An examination of the relationship between changes in National Health Service policy (1997-2000) and three patient groups : an empirical and theoretical study
The National Health Service [NHS] has increasingly become the focus of revised health policies. They take the form of reorganised administrative arrangements for delivering care, alternative methods of allocating funding of care, and recently innovations in emphasising the quality of care through clinical governance. The most recent policy initiative attempts to involve patients in their own care. These changes have all followed the original NHS legislation (The NHS Act 1946), when Aneuran Bevan committed the government to provide welfare based primary and secondary health care. Since 1997 the present government has concentrated NHS policy on adapting the service towards 'shifting the balance of power': away from providers of health care and in favour of service users. Attempts at 'shifting' on behalf of users has required professional staff and health service managers to adapt their working practices and intellectual principles to encompass the managerialist-consumerist philosophical approach to the phenomena known as patient involvement, also referred to as the democratic approach to participation. The approach to assessing this phenomenon has been defined by the World Health Organisation (WHO) as 'responsiveness' of organisations to change in line with service user influence. The value-base of health care has become affected to the extent that service users have to be included in decision making processes which affect the trajectory of the patient's condition, and their quality of life. This is especially critical for patients with a long-standing, chronic, and in one of the case studies to follow, a possibly terminal condition. This thesis reviews the impact of the 'shifting balance of power' and 'involvement policy' upon three patient groups; cancer patients, those with mental health conditions and those with Parkinson's disease. The thesis adopts a case study approach in order to examine the relationship of the patients in each group with the relevant NHS teams of professionals and managers. Several policy documents published by the Labour governments of 1997 and 2000, and the resulting legislation, are used to evaluate the impact of this policy. The degree of change in the practice of involvement by service users in NHS planning of health services in a UK locality (Cambridge and Huntingdon) is identified through theories of involvement. These theories are used to first, systematically evaluate the level to which service users are effectively involved in the NHS system, secondly, to examine and evaluate the pathways through which representation occurs, and finally, to assess the changes in treatment, and the impact upon the quality of life of the patients as a result of their inclusion in the decision making concerned with their care. The study provides a method for evaluating involvement not clearly identified previously, and neither adopted by the WHO, nor used in the context of health services. Recent literature has identified the need for this type of evaluation.