The attitude in healthcare towards patients has evolved dramatically over recent years. Historically the health professional/patient relationship has been very unequal, with health professionals in the role of expert, and patients the passive recipient of diagnoses and prescriptions. However, due to cultural changes in society, financial pressures on services, and the increasingly complex nature of medical treatment, the role of the patient is changing and with it their relationship to the professionals involved in their care.
Participation in care and treatment
Over the last century, medical science has been very successful in treating life-threatening illnesses. However, this means that the challenge often facing modern healthcare services is in dealing with long-term and/or complex conditions often associated with old age. This has led to a change in the way that patients are valued as part of both the design and delivery of services. Patients have had to become more involved in managing their healthcare, and those with long-term conditions build up extensive knowledge about their condition. Research has demonstrated the more patients are involved in decision-making, the more they will follow prescribed treatments, leading to less (re-)hospitalisation and better outcomes[i].
Feedback and consultation
In a culture of consumer rights, patients, and the wider public, now expect much greater transparency from healthcare providers about the standard of services, and what is being done to address shortcomings. The Francis report following the mid-Staffordshire enquiry highlighted dramatically the importance of listening to patient and carer complaints in order to identify potential failings in the system. The use of patient and carer feedback to help design and commission services is also seen as a way to gain public acceptance of the difficult decisions that have to be made about how to use the limited resources of the NHS.
Involvement in medical training
At the more personal level of the health professional/patient relationship, the importance of developing patient-centred skills and behaviour in future health professionals is a key element of medical training. This includes access for students to real life situations which provide context to their learning, where they can develop empathy and clinical reasoning skills, and gain new insights into the patient experience.
Patient involvement in medical training also includes input into the design and delivery of training, and feedback on the quality of learning and assessment. Within MAHSE, we have two public/patient representatives on the boards for each of our STP programmes, who contribute their experiences to enhance the provision of clinical training. Their input into the interview process, course content and assessment processes means that the STP programmes focus trainees on developing an ability to provide personalised care, and to recognise that the needs of individual patients are at the heart of all medical practice.
NHS Constitution and the Health and Social Care Act 2012
The focus on patient and public involvement in healthcare will impact on the career of any medical practitioner, both at the level of personal relationships with patients, but also at an operational/strategic level. The concept of patient-centred care was enshrined in the NHS Constitution, which requires the rights of patients to be taken account of by all NHS service providers when making any decision. Under the Health and Social Care Act 2012, the concept of patient-centred care is reflected in the legal duties imposed on Clinical Commissioning Groups to involve patients in their own treatment, and for public participation in the commissioning process. In turn, commissioning drives the focus and priorities of services provided by healthcare professionals. The NHS England document, Transforming Participation in Health and Care, outlines how commissioning will operate to deliver patient-centred care, and provides an excellent insight into how this ethos will shape the future of healthcare service delivery.
[i] *NHS England (2013) Transforming Participation in Health and Care