Website of the Department of Health

Introduction

10.1 Patients are the most important people in the health service. It doesn't always appear that way. Too many patients feel talked at, rather than listened to. This has to change. NHS care has to be shaped around the convenience and concerns of patients. To bring this about, patients must have more say in their own treatment and more influence over the way the NHS works. The reforms outlined here give patients new rights and new roles within the health service.

Information to empower patients

10.2 Patients will have far greater information about how they can look after their own health and about their local health services. The 'Expert Patient' Programme will be extended. The National Institute for Clinical Excellence will publish patientfriendly versions of all its clinical guidelines. Patients will be helped to navigate the maze of health information through the development of NHS Direct online, Digital TV and NHS Direct information points in key public places. This will include information on local NHS dentistry.

10.3 Patients will for the first time also have the option of having much greater information about the treatment that is being planned for them. Patients have the right to see their medical records, though in practice much communication between professionals is not available to the patient concerned. Patients often do not know why they are being referred, or what is being said about them. In future, as a result of this NHS Plan:

10.4 These innovations will give the patient a clear explanation of what is happening to them and why. They will provide the patient with a personal record of their contact with the health service.

Strengthening patient choice

10.5 Patient choice will be strengthened. Patients have the right to choose a GP. To make it easier for patients to exercise informed choice, a much wider range of information will be published about each GP practice including: list size; accessibility; and performance against standards in national service frameworks. Figures will also be published on the number of patients each practice removes from their list.

10.6 Patients' choice over hospital treatment will be improved by ensuring that by 2005, every patient will be able to book every hospital appointment and elective admission giving them a choice of a convenient date and time rather than being assigned a time by the hospital.

10.7 The choice GPs are able to exercise on behalf of their patients is also important. Prior to 1991, GPs could refer patients to the hospital of their choice. The introduction of the NHS internal market changed that because GPs who were not 'fundholders' could no longer automatically refer patients outside their local area. Instead the patients' and GPs' choice was second-guessed by the health authority who could withhold approval for an 'extra contractual referral'. Since 1999 the creation of primary care groups and trusts has restored choice of referrals to GPs. GPs collectively now decide where to fund services. Ninety-two per cent of patients say they are given appropriate choice about where their GP refers them for hospital treatment. But in those cases where this does not happen primary care groups will be able to act on published information about patients' views of hospital services by moving service agreements from one hospital to another.

Protection for patients

10.8 Standards of care for patients are often good in the NHS. Sometimes, however, they need to be better. New quality assurance systems are already being introduced in the NHS to raise standards. Now this NHS Plan will introduce new mechanisms to satisfy patients that the care they get is quality assured.

10.9 We will establish a full mandatory reporting scheme for adverse healthcare events. There will be a full single database for analysing and sharing the lessons from incidents and near misses in place from the end of 2001, with the framework in place by the end of this year. This will help clinicians to minimise the risk to their patient and improve the quality and safety of patient care.

10.10 The NHS will also have new rapid and robust mechanisms for dealing with under and poor performance among individual doctors. Following extensive consultation, the Department of Health will now implement the Chief Medical Officer's proposals in Supporting Doctors, Protecting Patients. All doctors employed in or under contract to the NHS will, as a condition of contract, be required to participate in annual appraisal, and clinical audit, from 2001. This will underpin, and provide much of the data to support, the General Medical Council's mandatory five-yearly revalidation process, which is likely to begin in 2002. Subject to Parliament, by April 2001 all doctors working in primary care, whether principals, non-principals or locums, will be required to be on the list of a health authority and be subject to clinical governance arrangements. These will include annual appraisal and mandatory participation in clinical audit.

10.11 A National Clinical Assessment Authority will be established as an arms-length Special Health Authority from April 2001. Its board will be appointed under Nolan principles. Where concern has arisen locally, it will provide a rapid and objective expert assessment of an individual doctor's performance, recommending to the health authority or employing trust educational or other approaches as appropriate. It will mean an end to the current arrangement where doctors can remain suspended for years while concerns or allegations about their practice are resolved.

10.12 The NHS Tribunal will be abolished, and the power to suspend or remove GPs from a health authority's list will be devolved to health authorities, subject to a right of appeal to the Family Health Services Appeals Authority, from 2001. The right of consultants to appeal against disciplinary action direct to the Secretary of State under the 'paragraph 190' arrangements will end, so that responsibility is devolved from the Secretary of State to NHS trusts locally, from 2001.

10.13 The regulation of the clinical professions and individual clinicians also needs to be strengthened. As a minimum, the self regulatory bodies must change so that they:

10.14 Our proposals for new regulatory bodies for nursing, midwifery and health visiting and for professions allied to medicine, on which we will be consulting shortly, meet these tests. They are the minimum tests that must be met by a reformed General Medical Council. But the GMC should also explore introducing a civil burden of proof and making other reforms if it is to genuinely protect patients. Government and Parliament will have to judge whether the reforms proposed by the GMC following its own consultation process will indeed protect patients and restore public and professional confidence.

10.15 There also needs to be formal co-ordination between the health regulatory bodies. For this reason, a UK Council of Health Regulators will be established, including the GMC, the successor bodies to the UKCC for Nursing Midwifery and Health Visiting, and the Council for Professions Supplementary to Medicine, as well as the General Dental Council, the General Optical Council, the Royal Pharmaceutical Society, the General Osteopaths Council and the General Chiropractic Council. In the first instance the new body would help co-ordinate and act as a forum in which common approaches across the professions could be developed for dealing with matters such as complaints against practitioners. Were concerns to remain about the individual self-regulatory bodies, its role could evolve.

10.16 These modernised and more accountable professional regulatory arrangements will work alongside the NHS's own quality assurance arrangements to offer better protection for patients.

A new patient advocacy service

10.17 When patients are concerned that the NHS is not delivering for them they should get their concerns addressed. As a result of this plan:

10.18 Patients need an identifiable person they can turn to if they have a problem or need information while they are using hospital and other NHS services. Usually situated in the main reception areas of hospitals the new patient advocate team will act as a welcoming point for patients and carers and a clearly identifiable information point. Patient advocates will act as an independent facilitator to handle patient and family concerns, with direct access to the chief executive and the power to negotiate immediate solutions. In mental health and learning disability services, the Patient Advocate and Liaison Service team will build on and support current specialist advocacy services.

10.19 Patient advocates will be able to steer patients and families towards the complaints process where necessary. The Patient Advocacy and Liaison Services will take on the roles which community health councils currently fulfil, of supporting complainants. We will work with other organisations, such as Citizens Advice Bureaux, to ensure additional support for people complaining.

Rights of redress

10.20 Patients will have the right to redress when things go wrong. They need to know that problems will be sorted out and put right. As a result of this NHS Plan:

10.21 Patients have the right to complain. Complaints are not always dealt with quickly, with resolution often taking months. The role of the independent convenor has been criticised and the overall complaints procedure is not seen as being independent or transparent. The NHS needs to find a better way of dealing with patients' concerns, preferably before they become official complaints. The NHS also needs to be seen to say sorry where things go wrong, rather than taking a defensive attitude, and to learn from complaints so that the same problems do not recur. The Government is at present evaluating the complaints procedure, taking evidence from a wide range of sources. The Government will act on the outcome of this evaluation and reform the complaints procedure to make it more independent and responsive to patients. Making the complaints procedure less adversarial should result in fewer clinical negligence claims against the NHS. We will look to make further changes to the current system of clinical negligence.

10.22 By 2001 a new NHS Charter will replace the current Patients Charter. It will make clear how people can access NHS services, what the NHS commitment is to patients, and the rights and responsibilities patients have within the NHS.

Patients' views

10.23 In 1974, the then Government tried to give greater prominence to the views of patients by creating community health councils. They attempted to combine three distinct functions: supporting individual patients and complainants; monitoring local hospital and community (but not primary care) services; and providing a citizen's perspective on service changes. It is time to modernise, deepen and broaden the way that patient views are represented within the NHS. As a result of this NHS Plan:

10.24 For the first time financial rewards for trusts will be linked to the results of the annual National Patients Survey, a methodologically robust measure of patients views about local NHS services (see paragraph 6.25).

Scrutiny of the NHS

10.25 Local authorities are an important democratically-elected tier of government. As they modernise they will become more effective channels for the views of local people.

10.26 As a result of this Plan local government will be given the power to scrutinise the NHS locally. Chief executives of NHS organisations will be required to attend the main local authority scrutiny all-party committee at least twice annually if requested. 10.27 The power to refer major planned changes in local NHS services to the Secretary of State will transfer from unelected community health councils to the all-party scrutiny committees of elected local authorities. The council scrutiny committees - which must meet in public - will be able to refer contested major service reconfigurations to the new Independent Reconfiguration Panel (see paragraph 6.50). Clear criteria will be set out on the definition of a major service change that can appropriately be referred for consideration nationally.

Patients represented throughout the NHS

10.28 Patients and citizens have had too little influence at every level of the NHS. As a result of this Plan, each health authority area will be required to establish an independent local advisory forum chosen from residents of the area, to provide a sounding board for determining health priorities and policies, including the Health Improvement Programme.

10.29 There will be major increases in the citizen and lay membership of all the professional regulatory bodies, including the General Medical Council.

10.30 One third of the members of the new NHS Modernisation Board will be citizen and patient representatives.

10.31 Citizens and patient representatives will make up one third of the new Independent Reconfiguration Panel on contested major service changes.

10.32 The Commission for Health Improvement will include citizen and lay inspectors on all its review teams.

10.33 Older people will be represented on Commission for Health Improvement inspection teams to ensure older people's dignity and interests are fully taken into account in all inspections.

10.34 A new Citizens Council will be established to advise the National Institute for Clinical Excellence on its clinical assessments. It will complement the work of the NICE Partners Council which provides a forum for the health service and industry to comment on the work of NICE.

Conclusion

10.35 These are far reaching and fundamental reforms which will bring patients and citizens into decision-making at every level. They represent a significant change from 1948. There will be changes to existing structures for representing patients and entirely new ones. A tier of elected government in England other than in Whitehall will be involved in scrutinising the local NHS. This is a package of radical reform. It will enhance and encourage the involvement of citizens in redesigning the health service from the patient's point of view. As a result community health councils will be abolished and funding redirected to help fund the new Patient Advocate and Liaison Service and the other new citizens empowerment mechanisms set out above.