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Health service needs to engage more with patients, says Nuffield Trust

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39348.850880.BE (Published 27 September 2007) Cite this as: BMJ 2007;335:632
  1. Zosia Kmietowicz
  1. London

    Reform of health and social services in England needs to slow down to allow the full engagement of staff and the public in the process, says a report from the independent health research organisation the Nuffield Trust.

    The report, which examines the health and care needs of people in England in the next 15 years, says that reform of health and care services in England “is in danger of stalling.” But although further change is needed, this should proceed with a “re-engagement with consumers, health workers and citizens, in re-imagining and co-creating a shared vision of their future health and care services.”

    Sandra Dawson, one of the report's authors and professor of management studies at Judge Business School in Cambridge, said that morale among health and care staff was particularly low and they needed to feel involved in designing future services.

    She welcomed the review of the NHS currently being conducted by the health minister Ara Darzi, which last week involved consultations with staff and the public. “It [the review] should be strongly supported, but we should not expect instant answers,” she added.

    The Nuffield report echoes two other publications issued last week—by Derek Wanless and by the Institute for Public Policy Research—in calling for the devolution of power from Whitehall and greater support for individuals, families, and communities to take control of their health and wellbeing by shaping local health policies.

    The report says, “We can hope to replace a health and care system led from the centre with one based around a focus on patients and communities, connections—professional and organisational—rather than boundaries, and an emphasis on local rather than national solutions.”

    It calls for policy makers to define a basic insurance package for health and social care, with information on which services are freely available and which can be bought through top-up insurance schemes or by paying for them.

    Pam Garside, a management consultant who helped write the report, said that people know that certain services, such as infertility treatment and dentistry, have to be paid for to some extent. She took the view that other treatments able to be bought in this way needed to be clearly defined.

    The report concludes: “While engagement at all levels may slow reforms, it is the only way to achieve lasting change. This does not mean that reform must move at the pace of the slowest; it demands bold vision and leadership, beyond the time-limits or political constraints of governments. Such visionary leadership must provide the motivation for the reformulation of professional values and public re-imagining of health, care and wellbeing in the 21st century.”

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