The NHS should make the most of responsible citizens

The NHS wastes about 8,666 hours per person every year.

Of those hours a person with a long term condition probably spends 100 with care professionals. For most of us it is much less.

‘In no way can the NHS claim to have drawn on the patient as a considerable resource’

While self-care, using services responsibly and adopting healthy lifestyles are all things we would like to see, in no way can the NHS – or public services more broadly – claim to have systematically drawn on the patient as a considerable resource.

Responsibility revolution

Our report NHS@75 identified two key things.

First, providers of healthcare have a long way to go to become more adaptable.

‘Healthcare providers have a long way to go to become more adaptable’

Second, patients themselves need to become more responsible. This requires a concerted change in the way the NHS interacts with patients.

We think there are five key things that the NHS could do to start a revolution of responsibility. They are:

• Switch the default to self-care. The expectation should be that a patient comes for a consultation having reviewed their results and their care plan. Clearly some patients will not be able to do this, but it should be the norm.
• Use IT to enable self-service. We could take a leaf out of leading local councils’ books where self-service is normal through the use of online services. This not only creates efficiencies, but also opens up things like planning and reporting. This probably needs a change in the attitudes of some clinicians. Research commissioned by PwC and conducted by the Economist Intelligence Unit found that 42 per cent of clinicians worry mobile health solutions might make patients “too independent”.
• Share the problem. The NHS should move from consulting on a solution to engaging the public in the problem and designing the solution. Successful co-production has shown how innovative, radical and parsimonious the public can be, leading to eliminating unneeded follow up appointments or investing in epilepsy nurses in place of new medication, for example. 
• Feedback, feedback, feedback. At every opportunity offer the public feedback on using the service in an alternative way. Over time their use will change and, with a million consultations working in general practice every day, the potential for changing health seeking behaviour is enormous.
• Focus on prevention. The transition to prevention must be made a reality, with an emphasis on general wellbeing and public health. This requires a change in the way the public and the NHS interact, incentivising earlier and altered contact points. Evidence suggests paying providers on a capitated basis drives this kind of change.

Responsible use of the NHS is not about rationing but recognising that the health service is a great institution set up for the benefit of all. As one delegate at an NHS@75 roundtable said: “The NHS – paid for us by us.”

Janet Dawson and Tim Wilson are healthcare lead partners at PwC