In the months ahead of the General Election, the NHS has taken centre ground. Political parties left and right are eager to show their commitment to the NHS with the weight of their wallet. Yet whatever the size of the cheque, the need for a permanently more productive NHS remains.
New analysis by Reform shows that patients themselves could improve NHS productivity and help the health service save £2 billion by the end of the decade. The potential of the patient to add value in this way was recognised by Simon Stevens in the Five Year Forward View. Rather than characterising patients as a burden to the NHS, Stevens described them as a source of "renewable energy" who could be "fully harnessed" to sustain the health service.
This same opportunity was identified by Derek Wanless back in 2002, who argued involving the public and patients in their health and care could save the NHS £30 billion by 2022. Wanless' vision would require radical changes to patient and public behaviour. Under the most ambitious of his three scenarios, "fully engaged" patients would have more control over their health and wellbeing. They would monitor and medicate their own conditions at home, with less dependence on GPs and A&E. Moreover patients would be less likely to get ill in the first place, leading to dramatic improvements in the nation's health.
Now well over a decade since Wanless' landmark review, the NHS has barely scratched the surface of this patient resource. The former Health Secretary Andrew Lansley was not afraid to make this point at the start of his tenure when he said "look[ing] at the Wanless report from 2002 and where we are today, we are on pretty much the poorest of those three scenarios. We are not in a fully engaged scenario."
The evidence supports this view. Rather than the vast improvements in public health that Wanless envisaged, adult obesity is continuing to climb and smoking rates have flatlined.
So why has the NHS failed to fully engage patients?
Successive governments have attempted to engage patients through individual initiatives and programmes but the impact so far has been limited.
The drive to empower patients by granting them rights has had limited success. Just under half of patients are aware of their right to choice under the NHS Constitution and even fewer - just over a quarter - have ever heard of the Constitution at all. The NHS has done more to gather patient feedback, such as through the Friends and Family Test, but hospitals have yet to effectively use this to drive performance. The NHS is doing more to embrace the "digital revolution", but two thirds of people remain without access to their electronic medical record
This failure to engage is an indictment on the NHS rather than its patients. Patients want to be more involved in their care. When asked what matters to individuals in their healthcare, over three quarters rank being involved in decisions as one of the most important factors.
Yet these "expert patients" are engaging outside the NHS rather than within it. They are using smart phones to monitor their diet, health and fitness. They are using gyms and nutritionists to live healthier lives. Figures suggest that one in twenty searches via Google is for health-related information. Apps such as Babylon are allowing patients to skype their GP via their smart phone while DrThom helps patients order prescriptions online, to be delivered to their front door.
In many respects the "fully engaged" patient has arrived. Yet progress towards engagement has taken place at the margins of the NHS, rather than being its core business. If the NHS is to deliver the savings it needs, it must find a better way to tap into this human resource.
Amy Finch, Researcher, Reform