1990’s
Labour placed partnership at the center of its proposal, with a
partnership between health and social care
DH 1997 The New NHS: modern, dependable (White Papers)
Establishment of primary care groups
1998 NHS Executive et al, In The Public Interest
Call for a:
 Better treatment and care outcome
 Increasing sense of control leading to improved self esteem
 A more pleasing experience of contact with health care services
 Easier to access and more responsive service
DH 1999 Saving lives: Our Healthier Nation
Primary care groups were given more responsibilities to “improve the
health of, and address health inequality in, the local community” and to improve
the overall health of the population, through partnership working between
sectors with an influence on health
 However no explicit national targets were set at the time to reduce health
inequality
DH 2000 The NHS Plan
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Recognition of the critical role of individuals in their own care, with a shift
also, towards consumer or patient choice
The need to be responsive to patient’s views.
Provide information on the quality of provider services
Clinical choices made in consultation with the patient
Patient choice reflects an increasing emphasis on choice and
consumerism in public cervices while the increasing policy emphasis on
supporting self – care highlights individual responsibility and limits the
role of public services in the maintenance of health and well – being
(Department of Health, 1997 The New NHS saw the initial outlining for
the critical role patients play in their care)
The NHS Plan led to
o (PALS) Patient Advisory Liaison Services – The introduction of
local patient forums and the formation of patient advisory liaison
services, indicate that the public are being consulted
DH 2001 Tackling Health Inequalities
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Report reinforces the broader societal and partnership approach required
to tackle health inequalities
DH 2001 Valuing People
Highlighted the principles of:
 Rights
 Independence
 Choice
 Inclusion
DH 2001 The Expert Patient (White Paper)
Whilst acknowledging that many patients with chronic diseases have a
more in – depth knowledge of the personal management of their particular
condition than the professional, it also conveys the message that patients are
able to be more independent if encouraged to take control of their management
DH 2004 Choosing Health (White Paper)
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Introduced health trainers
Placed a greater emphasis on individual skills for preventing illness
Continue to reduce health inequalities
Improve health through providing practical solutions to a number of
public health concerns
Identified establishing smoke – free workplace and public environments
as a contentious issue. Subsequent legislation was passed
Informed choice: provide credible information for people to make their
own choices about their health
Personalization: tailoring support to the “realities of individual lives, with
services and support personalized sensitively and provided flexibility and
conveniently” in order to be effective in tackling health inequalities
Working together: government should lead, co-ordinate and promote
effective collaborative partnerships across communities with local
government, the NHS etc
While there is widespread support for self – care, recent surveys suggest
that the UK NHS is poor at providing support for self – care, and
individuals require the confidence and knowledge to successfully embark
on self – care, with some demographic groups such as older people
requiring more support than others
DH 2005. (Green Paper on Adult Services) Independence, well –
being and choice
Highlighted the need to support people with long – term conditions to
manage independently
DH 2005 Self – care – A real choice, self – care support – a real option
Benefits of supporting self – care:
 Improved health outcomes
 Better quality of life for those with long – term conditions
 Increased patient satisfaction
 Effective use of healthcare resources
DH 2005 Commissioning a patient led NHS
DH 2005 Independence, well – being and choice
DH 2006 Our Health, Our Care, Our Say
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Focuses on the role of the consumer as being responsible for managing
their own health and choosing between different locations for their
treatment
The self – care agenda focuses on the contribution of patients (and their
carers) to their own health and well being, which has key relevance to the
development of primary and community health services and the role of
health professionals
Stressed the support role of the NHS
Approaches to developing community based services
Supporting people with chronic health problems
Self - care
Service re - organization
Pressures for change:
o Demographic – an aging population
o Epidemiological – a change from infectious diseases to chronic
ones
o Changing relationships between healthcare professionals and
patients
o Social factors
o Inequalities of health
o Widening gap between demand and resources
Wider emphasis on choice in public services that aims to meet individual
needs with:
o More responsive services
o Challenging the power of professionals
o Drive quality improvements
o Improve equity
This:
o Gives patients more control
o Raises important questions about the way healthcare is accessed,
delivered and experienced
A survey in May 2006 found that only 30% of patients recall being offered
a choice of hospital for their first outpatient appointment
DH 2008 Darzi Report: In the Public Interest
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Need for people to be able to exercise choice
Agreeing on goals
Choosing services
And educating patients on how and where to access these services
 In England, the emphasis is on consumerism and the use of choice as a
driver for improving quality and efficiency alongside other suppliers
develops to create contestability
 In England, patient choice is based on the belief that giving patients
appropriate information on service providers will achieve greater
responsiveness to patient needs, increase technical and allocative
efficiency and enhance quality of services and improve equity
o Funding follows the patient
o NHS direct
o Walk – in centres
 Developing specialist nurse roles and enhancing the skills of generalist
nurses to focus systematically on particular groups of patients (including
the development of community matron type roles) have been shown to be
effective approaches to supporting people with long – term conditions
 Arnstein’s (1969) Ladder describes power relationships between users
and organizations. It provides a useful framework to examine factors that
contribute to or inhibit the development of meaningful partnerships
between users and professionals