From paternalism to patient power

Nye Bevan and Sylvia Diggory at the outset of the NHS

The disturbing Alder Hey organs case has led to calls for an overhaul of the health service's "paternalistic culture". The balance of power between patient and doctor is already starting to shift.

In the half century since 13-year-old Sylvia Diggory became the first NHS patient, the National Health Service has changed radically.

But there is something about the publicity picture of Aneurin Bevan, the health minister who founded the service, standing over Sylvia's bed and patting her on the head, that speaks volumes about today's NHS.

Dead babies' organs were stored without consent

Not only has the medical profession come under fire for arrogance and elitism, Health Secretary Alan Milburn has condemned the organisation's "paternalistic culture".

This was one traditional aspect of the NHS that needed to be overhauled, he said, adding that this entrenched "1940s system" helped lead to the Alder Hey scandal in which the body parts of dead children were retained without parental consent.

The issue of the relationship between medical staff and patients is immense, but changes have begun in some areas at least.

The government is setting up a new national reporting system for logging all mistakes in health care following the recommendation in a report last year.

It means that in the future patient complaints will be fed into a national database so the whole NHS can learn lessons, in the same way the aviation industry does following a plane crash.

Finding a voice

Last year's wide reaching plan for reforming the NHS also put a strong emphasis on patient rights.

"Take two a day and no more questions"

Its targets include guaranteeing an appointment with a GP within 48 hours, booked hospital appointments to replace waiting lists and a maximum waiting time at any stage of treatment of three months.

Mike Stone, of the Patients Association, says greater consumer clout means the public has started to make its voice heard in hospitals and doctors surgeries.

"The patient used to be someone who sat in the corner of a doctor's consulting room saying nothing unless they were asked," he says.

"It's a very recent thing, probably going back about 10 years, and it's very gradual.

"The old thing in Carry On movies, of a school ma'am matron and a consultant going on his rounds with an entourage and never ever addressing the patient directly, used to be true. Thankfully, it's now gone."

Controversial move

One example of a positive move, says Mr Stone, has been the setting up of resolution forums for patients who face being struck off by their GPs.

Before the forums were created, individuals could be struck off automatically. Now they may put their side of the story.

The pace of change is gradually picking up

A more controversial plan is to abolish community health councils in England, which the government says are "inactive" and ineffective".

It plans to replace them with patient advocacy services that will be based in hospitals. Critics fear this means they will be too closely allied to the NHS establishments under scrutiny.

However, the Department of Health has agreed to investigate proposals for a national body to represent patients.

Reform elsewhere is needed, says Mr Stone, not only in hospitals. Nine out of 10 times when people use the NHS a hospital is not involved.

The complaints procedure is one area that has been singled out as especially in need of improvement.

According to a report in 1999, the NHS complaints procedure is daunting and unwieldy and many lost confidence before they reached the end of it, which sometimes takes years.

There are thousands of people with a grievance who are not interested in mega million pound settlements

Mike Stone

There is particular concern about the procedure against GPs, which requires patients to refer their complaint first to their local practice.

The Patients Association would like to see "no blame" forums that would allow disgruntled patients to discuss matters openly with doctors, and without the threat of litigation.

"There are thousands of people out there with a grievance who are not interested in mega million pound settlements," says Mr Stone.

"They just want to hear one word, and that's 'sorry'."