Guardian Healthcare Network’s expert panel discussed the barriers and experiences of trying to include patients’ opinions in their care – here’s a debrief
- What problems does the idea of choice create?
Jonathan Hearsey, extended scope practitioner, Sussex MSK Partnership:The confusion regarding what choice means in some clinical situations could break the valuable relationship between patient and clinician and, ultimately, [possibly affect] outcomes. In musculoskeletal medicine, it is common for patients with non-specific mechanical back pain to attempt to exercise choice in order to demand needless imaging or clinical tests like MRI scans or blood tests. In some instances it is perfectly correct to order tests but in the majority of cases MRI scans are unnecessary and lead to patient concern about normal changes in discs or joints.
Natalie Koussa, programme lead, National Voices’ Wellbeing Our Way programme: People need to understand that patient control isn’t just about simple offers such Choose and Book for elective procedures, but around people taking control of the decisions which enable them to live in the ways which matter to them. End of life is an area in which we know that the vast majority of people would prefer to die at home, and yet are unable to. Charity Compassion in Dying found that 75% of service users who completed a written statement about their wishes for their end-of-life care – such as an advance decision or advance statement – stated they felt happier about the future or had greater peace of mind.
- What are the main obstacles to patient choice?
Jacob Lant, head of policy and partnerships at patient advocacy organisation Healthwatch England: I think one of reasons choice doesn’t always work as intended is because of simplistic examples of villages with only a single GP practice with just one GP. The conversation often focuses on the fact the patient has no choice of which GP to go to in that situation. But there are lots of constructive conversations that could be had about how that single surgery offers a range of services. We shouldn’t let local variation in services prevent conversations about how choice can work.
Sean O’Sullivan, head of policy, Royal College of Midwives: I was struck in the Mid Staffs report by the weakness of the then patient organisations. This feels like a perennial issue since the demise of community health councils. For maternity services there are maternity services liaison committees, which can be effective and dynamic vehicles for user involvement where they work well, but this is not the case everywhere.
Frontline midwives have the information necessary to inform patients of their options, but they lack time. There are so many issues that midwives are expected to discuss with women at antenatal booking appointments – smoking, diet, nutrition, breastfeeding, FGM, domestic violence, immunisation etc – but the time available is finite and it can be hard to do more than what feels like a tick-box exercise rather than a genuine discussion.
Read the full debrief here