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Start with the patient, not the system

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Patient care should come first Patient care should come first

On 5 November 2012, the government set out proposals to strengthen the NHS Constitution. As chief executive of the Health Foundation and a member of the Future Forum Working Group on the NHS Constitution, I was pleased ministers had accepted all our recommendations to strengthen patient involvement.

Recent media headlines have focused on proposed changes to the constitution to address concerns about the Liverpool Care Pathway and the involvement of patients and their families in decisions about care at the end of life. This is vital, but we need more than this. We need an NHS that puts patients first throughout their lives.

Actively involving patients in decisions about treatment and supporting them to manage their care more effectively is central to delivering high quality care. Evidence shows helping people to play a more active role can lead to better clinical outcomes and greater satisfaction with care.

However, there is still a way to go to ensure the vision of a fully engaged patient becomes the norm. Genuine patient involvement requires a fundamental cultural shift in the relationship between patients and services. To have the confidence, knowledge, skills and behaviours to successfully manage their health and healthcare, patients need health professionals, services and systems that invite and enable a more active role.

The Health Foundation is exploring ways to ensure patients are equipped and supported to play an active role in their own healthcare, including testing how to embed shared decision-making and supported self-management.

In my experience, there is real energy and enthusiasm among staff, patient and carer representatives for a reinvigorated constitution that starts with the patient, not the system. By caring about the individual, their values and the health outcomes they want, I am confident we will have a better constitution in future. All that will then be left to do is for the DH and the NHS to dramatically increase awareness of it and ensure its aspirations are met. The journey has begun.

Stephen Thornton, chief executive, The Health Foundation

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