National Health Service

Earl Howe Excerpts

Tuesday 17th June 2014 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I am delighted that the noble Lord, Lord Crisp, has raised this important topic for debate this afternoon. I would like to thank him for sharing the report on patient empowerment by the six all-party parliamentary groups to which he referred, which I read with great interest.

Giving patients more power in the NHS involves concerted effort at every level: national, regional and local and, perhaps most importantly of all, in the consulting room itself, in the one-to-one conversations between clinician and patient. As the noble Baroness, Lady Pitkeathley, pointed out, the terrible events at Mid Staffordshire show what can happen when patients have no power at all. The deeply unfortunate experience of the noble Baroness, Lady Wilkins, as recounted by the noble Baroness, Lady Masham, is a further example. As a Government, we are committed to putting patients genuinely at the heart of the NHS, to giving them the information, tools, support and care to help them get well and stay well and to give real life to the commitment in the NHS constitution on that theme.

Involving patients and the public in health matters is something that the Government, my department and our partner organisations are firmly committed to. Indeed, there is a general consensus that patients should be at the heart of the health system and that putting the patient first needs to be made a reality.

Ensuring that patients have more say in how their care is delivered and embedding choice are key themes in the Health and Social Care Act 2012, to ensure that we genuinely put the patient first and drive improvements in quality. As part of that, involving patients and ensuring that there is “no decision about me without me” needs to become the norm, not the exception. The same applies to the very apt question, “What matters to you?”

We are passionate about ensuring that people have every opportunity to have their voices heard; that people have the opportunity to shape the services that affect them and their families; and that they are empowered to make decisions about their own healthcare and management. That is why we want everyone to be able to make informed choices about health and social care.

The noble Lord, Lord Crisp, asked me to endorse the principle of patient empowerment, which I readily do. We know that empowering patients and citizens is key to ensuring that health services meet people’s needs, that people have a better experience of care and are able to take better care of themselves; all of which—as the noble Baroness, Lady Pitkeathley, pointed out—will help to sustain the system itself, a system in which we all place so much value.

My noble friend Lady Brinton referred to the need to measure the patient experience, not just patient outcomes, and of course she is right about that. There are a number of measures for collecting information about different aspects of patients’ experience. One way of doing that, which is supported by various parts of the health system, is a validated measure devised by Warwick University.

To do all this it is vital that we understand what patients want from their care. There are a number of ways in which we do that. One in particular can be mentioned; namely, that we have received over 2.5 million responses to the Friends and Family Test in inpatient and A&E settings. That is proving to be a really useful tool in shining a light in almost real time on patient experience.

Patients must be given the chance to be as involved in their decisions about their care as they wish to be. We know that there is an appetite among many people to be more involved in their care than they currently are. Involved patients are in a far stronger position to manage their own healthcare, resulting in improved patient outcomes, a reduction in unnecessary consultations, improved patient experience and better use of resources. This is not a new agenda, and already a lot of progress has been made.

The noble Lord, Lord Crisp, asked about patient decision aids. NHS England is updating the patient decision aids as part of its work to establish a sustainable model of PDA which is underpinned by clinical leadership and partnership with organisations that can stimulate patient use and clinical buying in. Research shows that the tools need to sit within a wider system amenable to partnership, with patients and shared decision-making with clinicians as the norm. Patient decision aids comprise a shared decision-making website. That allows patients to plan their healthcare pathway. As for NHS England, the NHS Citizen programme seeks to put the patient voice at the heart of the decision-making that NHS England itself undertakes. That is a commitment from NHS England.

I am struck by how much engagement has taken place throughout the healthcare system in the past year, with a diverse range of people and organisations: patients, carers, the public, the voluntary sector, social enterprises and the community sector. It is important that we get this right, and we must engage the support of the public and other stakeholders in doing so.

The noble Baroness, Lady Pitkeathley, referred to carers as citizens, and of course I agree fully with her. It is important to gather the views of carers through a number of feedback mechanisms, including the Friends and Family Test and the GP Patient Survey. We have to understand the particular needs of carers to ensure that we can tailor the support that is required. NHS England will be publishing commitment to carers this year.

Of course, if we are serious about putting the patient first, that involves much more than giving patients and the public a chance to shape the services, although that issue should not be overlooked. The noble Lord, Lord Hunt, asked whether Healthwatch England was making a difference. We can now see the role of Healthwatch England making itself felt, ensuring that people’s experiences and views about their care and treatment are listened to and acted on. It is providing worthwhile leadership, support and advice to the local Healthwatch network, which is promoting a local consumer voice.

The noble Baroness, Lady Pitkeathley, referred to the patient leaders concept. The Care Quality Commission aims to involve people who use health and social care services in everything it does. For example, Experts by Experience takes part in inspections of health and social care services and visits to monitor the use of the Mental Health Act. Furthermore, NHS England has invested a significant amount of effort to improve the way in which it supports people to manage their own care. There is a number of core programmes, such as personalised care and support planning, so that people with long-term conditions and disabilities can work together with their health and social care professionals. Personal health budgets will give people more choice and control, and sites have now been chosen for piloting personal health budgets for people with mental health conditions.

The noble Lord, Lord Crisp, referred to the benefit of empowering patients to ask more questions. The key to giving patients more power in the NHS is the provision of high quality and accessible health information. Already, NHS Choices helps to put people in charge of their healthcare. The noble Lord, Lord Hunt, and the noble Baroness, Lady Murphy, referred to technology. NHS Choices also includes a health apps library spanning a whole range of lifestyle and clinical conditions to help people choose apps that are safe to use. As part of NHS England’s work to give patients access to their records, the Patient Online programme’s accelerator sites will be testing how that is impacting on patients and clinicians. That represents a real shift in emphasis and the relationship between patients and professionals, so it is important that we test it out first. It is about doctors trusting patients to use information responsibly. Having said that we need to test it, the principle of giving patients practical ownership of their records is surely right, and I think that that work will provide the foundation for that. Of course, we would like to move faster with this critical agenda, but it is important that we do this at an appropriate pace to bring people with us and to learn lessons from trying out new ideas.

Let me pick up the theme that my noble friend Lady Brinton spoke to so powerfully. We must not forget the importance of supporting the workforce. Some are already doing an excellent job in involving patients in their care. But more widely, the right medical education and clinical training needs to be in place, because by empowering health professionals we can empower patients. The NICE standard on patient experience defines best practice in this area and provides evidence-based statements for commissioners to support a cultural shift towards a truly patient-centred service.

I am pleased that NHS England together with other organisations across the health, social care and voluntary sectors has formed a coalition, the Coalition for Collaborative Care, to make person-centred care a reality for people living with long-term conditions. Furthermore, a key part of increasing the involvement of patients in their own care is being able to measure the skills, knowledge and confidence that people have that predispose them to be able to manage their own conditions better. As the noble Lord, Lord Crisp, said, diabetes is an excellent example but we must also think in terms of more complex conditions, as the noble Lord, Lord Hunt, rightly pointed out. Working in partnership with the Health Foundation and the King’s Fund, NHS England is piloting the patient activation measure in five CCGs and the renal registry. This is an exciting development. It is a score based on patients’ responses to 13 questions that include measures of an individual’s knowledge, beliefs, confidence and self efficacy. It has the potential to drive real improvements in participation.

Finally and importantly, the move to a new health system, including the transfer of the public health function to local government, has created the potential for action on health and health inequalities to be centred on people and places. I am delighted to see how Public Health England and NHS England are working in partnership. With Healthwatch championing the needs of children, young people and adults, the health and care system as a whole is working together to make things better for everyone, especially the most vulnerable in our communities.

There are a number of points that I feel I should pick up, but in view of the time I hope that noble Lords will allow me to write to them on those points. In saying that, I would like to thank all speakers for their contributions to what has been a very fruitful debate.