Power to the people? Person centred care and the ten year health plan for England 

Chris Graham, Group CEO, Picker Institute Europe

You can read the ten year health plan for England in part as a response to a crisis in waiting times: the Prime Minister himself invites as much by putting the issue in the first paragraph of his foreword. In truth it is much more – a genuinely ambitious vision of the future of health built around “one core purpose: to put power in patients’ hands” (p22). The goals are lofty: but has the plan itself been worth the wait? 

Putting people at the centre

I’m delighted to see such a strong focus on putting people at the centre. The plan doesn’t often use the phrase ‘person centred care’, but it embraces the concept warmly – describing an “ambition to create a new model where patients are empowered to control their care” (p18); treating patients not as “passive recipients of care [but as] active partners” (p34); etc. These are things we at Picker have advocated for for decades and it is powerful to see them at the forefront of health policy. 

A key driver for this ambition is putting “patient choice, voice and feedback at the heart of how we define and measure quality” (p86). Again, this is very welcome: only patients can judge whether care is person centred, so a recognition that the system must seek their views – and a frank acknowledgement that “the NHS does not take patient feedback seriously enough” (p51) – are important.  

At the same time, these commitments are not new. The NHS Plan (2000) argued that the NHS’s core problem was that it was “not sufficiently centred around the needs of individual patients” (p26) and that it should become more patient centred. Lord Darzi’s High Quality Care For All: NHS Next Stage Review (2008) described a vision of “an NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart” (p7) – with ‘quality’ explicitly including patient experience, alongside patient safety and effectiveness of care. The natural temptation is to ask what is different this time.  

Using patient feedback

There are signs that this plan includes a deeper commitment to using patient feedback. There are eye-catching but potentially troublesome plans to trial ‘Patient Power Payments’ (eg p136), where patients can direct payments to be withheld from providers and redirected towards a regional improvement fund. There is a commitment that “by 2029, both PROMs [Patient Reported Outcome Measures] and PREMs [Patient Reported Experience Measures] will be used universally” (p88), and, separately, that “the NHS App will give patients the chance to leave their feedback on a service, clinical team, or healthcare provider” (p51). Overseeing this will be a new National Director of Patient Experience at the Department of Health and Social Care (DHSC) (p89), a welcome return to the Department after many years. 

These are bold plans, but crucially they lack detail. How will patients be contacted about ‘Patient Power Payments’, and what will they be asked? How will feedback collected through the NHS App work alongside other sources of evidence, and how will the risk of digital exclusion be effectively managed beyond ‘App Ambassadors’ and partnerships with local libraries? These initiatives are not risk free. Using poor quality data in payment by results schemes could create distrust from providers and drive a wedge between them and their patients: providers may feel ‘held to ransom’, or simply doubt the meaningfulness of the exercise. Similarly, collecting patient feedback through the NHS App is likely to raise concerns about confidentiality – and a singular focus on the NHS App as a platform for communication and voice risks disenfranchising people who have lower digital literacy. 

These questions are, as yet, unanswered – so much will depend on the details of delivery and implementation. Given the scope of the plan, it feels reasonable for ‘delivery’ to be held separate – but there is a certain irony that, for health policy enthusiasts, this does mean another wait.  

Opportunities and risks

With those caveats and uncertainties – and alongside the disruption of reorganisations across arm’s length bodies – there are some great opportunities for the health service to get better at understanding, measuring, and improving people’s experience. But there are also risks that will need to be carefully managed. Fortunately, a wealth of knowledge and evidence already exists. The imperative now is for the focus on person centredness to be maintained, and for ‘the centre’ to draw on the expertise of people with lived experience and the third sector alike to develop a detailed, effective approach to putting the power in patients’ hands.