly happy to allow people to wait for two years before they could see properly.

For the record, before the private-sector initiative surgeons were performing, on average, three procedures in a session in an NHS hospital and in excess of 15 in the private hospital across the street. These same surgeons were now performing between 10 and 15 in the NHS. Without an appropriate competitor, there was not any incentive to change behaviour.

Today, the NHS has cut end-to-end waiting times to 18 weeks, arguably still some of the longest in the western world, although given the place we started from, two to three years, this was a mammoth achievement.

The decrease in waiting times was not accomplished by dumping more money down a black hole, it was done through market-based dynamics that allow organisations to measure their effectiveness, patients to exercise a choice and tell providers, by walking, they are not up to the standard required.

Is the NHS where it needs to be? Nowhere near. It still lags behind countries like Poland in outcomes in some specialty areas. It is, however, safe to say that patients finally have a platform from which to make informed decisions and demand that they are participants and not passengers in their treatment. They can begin to measure around data points that are meaningful to them the quality of the treatment they receive and, most importantly, begin to shape the NHS from a patient’s and not an employee perspective.

Critics of the empowerment of patients and of the requiring of health professionals to be accountable normally talk in anecdotal non-fact-based code.

Frequently doctors’ unions will use phrases like “this could possibly impact on quality of care” or “could possibly put patients’ lives at risk”. Frequently they won’t engage in discussing how we move from our current 1960s-based health provision model into the 21st century.

In France, (where the health system frequently ranks at the top of the World Health Organisation’s best providers) 40 per cent of health provision is supplied by the private sector.

The French enjoy choice, clean hospitals and friendly staff, not to mention some of the highest quality outcomes in the world, and GDP spend on health is not dissimilar to that of the UK.

France has embraced an agnostic system where providers are chosen and survive based on ability and quality of outcomes and not idealism. For too long we have allowed patients to suffer while high-level discussion around the politics of health take place. France and others have proven that the discussion must centre around the patient and their needs. Most importantly, the patient must be at the centre of that debate and not be kept on its periphery.