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Government policy 2009 - why clinicians need to take the lead

Nicola Russell
Director of Services, MS Trust

Way Ahead 2009;13(2):2-3

'Life's not just being alive, but being well'
Marcus Valerius Martialis AD c40 - c104

Houses of Parliament

Last year was the 60th anniversary of the NHS and it was during 2008 that the initial announcements were made about an NHS constitution. Now it has been formally launched.

The constitution makes pledges to patients and to staff and is a first in the history of the NHS. Its aim is to set out in one place what everyone, staff and patients, can expect from the NHS.

The seven principles of the constitution are:

  1. The NHS provides a comprehensive service available to all
  2. Access to NHS services is based on clinical need, not an individual's ability to pay
  3. The NHS aspires to high standards of excellence and professionalism
  4. NHS services must reflect the needs and preferences of patients, their families and carers
  5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
  6. The NHS is committed to providing best value for taxpayers' money and the most effective and fair use of finite resources
  7. The NHS is accountable to the public, communities and patients that it serves.

The constitution also lays out six core values:

  • respect and dignity;
  • commitment to quality of care;
  • compassion;
  • improving lives;
  • working together for patients;
  • everyone counts.

What does the constitution mean for a health professional working in the NHS? In essence, as well as bringing together existing rights and principles, it makes some specific pledges to staff:

  • to provide all staff with clear roles and responsibilities and to reward teams and individuals who make a difference for patients, their families, or carers;
  • to provide all staff with personal development and training, and line management support;
  • to provide support for staff to maintain their own health, wellbeing and safety;
  • to engage staff in decisions that affect them and the services they provide. All staff will be empowered to put forward ways to deliver better and safer services.

I know that as many of you read these words you will be thinking 'I have heard it all before!' I would urge you however, to recognise that health professionals have a real opportunity at this time, an opportunity that may not be repeated. For many years managers have held a financially dominated powerbase where quality has been at risk, often coming in a poor second to centrally driven targets.

Lord Darzi's 'High Quality Care for All'1 sets out a framework that shifts that balance of power toward quality and the role of the clinicians. After far too long, Lord Darzi has reminded us all that it is quality that is important, not just numbers.

Quality is especially important for people living with MS. Their aspirations for their lives will vary between individuals and will also vary depending on the severity of their condition at any point in time. Their need for informed health professionals is vital.

Quality is also the key feature in a further DH document entitled 'Supporting people with Long Term Conditions - Commissioning Personalised Care Planning'.2 This document acknowledges that the NHS needs to be more empowering and less paternalistic and encourages commissioners to be aware of the quality aspects of the services they are funding. In addition this document reminds all employees that embedded in the Operating Framework for the NHS 2009/10 is the statement:

'Over the next two years to ensure that those living with a long-term condition receive a high quality service and help to manage their condition, everyone with a long-term condition should be offered a personalised care plan'.3

Commissioners will therefore have to work with providers to generate care plans for people with long-term conditions, and consider how information from care plans can be aggregated to feed into commissioning decisions, and commission appropriate services.

Patient reported outcome measures (PROMs) are one of the current buzzwords of NHS management. For all health professionals working with people with MS this should be a real boost. We know that people with MS rank good healthcare support very highly. Make sure you know how your patients value your service and that the evidence fits with the wider objectives. This will ensure access to funding.

Many of you will be personally responsible for coordinating or contributing to the personal care plan for an individual with MS. Make sure you know where gaps exist in services available to deliver the personal care plans for your caseload. These gaps should be addressed and discussed with your manager, and with commissioners.

For the last decade clinicians have played second fiddle to managers; now is the time to assert yourself as a clinician, to know your caseload needs and how your service fits with those needs, and to articulate this to the commissioners within your locality. On the other side of the coin, for health professionals to provide quality care to people with MS they too need to be well informed and supported, and this is where the constitution can be helpful. If you feel you need further development, take your request to your manager aligning the need to the competency requirement for your post.

At the MS Trust we work to provide education and developmental support for health professionals working with people with MS. If you are having difficulties contact us and we will see if we can help. Two documents that may provide guidance are: 'Competencies for MS specialist services'4 and an 'MS commissioning pathway'.5

For further information contact Nicola Russell or Vicki Matthews at the MS Trust

References

  1. Darzi A.
    High quality care for all: NHS Next Stage Review final report.
    London: DH; 2008.
  2. Department of Health.
    Supporting people with long term conditions - commissioning personalised care planning.
    London: DH; 2009.
  3. Department of Health.
    The NHS in England: The operating framework for 2009/10.
    London: DH; 2008.
  4. Multiple Sclerosis Trust, Royal College of Nursing, UK MS Specialist Nurse Association.
    Competencies for MS Specialist services.
    Letchworth Garden City: MS Trust; 2009.
  5. Multiple Sclerosis Trust.
    MS commissioning pathway.
    [cited 2009; February 6]
    Available from: URL: MS Trust commissioning pathway/