Can NHS keep up with expectations?

Dr Michael Dixon OBE FRCGP, Chairman, NHS Alliance, asks whether the NHS can keep up with public expectations

As a philosophy graduate as well as a doctor, I believe there are three logical ways in which we can ensure the National Health Service keeps up with public expectations.

We can raise our game to meet expectations as they currently are. And we can modify those expectations with public debate and local involvement.

Finally - and this is the big idea - we can make local people and frontline professionals an intrinsic part of planning and monitoring health care.

In that way, meeting public expectation would become less a matter of chance and more a self-fulfilling prophesy.

The first of these three, the head on approach if you like, is where we are going at present.

The first stage has been to increase the size of the pot through extra finance and capacity and with the emphasis largely on secondary care.

The result has been a visible improvement in waiting times not only for people with serious heart disease and cancer but in everything from hip replacements to cataracts.

Primary care has upped its game too, with much improved access to doctors or nurses, and quality standards in general practice, which must now be the envy of the world.

The next stage of this process, in which we are currently involved, is less about increasing the size of the pot and more about making best use of the pot we have - cost efficiency.

This route involves commissioning and, in particular, the full involvement of frontline clinicians in redesigning more cost efficient services and ensuring they are used appropriately by clinicians and patients alike.

This will lead to many services currently provided in hospitals being provided more locally, cheaper and better.

This particular approach to cost efficiency should help to squeeze out extra money to pay for high technology interventions when needed.

Polls into public satisfaction in the NHS show, surprisingly perhaps, that you can only partially meet expectation by improving the service.

Hence, our second logical approach sees public expectation not as some sort of a constant but as something that can be moulded by open public debate both at national and local level.

I know they say that open debates on what the NHS can or cannot afford represent a painful method of political suicide. But it has to happen and maybe that debate needs to be raised outside party politics.

Otherwise, we will forever have a population that has expectations of the NHS that lie beyond its ability to pay for it.

In modern politics, politicians almost have to offer “Bread and Circuses” but through national debate and local involvement of patients, I believe that we could make expectation far more realistic.

In my own GP practice ‘patient group’, I have been amazed by how quickly patients understand that there are resource limits and that priorities have to be made.

I brought one member of that group to a session at this year’s Guardian conference and she said quite explicitly, on the stage - to an audience of the leading thinkers and health care planners in the country - that she and her colleagues would be happy to roll up their sleeves and make some difficult decisions about what practice the practice-based commissioner could or could not afford.

And that brings me to the third option. That is simply to make local people and frontline clinicians an intrinsic part of meeting expectation.

It is the “fully engaged scenario” that Derek Wanless talked about in his report for the Chancellor of the Exchequer not long ago. And that is the crucial new approach that we have yet to deliver.

The report was entitled: ‘Securing our future health: taking a long term view’ for HM Treasury, 2002. Among the report’s recommendations was a focus on health promotion and disease prevention so that people would be fully engaged in caring for their own health.

We need to create ‘NHS local’ where all local people and frontline professionals identify with and see themselves part of the NHS.

They might even carry a membership card based on their local practice based commissioning scheme, which is more likely than not to involve a number of local GP practices.

The greater engagement and leadership role of frontline clinicians both at practice and primary care trust level will itself have an enormous effect on public expectation, as witnessed by a recent MORI poll.

It showed the enormous influence that clinicians can have on the perspective and expectations of their patients.

The Government is determined to make it possible for doctors, nurses and other health care professionals to play a full role in their PCTs, and the NHS Alliance is driving much of the work on this nationally.

As for the patients and public themselves, membership of “NHS local” will make them an intrinsic part of meeting expectation, and give them ownership and the motivation for expectation to be met.

That ownership will extend from a focus on self help and personal health to an extended role of the community itself.

Thus we end that old dichotomy where we have patients and people on one side of the fence and the NHS on the other, failing to meet their expectations. NHS Local becomes a mutual partnership with mutual aims and mutual buy in.

So I believe the answer to “Can the NHS keep up with public expectations?” is yes but we need to do this by two means.

On the one hand, we must create a razor sharp service, almost consumerist, which delivers value for money, while on the other we must create a partnership between the public and the NHS, which will itself create health and make it more likely that we will meet expectations.

The NHS Alliance

The NHS Alliance is recognised as the principal representative organisation for primary care.

It is the largest such forum in the UK with links to other European and worldwide primary care bodies. It has a particular focus on commissioning and commissioners.

Today membership includes GP practices and primary care trusts together with individuals from all of the clinical professions, NHS managers and lay PCT board members - ensuring that it genuinely represents the collective voice of primary care.

It is unique in bringing practices and PCTs together on an equal basis to plan, secure and evaluate local health services. It holds strong values on fairness, accountability and equity, and has spoken out for almost a decade on behalf of primary care.

Above all, the NHS Alliance keeps its feet firmly on the ground.

All members of the hard-working national executive have real day jobs within primary care - GPs, chief executives, PCT chairs, nurses, allied health professionals and practice managers.

The Alliance has regular contact and meetings with Ministers, Department of Health officials and senior representatives of all national agencies.

Member surveys, varying from working groups and detailed questionnaires sometimes with follow-up interviews, to mini snap-shot surveys, make sure the views of those working in the front line are accurately represented and reflect a shared view of ‘hot topics’.

Its 13 specialist networks play an extremely important role in leading national thinking.

This article is based on a speech by Dr Mike Dixon at a meeting organised by the Institute of Public Policy Research (IPPR) at the Annual Labour Party Conference, September 2006.