It is unlikely that patient and public engagement is to feature highly on the agenda of our political masters or for those with the daunting task of managing our public health services for the foreseeable.
Legislation barely mentions any testable duty on engagement and the process for consulting users on significant changes to their service remains opaque at best. And, significant changes to services are now more likely than ever.
This is hardly news. And, this is hardly anything that registers as outrage given the more pressing issues facing the NHS, like the 30% hitherto never achieved efficiency saving that will in theory maintain the NHS Budget in real terms. Good luck with that!
What PPI lacks in legislative muscle it more than makes up for in the continued abundance of NHS bodies that purport to enshrine engagement in their very DNA. But intention to engage is not the same as having the skill to engage that properly reflects the needs of users.
In October of last year I attended a Westminster Health Forum that brought together a few grandees to bang the drum for reform – liberating reforms – I saw one sallow faced presenter suggest – and heard precisely nothing about patient engagement and even less about how you make services run more effectively by knowing more about those that use them.
When I posed the question to the panel as to whether the reforms would ‘amplify’ the patient voice in how services were to be run and commissioned you could hear a sharp intake of breath (I jest – but you get my point). I was told that the patient voice is served by patient choice. So there.
And it is hardly surprising given other pressing issues and the fact that it is very difficult to test how important patient and public engagement is or can be in shaping both quality and efficient health services that PPI’s golden years of the late 90s and early 00s are probably over.
PPI theory draws from consumerist models of engagement to participatory democratic models of engagement. And, much is made of the need for the appreciation of the complexity of the nexus of power and control that exists in a free at the point of access cradle to grave health service.
Therefore effective engagement methodologies are slaves to context and objectives. Determining the best delivery of severe burn care or dialysis requirements will require specific work with the population of people who may find themselves in the unfortunate position of needing such services.
When it comes to considering how best to develop blood testing services for an increasingly elderly patient population to ensure that the onset of long term chronic conditions brought on by lifestyle and the aging process than it makes sense to refine services with a clear understanding of how best to ensure the process is high quality and efficient at signposting needs for early intervention – medical or otherwise.
Simple service user and potential service user surveys can go a long way in shaping a service that operates efficiently for all concerned. It is precisely for their health that the private sector spends such efforts on understanding their consumers. It is not quite the same – but it is near enough.
GP Consortia through their GP surgeries have potential to access a patient database that almost covers the entire population in their particular region. These records will have a whole host of fields that will include name, contact details, age, gender, test history, some lifestyle indicators (e.g. smoking) and will serve as an administrative engine for the surgery. A patient panel to die for! Not 100% for sure – but near enough.
To my astonishment there appears to be a ‘data protection’ bar on the availability of individual GP surgery data to the ‘corporate’ body – the commissioning consortia.
The notion that as a patient I have an expectation that the data held on me that resides in the GP surgery system will not be available to the corporate body that is tasked with commissioning services for that surgery to protect my confidentiality is absurd.
Surely I am not alone in encouraging my GP surgery to make it’s patient data available to the mother ship to facilitate an economy of scale in the deployment of mechanisms to survey and engage the population on how best to deliver essential services to it.