My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Meeting the mandate and improving health literacy

Filed Under (National Commissioning Board, Patient involvement, Self Management) by Paul on 17-12-2012

The Secretary of State’s mandate for the National Commissioning Board lays clear responsibilities on it to improve the capacity of patients to self manage. In fact the mandate says that the board must become dramatically better at involving patients,

“2.5 The NHS commissioning board’s objective is to ensure the NHS becomes dramatically better at involving patients and their carers and empowering them to manage and make decisions about their own healthcare and treatment. For all the hours that most people spend with a doctor or nurse, they spend thousands more looking after themselves or a loved one.”

Readers will know that I have been working with a number of organisations to improve the ways in which the NHS can help patients to better self-manage.

The mandate is NOT saying to patients that they are on their own. But, as it points out, patients and their carers spend many thousands of hours caring for themselves in their homes. and it is the job of the NHS to work with patients to improve the way in which they do that. It’s an ugly word, but this is much better called “co-production” of healthcare.

This sounds simple, but in fact it involves an enormous change to the way in which the NHS works. For example for the NHS to work with patients to improve self-care it needs to look very carefully at all of the interactions between itself and patients. We need to carefully review these to see if they add to the power of patients or diminish it.

Because the NHS can diminish the capacity of people to self-manage their healthcare.

Imagine, for example, the doctor says he wants you to try something a bit different in your self-care and hands you a letter with the details. You get home but can’t understand the letter. You’ve been told it’s very important, but you don’t know what you have to do. That’s very worrying for you, but it happens all the time.

A few weeks ago an important study was carried out by Professor Gill Rowlands from South Bank University. The research suggested that health information provided by the NHS and pharmaceutical companies is too complex for most patients and their carers. It makes the point that failure to provide simple instructions is putting people’s health at risk. It points out that people struggle to self-manage illnesses such as diabetes, coronary heart disease and asthma.

The study is the first to examine levels of health literacy across England. It was conducted by an international team of experts in medicine, public safety and education who assessed a wide range of literature – including health screening posters, letters from GPs, and labels on medicines.

Materials were rated for difficulty and compared to the literacy and numeracy skills of the working age population of England. The research concluded that 43% of men and women are unable to understand and use everyday health literature, and the figure rises to 61% when you include mathematical skills.

This is a serious resource problem for the NHS. The NHS only works because the 15 million people with long term conditions try to self-manage to the best of their ability. But their ability to carry out this vital role is diminished by the way in which the NHS fails to communicate with them. .

Gill Rowlands used to be a GP in South London and points out in support of her study that when she was a GP,

“Patients made appointments with me simply to ask me to read and explain letters they have received from hospital. There were times when I myself struggled to understand what the hospital was trying to say”

I have checked this with a couple of practising GPs and they confirm that this happens – not every day – but frequently. This is probably one of the clearest examples of one part of the NHS wasting another part’s resources. Any other industry would find it a bit weird that we employ one expensive professional to interpret what another expensive professional is trying to communicate to the taxpayer who employing them.

The NHS cannot afford this wasting of time for both doctors and patients


One Response to “Meeting the mandate and improving health literacy”

  1. Paul, this sounds like an interesting study – and as interesting for GPs and CCGs as for NHS CB.
    I haven’t been able to locate it: can you tell us where it has been published?

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