Self service

"THE National Health Service is a great national institution. The principles it was founded on are as important now as they were then: free at the point of use and available to everyone based on need, not ability to pay.”

I did not think that up. It is introduction to the new White Paper on the NHS, Equity and Excellence, Liberating the NHS. I feel passionately about the NHS, as do many other people.

We have achieved something in this country of which we should be justly proud and many other countries envy. Everyone contributes and everyone uses it. It is something which binds us together as a community in an increasingly individualistic and self-centred age. It is popular and it works. It is not dominated by a private sector, as education is, where many people see public provision as second best. So we have got to be very careful before we start trying to change it.

It is also highly efficient. The Government can control the finances very tightly so, contrary to public belief, there is not massive waste. The US spends a far greater proportion of its wealth on health than we do, with very unequal outcomes. Once private providers are allowed to dominate, as in the US, it is very difficult to introduce a universal scheme, since the vested interests are very strong. Recent events there have shown this. So we should cherish and strengthen the NHS.

But that does not mean it should not be improved, and we should constantly think of ways to make it work better, particularly to reduce health inequalities. The present proposals about GP commissioning which The Northern Echo has been considering recently, are in many ways a continuation of what the Labour government started.

My big concern is that the NHS, as a public body, should be accountable, and should involve people. I have recently done some research with Doctor Stephen MacDonald, of Sunderland University, into the effectiveness of public involvement in Easington, the area where I live.

Practice Based Commissioning in Easington was initiated by the old Easington Primary Care Trust (PCT), now merged into the Durham PCT. Part of the process was involving the patients and the public through a body known as the Monitoring and Advisory Board (MAB). What I was trying to find out was how effective this process was.

The fact that we now live longer has changed what the NHS does. When it was established it had to deal with epidemics. The emphasis now is more on caring for people with longterm conditions and encouraging people to live healthier lives to reduce the risk of becoming ill. More facilities need to be available in the community and there have to be programmes to care for the long-term sick and help people manage their conditions.

Of great concern to many of us, too, is the fact that, despite 60 years of the NHS, and excellent hospitals, health inequalities persist.

People die up to ten years sooner in parts of the North-East compared to the prosperous South.

Medical opinion seems to be almost universally agreed that better programmes of health promotion, disease prevention and the management of long-term conditions would not only reduce the number of people having to go to hospital, but also reduce these health inequalities.

The Easington GP cluster has already started a programme of Chronic Obstructive Pulmonary Disease (COPD) monitoring to alert people to the need for treatment for breathingrelated conditions. This reduces the need for hospital admissions. There has been a successful programme to treat people for diabetes in Bishop Auckland locally by GPs and a largescale programme in Northamptonshire to reduce hospital admissions for back pain by providing physiotherapy locally. These are all the result of GP-led initiatives.

This is where public and patient involvement comes in. What our research found was that the volunteers were not very interested in the technical aspects of commissioning whereby GPs decide how many different kinds of treatment to provide for in hospitals. What they were very keen on were programmes to support patients with long-term conditions, such as stroke and diabetes.

They were also enthusiastic about programmes to promote healthy lifestyles, such as smoking cessation and healthy eating. The best way of making headway here is not preaching or poster campaigns, but what is known as social marketing. This means a group of volunteers working with people who want to change their behaviour by supporting and encouraging them. The results show it seems to work.

I was very impressed by the Blackhall Health Forum. This group worked with the GP practice and the local parish council to use a small budget to promote all sorts of initiatives which would encourage health.

THEY leafleted a village and provided broth to encourage elderly people to come and have their flu injections, and encouraged various youth groups to do outdoor activities.

One of their most successful was installing low-level lights in the homes of the elderly to reduce falls. All this cost the PCT money, but the benefits in terms of promoting health and reducing hospital admissions are substantial.

It was run by volunteers, but they need support and resources. I am disappointed to learn that the PCT is stopping the funding next year.

Hopefully, some other body will continue the support under the new arrangements.

So, this is what successful public involvement is about, but two points stand out. Volunteers need support from NHS professionals.

But the savings on promoting health and reducing the need for hospital admissions will be substantial. One of the proposals in the White Paper is to transfer public health to local authorities, so it is unclear whether the activities I have described will still lie with GPs to fund or the local authority.

Whatever happens, we should remember the NHS belongs to all of us, and it should encourage people to be involved as much as possible.

■ For a copy of the report The Role of Patient Involvement in Practice Based Commissioning within Easington NHS Services, contact David Taylor-Gooby on David.Taylorgooby@btinternet.com) ■ David Taylor-Gooby is vice-chairman of the Easington MAB