Intended for healthcare professionals

Analysis Essay

Patient power needs to be built on strong intellectual foundations: an essay by Nigel Crisp

BMJ 2012; 345 doi: (Published 21 September 2012) Cite this as: BMJ 2012;345:e6177
  1. Nigel Crisp, former NHS chief executive
  1. 1House of Lords, London SW1A 0PW, UK
  1. crisp{at}

The balance of power in health systems needs to be shifted so that people are enabled to live the life that they want rather than having to fit in with professional and commercial views, says Nigel Crisp

There are many parallels between the current reforms in the English NHS and those under way elsewhere in the world. Almost all these programmes focus on market solutions and on changing the relationship between the public and private sectors. Most also emphasise prevention and the need to combat the epidemic of non-communicable diseases.

These similarities are particularly striking because different countries have such different economic prospects. China, India, and other fast growing economies are investing heavily in healthcare, and many plan to introduce universal health coverage. Many European states, in stark contrast, are looking at ways of cutting costs and restricting coverage.1 Meanwhile the poorest nations remain dependent on foreign aid and have the worst health and the worst access to healthcare.

It is also striking that no country has yet been successful in giving its citizens a truly central role in improving health and healthcare, preferring instead to rely almost exclusively on economic and professional levers. People are defined in terms of economic and professional frameworks and are reduced to being mere consumers in need of satisfying or passive patients in need of treatment or education. They are not seen as active participants in their own right.

The dominant mindset sees the world in economic and professional terms. We need to offset this by developing an equally powerful intellectual framework and language based on the roles and rights of each of us as individuals and citizens. To do so we need to ask the seemingly simple question: what do we want from our health service?

Economic and professional dominance

Economic thinking is now as dominant …

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