Now Reading: A 73-cents-like call to action in “Equity and Excellence: Liberating the NHS”?

I read the UK coalition government’s Health White Paper, which sets out the “Government’s long-term vision for the future of the NHS,” published on July 12, 2010, with comment periods closing in October, 2010, with two interests in mind:

  • If (when) innovation is happening in other systems, I’d like to learn more about it; and
  • The National Health Service has traditionally been working toward a patient-centered model, what does the latest vision do to advance its ideals?

I’ve only highlighted a small portion of the vision for the NHS detailed in this White Paper. This includes significant (huge) organizational changes for people familiar with this health system, such as the abolishment of PCT’s and SHA’s (again for those who know what these are).

I need to state up front that I am not an expert on the NHS and like any large organization, there are far more nuances than can be captured in a White Paper proposal, so I am going to stick to what’s printed here, and support readers in finding local commentary and experience which can be found here, here, and here.

With that in mind, the proposals are interesting and worth learning more about – what would it be like to have a similar system set up in the U.S.?

Shared Decision-making: nothing about me without me (p 13)

The white paper discusses the value of involving patients and care in their treatment and further goes to the effort of citing literature that supports the view presented:


We want the principle of “shared decision-making” to become the norm: no decision about me without me. International evidence shows that involving patients in their care and treatment improves their health outcomes,17 boosts their satisfaction with services received, and increases not just their knowledge and understanding of their health status but also their adherence to a chosen treatment.18 It can also bring significant reductions in cost, as highlighted in the Wanless Report,19 and in evidence from various programmes to improve the management of long-term conditions.20 This is equally true of the partnership between patients and clinicians in research, where those institutions with strong participation in clinical trials tend to have better outcomes.

An NHS information revolution (p 13) <- the 73 cents part

Also on this page is call for data transparency, right down to the medical records held by GP (General Practitioners, the UK version of United States’ Family Medicine specialists):

The Government intends to bring about an NHS information revolution, to correct the imbalance in who knows what.


We will enable patients to have control of their health records. This will start with access to the records held by their GP and over time this will extend to health records held by all providers. The patient will determine who else can access their records and will easily be able to see changes when they are made to their records. We will consult on arrangements, including appropriate confidentiality safeguards, later this year.

My own health information technology experience tells me that this is easier said than done; however it’s worth noting that even the United States’ Meaningful Use criteria does not go this far in promoting patient access.

Patient and public voice – creation of “HealthWatch England” (p.19) <- The Patients-in-Chief part

This proposal was highly interesting to me, as I don’t think anything like it exists in the United States:

We will bring forward provisions in the forthcoming Health Bill to create HealthWatch England, a new independent consumer champion within the Care Quality Commission.

These organizations are proposed to be local and national in nature and are mandated to be funded by local authorities to:

…ensure that the views and feedback from patients and carers are an integral part of local commissioning across health and social care;

and (from the companion Consultation Document, page 4):

We also propose that HealthWatch perform a wider role, so that they become more like a “citizen’s advice bureau” for health and social care – the local consumer champion – providing a signposting function to the range of organisations that exist. We therefore propose that they are granted additional specific responsibilities, matched by additional funding, for:

NHS complaints advocacy services. Currently, this is a national function for the NHS, exercised through a Department of Health contract for the Independent Complaints Advocacy Service. We propose that this responsibility is devolved to local authorities to commission through local or national HealthWatch, so that they can support people who want to make a complaint.

In addition, these organizations will have accountability to the community, in a kind of two-way street (where people drive on the right…):

Local authorities have a vital role in commissioning HealthWatch arrangements that serve their local populations well. They will continue to fund HealthWatch, and contract for their services. Local authorities have an important responsibility, set out in statute, for discharging these duties, and holding local HealthWatch to account for delivering services that are effective and value for money. They will also ensure that the focus of local HealthWatch activities is representative of the local community. In the event of under-performance, a local authority should intervene; and ultimately re-tender the contract where that is in the best interests of its local population.

I found an example of an already functioning HealthWatch here, for people to learn more.

What would it be like to have something this in the United States? Is this akin to @ePatientDave ‘s proposal for Patient-In-Chief and could it be a model? See what you think.

1 Comment

I will follow your links to learn more about the HealthWatch and patient-in-chief ideas because I think they may address the fundamental problem I encounter as a communicator in health care: it's so darned complicated. I think people know in their gut that thus stuff is important, but life is too short to get schooled. So most are allowing politicians to condense it for them. A group that starts from the patient perspective can tell the story in terms that are important to the patient and can help aggregate the patient perspective at the decision-making levels. NCQA is a good quality watchdog, but it starts from the clinical perspective and therefore has a hard time explaining what's in it for me.

Ted Eytan, MD