NHS five-year plans – the glaring omission

Place the funding headlines and the £30bn funding shortfall to one side and there are in fact some very positive ideas and suggestions in NHS England’s new five year strategy. There has been a long held belief that sustaining the health service is more than just about ring-fencing budgets; it is about changing how services are delivered so that the evolving and increasing healthcare demands of the population can continue to be dealt with into the future.

The change that needs to happen must also be about improving care for the patient and being able to deliver a “compassionate” health service, as NHS England chief executive Simon Stevens put it.

A focus on improving how patients are engaged and empowered was therefore a reassuring sight in the Five Year Forward View, something essential not only for the better management of costly long term conditions and co-morbidities, but also for prevention and for really involving patients so that care can be personalised for them. NHS England is arguing “for a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health” – a fundamental idea that underpins its plans to ensure the NHS can survive.

“Patients, their families and carers are often experts by experience”, the strategy observes in its section on better engaging patients. And this is something that still needs to happen in many areas, it fully admits: “We have not fully harnessed the renewable energy represented by patients and communities”.

Yet, despite the many laudable aims and admissions, is there something missing? There appears to be a glaring omission in the 39-page document. There is not one single mention of terms like “communication” or “listening” in NHS England’s new Five Year Forward View.

Some might think that communicating with patients and listening to what they have to say are prerequisites to achieving true engagement and by extension empowerment in care. I would be one of them.

If the last 12 months should have taught the NHS anything, it is the need to effectively communicate with patients. A failure to communicate effectively around the care.data initiative has certainly shown that. NHS England appeared to have taking this onboard when back in June, Tim Kelsey, the national director for patients and information, gave a very strong keynote presentation at the Health + Care event on how listening to patients was crucial going forward.

We are now talking about giving patients much greater control of their care – or even to take charge, both when making joint decisions about their care and during the 99 per cent of their lives when they are not sat in front of a medical professional. If the NHS doesn’t raise its game in communication, so that patients fully understand what they need to do and how they need to do it, can this empowerment really work? And will they ever have actually been engaged?

Communicating means listening too – it is a two way thing after all. There are mentions in the document about providing patients with better access to information to enable their involvement. But it is no good just telling patients they are going to be engaged and or instructing them that they will take greater control. During times of major change the NHS needs to really understand what patients are thinking to ensure a smooth transition to any new service landscape.

How can such terms as crucial as ‘communication’ and ‘listening’ be missing? Perhaps it is implied, or even assumed that this will happen. But for so long patients have not been listened to in a health service that was built for them and with them. Such an assumption therefore cannot be made – we must spell out how patients will be listened to and how they will be communicated with in all aspects of their care and in all changes that are made to the NHS that they pay for.

There is a lot of change about to happen to ensure the NHS survives into the future. Much of that change has the potential to do so much good for the health service and the people it serves. Open dialogue, effective communication and real listening are essential to making it work.

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