Watching TV a few days ago I saw a cosmologist talking about the possibility of an infinite number of parallel universes. Theoretically, he explained, there might be one that was almost like our own universe, but not exactly. It does, indeed, sometimes feel like we have gone though a portal into a different world. The idea of things being mostly the same but actually being subtly different seems to resonate with how we might describe the NHS in this Covid-tinged era.
In some ways, the NHS is the same as ever: dedicated staff with limited resources doing their best to look after us whatever our health issues, but in other ways, everything is different. Pressures on emergency care, elective surgery and community health services remain extraordinarily high as clinicians try to catch up on alarming backlogs. Meanwhile, the pandemic, with its consequences for mental and physical health, has not gone away. New ways of working have been introduced quickly in order to keep services running. But there has not always been time to plan for change nor the means to evaluate the impact of doing things differently.
So this era of change invites us to look afresh what patients can expect from the NHS. I am not suggesting a resurrected old-style Patients’ Charter. Targets have their place, but they often don’t affect organisational culture positively. Instead, it’s a conversation that we need. Since the pandemic has led to rapid changes, we now have an opportunity to think together about what works best for patients, as well as being manageable for healthcare professionals at a time of unprecedented challenge.
So what are the priorities for joint work between patients, clinicians and managers? There are so many, but in this short Blog, I can only mention a few.
First, we need to discuss an optimum balance between face-to-face and phone or video consultations. Patients and staff often agree on the benefits of virtual consultations, but the virtual environment doesn’t work for everyone or in in all circumstances. Access to technology, health literacy and many other factors make a difference to what works and for whom. For example, the needs of children and young people are different to those of adults across the whole age spectrum. Some patients won’t seek help at all if they feel they cannot be seen in person; and it may be different when patients already know the doctor and when they don’t.
Second, like doctors, patients worry that the virtual world will not be conducive to delivering the right sort of training for the doctors of tomorrow. Patients are concerned for future doctors as well as for themselves and their fellow patients.
Third, during the peak of the pandemic some means of engaging with patients and carers were put on hold. Delivering messages to patients may, understandably, have taken precedence over involving people in discussions about the future of the NHS. But unless patients and the public are engaged in sharing their experiences, championing good practice and advocating for fairer and more equal access to services, opportunities for positive change may be lost.
To put it simply, shared decision making has to begin well before there are any decisions for individual patients to make. And the time for this is now.
© 2021 Academy of Medical Royal Colleges.