Enhancing patient power in the NHS has been a long-cherished ambition. Successive governments have talked the talk but have not walked the walk when it comes to fundamentally changing the balance of power in the NHS. Today, patient power remains marginal rather than mainstream: the decisions that impact most on patients are still taken by clinicians, commissioners and policymakers in Whitehall.


This important report calls on the current government to change that. It rightly says that existing empowerment initiatives, notably the ‘choice’ and ‘voice’ agendas, are important if hospitals and GP practices are to become more responsive to their users. But it goes one stage further in arguing that, in a world where most healthcare demand comes from patients with long-term conditions, the focus must shift to creating health rather than responding to ill health. That means giving people the information, power and control to stay healthy, manage their conditions and choose their treatments. It identifies the new, empowering models of care that are emerging across the country, which bring about a fundamental shift of power from providers to patients. These models include social prescribing, the integration of care around the patient, peer support and care networks, asset-based community development, and technology-enabled care plans.

Today these innovative models are available only to a minority of patients. In the next few years, the objective should be to make them available to all of those who could benefit from them. As the report argues, there needs to be an acceleration of the process of giving patients personal budgets so that more of the money is put directly into their hands. That way NHS resources can be better used to design proactive care rather than it being spent on crisis management. New forms of technology – such as telehealth and telecare – have the potential to put real power literally into the hands of patients. Leaders at every level in the NHS should be prioritising how to harness this wave of democratic technological innovation not only to improve care but to change how healthcare works.

For decades, policymakers have focused on structural and organisational changes as the primary means of driving improvement. Other levers – competition, transparency, incentives – have also been deployed with some success. But a key lever of change has been missed: patient power. The opportunity now exists to make patients a key driver of change in the NHS. That will require, as this report outlines, an unprecedented shift in the culture, attitudes and skillset in NHS institutions and workforces. But if the NHS can rise to that challenge then it will help put it on a sustainable path. There is no more important task in the years ahead than for the NHS to stop treating patients as passive bystanders and instead to enlist them as active agents of change.

Alan Milburn
Health secretary, 1999–2003

Stephen Dorrell
Health secretary, 1995–1997