Martin McShane: Patients as customers

Martin McShane Sometimes you get a sense of cultural change: someone tells you a story and simultaneously you think “that’s a good idea” and “times they are a changin’.”

Some of the people I work with in NHS Lincolnshire went out to have a conversation with one of our consortia leadership teams. They all wanted to discuss how we might get patient and public involvement firmly rooted in the new arrangements that are emerging. They came up with a simple solution. Each practice, if it wants to be a member of the consortium, needs to have a patient participation group. Each patient participation group will nominate one person to participate in a consortium patient group. That group will nominate someone to represent their views on the consortium board (or whatever the final governance body is called).

Of course this is made feasible by the fact that the majority of our consortia are not huge. Size matters – depending on what you want to do.  If you simply want to manage the money then the bigger the budget the better.  If you want to change behaviours, foster a new culture, really generate transformation nimbly and swiftly then smaller groupings are likely to do that. Once they have embraced that change they can grow.

Most innovation doesn’t start at the top of big organisations; it starts with enthusiasts.  The challenge the NHS faces is that it is a behemoth. It has to try and reconcile being national, being equitable, balancing the books and being accountable for how billions of pounds of public money is spent. Yet, at the same time, it faces an unequivocal financial challenge that can only be met if we do things differently.

Bringing the patients and the public on board to shape and support doing things differently, has, in my experience over the last few years, had some startlingly positive results. We have been able to innovate.  In my reading around how other industries make change they do it by listening to their customers.  It seems at least one of our consortia has got it.  They want to listen and really engage with their patients, the public.

Just one more change would really reveal how far the NHS has shifted its culture. Could we stop using the term patient and public and just use a much simpler term for the people we serve –  customer?

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.