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banner Monday, 18 February, 2002, 10:19 GMT
The patient's voice
Putting the patient at the centre of the NHS was one of the government's key pledges, and the NHS Plan contained a raft of reforms designed to do this.

Eventually, say ministers, this could lead to patients having far more say in the way that the health service is run.

From March 2002, when a patient's operation is cancelled on the day of surgery for non-clinical reasons, the hospital will have to offer another date within 28 days or fund treatment at another hospital.

Perhaps one of the most significant pledges in the NHS Plan was to give patients the right of redress when their operations are cancelled at short notice.

It remains to be seen how this will work in practice in trusts where last-minute cancellation is commonplace.

Figures for cancelled operations are actually rising - an increase of 29% over the last year, although the government says that this reflects the increase in operations carried out.

The government has signalled its intent to go further than this, allowing patients who have waited longer than six months in certain specialties to opt for a private operation - or even a visit to Europe.

A pilot scheme in London is scheduled to be up-and-running by July 2002.

By 2005, patients, say the government, should be able to book hospital appointments at a time and date that suits them rather than being assigned a time by the hospital.

The government intends to set up panels of patients - called patient forums - in every trust to have their say in the way it is run.

Trusts were originally told to have them in place by April 2002, and legislation has already been put in place the National Commission for Patient and Public Involvement in Health, which will oversee and assist them.

However, the deadline for their creation is now April 2003.

The government is spending 10m on the Patient Advice and Liaison Service (PALS) - by April 2002, they say there should be a branch in every trust in the country.

PALS will handle patient and family concerns - and have direct access to the chief executive.

A concerted campaign to save community health councils (CHCs) resulted in a stay of execution - though not for long.

In January 2002, there were already 100 PALS services in trusts across the country.

However, there are concerns that PALS and patient forums will prove far more costly than the CHCs they replace. Ministers say this is because they will prove more effective - a claim hotly contested by those who support the retention of CHCs.

The government has pledged that at some point, patients will receive by right a copy of every letter sent about their care by hospitals or GPs.

The NHS Plan also says that individual "smart cards" - containing electronic medical information - will be given to everyone.

This, it says, will happen when the "necessary infrastructure" is in place - so may well be some years away.

The NHS needs to find a better way of dealing with patients' concerns, preferably before they become official complaints.

The present complaints system has been heavily criticised by both doctors and patients - the government intends to reform it.

Its detractors claim that it is not sufficiently open or transparent, and can give the impression to complainants that it is biased against them.

Ministers published a consultation document in 2001 giving broad suggestions as to how the procedure could be improved.

Among its suggestions were a single scheme covering every part of the NHS - and perhaps a new national "complaints authority" to oversee the fair handling of complaints.

The consultation ended in October 2001 and the government has not yet published its intended reforms, but says they will be in place by December 2002.

Fundamental reform of clinical negligence is long overdue. The current system does not work either for NHS patients or for NHS staff.

Patients who have been harmed by the NHS can face a long battle for compensation - which ends costing the NHS more in lawyer's fees than any eventual payment to the patient.

The average length of time to a settlement is five years.

In July 2001, Alan Milburn promised a revamp of the system - and began a consultation programme.

Options under consideration are:

  • "No fault" compensation - money paid out without any blame having to be placed directly on individual doctors
  • More use of mediation in disputes
  • Fixed tariff payments for specific injuries

A white paper containing specific proposals is expected in "early 2002".

The NHS Litigation Authority - which handles legal action against the health system - is already involved in a scheme testing out "fast-track compensation" for some cases.