BMJ 2014;348:g1942 doi: 10.1136/bmj.g1942 (Published 5 March 2014)

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NEWS Put patient power at heart of future NHS, says commission on whole person care Zosia Kmietowicz BMJ

Patients should be given more help to manage their own conditions, play an active role in shaping their local services, and be enabled to live at home safely, with the NHS and social care services collaborating more closely and sharing budgets, a report on the future of the NHS has recommended. John Oldham, chairman of the Independent Commission on Whole Person Care, said that the recommendations in his report “focus on helping people stay well, manage their illnesses and promote their independence.”

A GP and former national director at the Department of Health for England, Oldham said in the introduction to the report that “a new radical approach is needed for the next parliament to put the health and care system back on track.”1 The report was commissioned by Labour’s shadow health secretary, Andy Burnham, last May.

Although Oldham did not say that the current structure of the NHS was right, he believes that the NHS would not survive further structural change. What was needed, he said, was a focus on relationships between people who work in health and social care, to enable them to deliver holistic care “with the person, not the institution, at the centre.” He wrote, “What people with multiple conditions and complex needs say is: ‘I want you to care for the whole of me, and act as one team.’ This is what we require commissioners and providers of health and social care to achieve: the needs of one person addressed by people acting as one team, from organisations behaving as one system.”

A key recommendation of the report is greater involvement of patients in planning their own care, together with a personal care coordinator to advocate on their behalf and support for families and carers, rather than unnecessary hospital admissions and many visits from different professionals, each dealing with a separate issue.

The report said that patients’ organisations needed to play a fuller role in meeting the future health needs of the population and that the current payment system, which incentivises episodes of care and admission to hospital, needed to change to one based on capitation payments for a year of care, which would enable more care at home. More research was required into management of people with complex needs, said the report. Such care made up the bulk of NHS and social care activity, it said.

Oldham also recommended working with the royal colleges on new merit awards that would incentivise doctors to provide For personal use only: See rights and reprints http://www.bmj.com/permissions

coordinated, whole person care rather than rewarding them for treating patients “as if they were individual body parts.” Commenting on the report in the Daily Telegraph, the Labour Party’s leader, Ed Miliband, said that the NHS had failed to adapt to the reality of the multiple health and social needs of today’s patient population.2

“The challenges of today demand we put more power in the hands of patients. And, far from using up scarce resources, these changes are essential if the NHS is to survive and improve in an era of tough fiscal restraint,” he wrote.

“Too much money is wasted because services are fragmented,” said Miliband. More needed to be done to enable older patients who were stuck in hospital to return home, together with a focus on prevention, such as fitting £50 (€60; $80) grab rails in people’s homes to avoid treating a broken hip at a cost to the NHS of £14 000. Miliband said that Labour was looking at how it could implement the recommendations.

Richard Thompson, president of the Royal College of Physicians, welcomed the report, saying it was right that “hospitals should no longer be seen as bricks and mortar but instead as a skill base that can be deployed where it best meets patients’ needs.” He added, “Delivering this holistic approach to health and care will require a more ‘generalist’ workforce. We need more doctors skilled in the diagnosis and management of older patients with multiple complex conditions.”

Richard Humphries, assistant director of policy at the think tank the King’s Fund, said, “It is right to propose a new model of care with services coordinated around the needs of individuals, a stronger emphasis on prevention, and more care provided outside hospital. “The next government will need to respond to significant financial and service pressures in the NHS and social care. Today’s report puts flesh on the bones of how Labour could approach this challenge if elected but suggests some changes which differ from the party’s current position—there is clearly a good deal of detail to be worked through before definitive policy proposals emerge ahead of the general election.” 1 2

One person one team one system: report of the Independent Commission on Whole Person Care for the Labour Party. Feb 2014. www.yourbritain.org.uk/agenda-2015/policyreview/whole-person-care. Miliband E. How I would make our health system fit for the 21st century. Daily Telegraph 2014 Mar 4:10.

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BMJ 2014;348:g1942 doi: 10.1136/bmj.g1942 (Published 5 March 2014)

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Put patient power at heart of future NHS, says commission on whole person care.

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