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Patients Association’s response to the pause in the Health & Social Care Bill

Ahead of the Government’s announcement of the results from the pause to gather opinion on the Health and Social Care Bill, the Patients Association’s announced what patients, carers and members of the public want to see changed in the Bill.

The NHS Constitution was created to protect the NHS and sets out what patients can expect from NHS services, their rights and responsibilities. The Coalition Government must ensure that any proposed reforms respect and adhere to the Constitution.

These recommendations have been informed by well over 1,000 patients who responded to a Patient Associations survey and over 200 patients who attended a series of independent Listening Events.

The Patient Associations research shows that the majority of patients feel the Bill has not been explained properly and an over use of NHS jargon has meant many patients are confused by the proposed changes.

Patients want changes to the NHS but these are local changes – such as improving nursing care or access to services – rather than an overhaul and restructure. Patients are also keen to see a reduction in waste and bureaucracy in the NHS but the vast majority do not believe the Coalition Government’s Bill will achieve this.

Initiatives such as ‘shared decision making’ and ‘choice’ are welcomed by patients, but are meaningless if not backed up with accessible, easy to understand, tailored information so they can take part in informed discussions and decisions about their healthcare.

Patients want healthcare professionals to understand that also have a role in shared decision making and need to put patients at ease and encourage discussion.

Patients believe the Coalition Government is not taking the local patient voice seriously as local HealthWatch is not properly resourced and is expected to be staffed by volunteers. With a myriad of organisations now responsible for services patients don’t know who is responsible for what aspect of the health service and which organisation is accountable.

And finally, GP commissioning. No matter how this is spun by the Government it will just not wash with patients. No matter what measures of accountability are put in place, patients fear that GPs will face a huge conflict of interest by having to balance their books rather than buying in the best services for patients.

GPs need to be spending time with patients and that should be their primary focus. Yes, GPs should have an input into local services but they should not be responsible for commissioning them.

Katherine Murphy, Chief Executive of the Patients Association said:
“The results of our survey and Listening Events send a clear message to the Coalition Government about what patients want to see in the Health and Social Care Bill.

The original purpose of this Bill was to put patients at the heart of the NHS, but with well over a 1000 patients contacting us we know that many doubt this sentiment will be achieved by this Bill.

First of all we have many patients who are excluded from discussions about the Bill because it uses too much NHS jargon. How can the Government say this Bill is focused on patients when many patients find the changes confusing and hard to understand?

There are so many concerns about the reforms, so much is being changed at such a fast pace that patients can’t keep up with it.

With healthcare to fall under the responsibility of the Local Authority and GP consortia, patients are unsure of who is actually accountable? The NHS complaints system is already a mess, and without clearly laying out who is responsible for what aspect of the health service patients are going to be left even more high and dry.

The Coalition Government talks about HealthWatch as supporting and involving local patients, but without the proper resources behind it patients see this as a token gesture without real teeth.

As for GP commissioning, this idea just does not sit well with patients. Healthcare professionals should be involved in local services but they must not be distracted from their fundamental role which is loo king after their patients.

The Coalition Government must sit up and take notice of what patients are saying otherwise this Bill will send the NHS backwards and result in a service which can be summed up by “Decisions About Me, Without Me”.”

Notes to Editors:

Below is a list of the Patients Association’s recommendations, informed by patients, carers and members of the public. We would like the Coalition Government to consider these recommendations as part of its Listening Exercise and amendments to the Health and Social Care Bill.

1) Many patients do not understand the proposed reforms. The Coalition Government needs to urgently explain them in clear, everyday language that avoids the use of NHS jargon. Case studies and examples of what the changes would mean to patients would aid understanding.

2) The move to GP commissioning is not welcomed by the vast majority of patients who fear it will damage the relationship between doctor and patient. Patients want to know how GPs will manage the conflict between buying the best services for patients and balancing the budget and how patients will be able to action choice if their GP is tied in to a contract with a specific service provider. There needs to be real accountability to patients and GP consortia must publish their patient engagement strategy and account books.

3) “Any willing provider” is not welcomed by patients. Private providers will be focused on cherry picking the most profitable services, rather than providing quality services for patients. It is feared that this policy will result in privatisation of the NHS, depletion of resources from the NHS and instability.

4) The provision of well-run out-of-hours services needs to be addressed by the Coalition Government and these services advertised to patients at a local level.

5) With a number of organisations now involved in local healthcare - Local Authorities, Health and Wellbeing Boards, HealthWatch and GP consortia - patients do not understand who is responsible and who is accountable for their care. Local accountability needs to be based on statutory law and clearly defined and communicated to the public in layman’s terms.

6) A strong patient voice is needed at a local level. HealthWatch needs to be independent, properly resourced, advertised, hold statutory powers and be supported both centrally and at a local level. The Coalition Government should not rely on volunteers alone to provide Local HealthWatch functions - this is perceived as the Coalition Government not taking patient involvement seriously.

7) HealthWatch England’s position within the CQC compromises its independence – this conflict needs to be resolved.

8) The NHS reforms are too extensive and are happening too quickly. They are also poorly timed when the country is facing a period of financial austerity. The pace of the reforms needs to be slowed down and significant changes – such as GP commissioning - properly tested, instead of being rolled out in the guise of a ‘pilot’.

9) There is a place for reducing bureaucracy in the NHS and involving healthcare professionals and frontline staff in the planning of services. However, patients do not believe the Coalition Government’s reforms will achieve this. Rather than overhauling the NHS, the Coalition Government should identify and spread examples of good practice.

10) ‘Shared decision-making’ and ‘Choice’ are welcomed by patients but these initiatives need to be supported with the right information for patients. Patients need accessible, relevant information that enables them to understand their options and discuss these with healthcare providers.

11) For ‘Shared decision-making’ and ‘Choice’ to work, healthcare professionals need to ensure that they communicate effectively with patients, putting them at ease and enabling them to take part in discussions about their healthcare.

12) ‘Shared decision-making’ should extend to families and carers of patients, if appropriate


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