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Patient involvement in the NHS

Nicola Russell, Director of Services, MS Trust

Open Door - February 2005 page 4

I suspect that all of us living in the UK have long since become completely confused by the organisational structure of the NHS, and how as an individual one might participate in developing effective services. This topic is particularly relevant if one happens to have a long-term condition such as MS. Why is it so difficult to keep abreast of the structure and thus how to effectively interact with the NHS?

There are possibly two reasons for this:

  1. The NHS is a huge organisation. It is the largest employer in the whole of Europe, and it is second only to the Indian railways and the Chinese army.
  2. Because the NHS is such an important element of life in the UK, ever since its inception in 1948, politicians have seen it as a political tool, and thus different parties, and even the same party make endless changes to maximise the political credibility that comes from the NHS.

For all of us good health is probably the number one value, although we may not realise its value until it is taken away. It is therefore fundamental that we all work to maintain an effective NHS that is free at the point of delivery.

What are the most recent themes of the current government for the NHS?

National standards:

these national standards should set the foundations for a common high quality of health care throughout England, and by example across the UK. Since devolution Scotland and Wales have a degree of independence in health policy. The standards should also define the aspirations for the NHS both for the public and the staff that work within the system. This new focus on quality rather than quantity should be of particular relevance to people with MS. Specific examples of standards for MS are the NICE Clinical Guidelines for the Management of MS, and the forthcoming National Service Framework for Long-term Conditions expected in the spring of 2005.

Local action:

it is recognised that there is local variation in health care needs and thus that the Department of Health cannot be controlling everything from the centre.

The responsibility for assessing and reporting on the performance of Primary Care Trusts (PCTs), Hospital Trusts, Social Services and regulated care services will now rest with the independent Healthcare Commission and the independent Commission for Social Care Inspection (CSCI). They will act in a way similar to the schools inspectorate. The Department of Health launched these new regulatory bodies in July 2004 in a publication entitled National Standards, Local Action and the priorities clearly specified in this document were:

  • Health and well-being of the population
  • Long-term conditions
  • Access to services
  • Patient / user experiences

As an individual you may need to interact with the current NHS management structure in connection with your clinical needs. Listed below are some of the key bodies:

  • All NHS Trusts in the UK, whether primary care or secondary care, now have a Patient Advice and Liaison Service (PALS). These should be the first port of call should you have a problem with any of the services in your area. Details of the PALS contact can be found in either printed literature from the NHS Trust or on their website. Any communication made to a PALS body is automatically copied to senior management and has to be dealt with within a specified timeframe.
  • All NHS Trusts now have a Patients Forum to advise them on their development and management. Patient Forums are groups of ordinary members of the public who are chosen to provide direct user advice to the Trust management. Do you have the time or skills to sit on a Patient Forum body?
  • The Independent Conciliation and Arbitration Service (ICAS) is the body that reviews complaints from people about the NHS. Details can be found in printed documentation from the NHS Trust or their website.

This government is certainly spending more on the NHS. In the last seven years the average spend per annum per head of population has gone up from £680 to £1,345. We all need to help ensure that the government is spending our taxes wisely, and that we are getting the services we deserve.

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