International Journal of Applied Health Studies (ISSN: 1742-5263) Volume 1 Issue 3
Dr Lovemore Nyatanga
Faculty of Education, Health & Science, University of Derby
Senior Lecturer, University of Wolverhampton
In 2000 the National Health Service (NHS) Plan cited patient empowerment as one of its key modernisation agenda items. For instance, chapter ten of the NHS Plan clearly states patients are the most important people within the health service (Department of Health 2000). Within the context of the NHS Plan, communication and information exchange are considered critical mechanisms for patient empowerment. One document produced specifically to support the ideals of patient empowerment is “Shifting the Balance of Power” (Department of Health 2002). This document explains that under section eleven of the “Health and Social Care Act” the empowerment of patient, staff and the public will require major cultural and attitudinal change. In order to effect this cultural and attitudinal change, a duty has been placed upon the NHS Trusts, Primary Care Trusts (PCT) and Strategic Health Authorities (StHAs) to set up appropriate mechanisms for consulting and involving patients and the public in all matters involving the planning and delivery of services. Patients are expected to be represented on such forums as National Trusts Boards, Modernisation Boards. There will also be Expert Patient Programmes (EPP) as well as Patient Advisory and liaison Service (PALS). These seem far reaching changes capable of truly empowering patients and any service user. For non-patients or general service users, attention to the rights and responsibilities of citizens to participate and promote their own health has been sustained within the 2004 NHS Improvement Plan. Within this context people are put at the forefront of service provision in particular public service (Department of Health 2004). An extract from the NHS Improvement Plan reads thus, “..So that there is more choice, more personalised care, real empowerment of people to improve their health – a fundamental change in our relationships with patients and the public. In other words, we need to move from a service that does things to and for patients to one that is patient led where the service works with patients to support them with their health needs”, (DoH 2004).
Hot on the heels of the NHS Improvement Plan has been the related Government vision of:
The document is crystal clear about what patient-led services actually look like from a patients point of view and does indeed conjure up a rather Utopian NHS provision. It is rather utopian in the sense that the empowerment theme will run through care delivery practice. Patients will be respected, listened to, valued and will be seen as the best judge of what is needed for them as individuals, (DoH 2004).
The fact that empowerment is a fundamental part of the new health policy has been made crystal clear. Some policy analysts, however, would argue that The NHS reforms are overly focused on the wealth of the NHS rather than empowerment and the health of the population. The policy analysts may be sceptical because it is not clear how this new empowerment philosophy will necessarily change existing attitudes. The conventional attitude has tended to demand conformity from patients. Patients that question the conformity convention tend to be labelled as unpopular, (Johnson and Webb 1995). This makes it difficult if not paradoxical to see how the Patient-led NHS view of empowerment can be realised. The view suggests that care will be delivered not only with full agreement with the patient, but also with due consideration of their own knowledge and experience of their condition. For this seeming rhetoric to become reality then the conventional attitudes have to change and communication needs to be truly reciprocal (without denying professional expertise) in order to achieve true empowerment and utopian NHS provision. But there are certain other discrepancies within the empowerment approach. For example, the issue of compliance is being promoted alongside empowerment. Empowerment and compliance are arguably diametrically opposed to each other. Empowerment as advocated through health policy has a sense of autonomy and ownership. On the other hand compliance is about obeying or adhering to a set of given rules or treatment regimes often decided by experts. Yet as rapidly as empowerment has gained common parlance within health care, patient compliance has become an increasingly familiar term that is casually thrown into health discourse as the former. The act of compliance is normally associated with the taking of medication or complying with a prescribed course of treatment. Most people who are familiar with the NHS will also be familiar with the concept of following to the letter prescriptions of such treatment as antibiotics. It is a common phenomenon for people to wish to discontinue taking their medication and yet discontinuing without medical say so is the essential definition of non-compliance (Marinker 2000, Puri 2000). By implication, non-complying patients are deemed to waste NHS resources so ways of maximising compliance must be sought for these patients. Compliance and empowerment will be discussed again later, but attention will now turn to the seeming paradox of patient empowerment.