summary of written evidence
What kind of healthcare does the public expect, want or need?
Definitions
In determining the wording of this first question, the steering group had some discussion itself about definitions of public expectations, wants and needs. It was felt that by including all these terms in the question, all aspects of the debate could be covered.
Some of the evidence commented on the importance of defining ‘expects’, ‘wants’ and ‘needs’. The submission from LSE Health commented that “Public expectations and the wishes and desires of individuals are not necessarily the same as the legitimate needs of the population” and suggested that whilst research to ascertain public expectations could help inform thinking about healthcare, an exercise such as a comprehensive needs assessment would be the most satisfactory way of answering the question. The Institute of Directors felt that an idea of what the public expects from healthcare could be gained from conducting a series of comprehensive surveys. ‘Wants’ could only truly be ascertained through a functioning market, and needs could be best assessed by specialists such as statisticians, economists and clinicians, ascertaining health needs on clear economic and clinical criteria.
The majority of the submissions received made similar points about public expectations, wants and needs which can be summarised as follows:
The public expects, wants or needs healthcare which :
- Is of high quality, offering up to date treatment to a high clinical standard,
- Is regulated and accountable to those using the service
- Offers the complete range of services, including primary and community care
- Provides equity of access, or equal levels of access for equal need
- Provides services which can be accessed free at the point of delivery
- Provides continuity of care
- Provides services which are tailored around individuals rather than organisational needs
- Allows individuals to be fully involved in decisions about their care and given information about treatment and choices available to them
- Offers fast access to hospital services and short waiting times.
The general tone of many of the submissions is exemplified by the evidence from Age Concern which stated that “The public continues to endorse the founding principles of the NHS, a service from the cradle to the grave, comprehensive and free at the time of need”. However, others argued that the public already accepts that some services are paid for.
A number of submissions raised the question of whether public expectations of the existing system and what it can deliver, fuelled by the media and politicians, are too high. It could be argued, however, that on the basis of evidence submitted by patient groups, the expectations of many of those using the service are not high enough, particularly in terms of the level of personalised service offered by the NHS. The Royal College of Physicians of Edinburgh commented that “over the life of the NHS there has evolved a growing gap between NHS ‘customer care’ and that of most UK customer experience. Waiting lists, queues, waiting rooms, uncertain appointments, arbitrary cancellations and the persistent shabbiness that characterises much of the NHS environment have now largely disappeared from the rest of British life, and direct experience of NHS care is now considerably at odds with public expectations and experience elsewhere”.
In its document ‘A Concerted Strategy for Modernising Social Protection’ (COM (1999) 347 final), submitted as part of its evidence to the review, the European Commission outlined four broad objectives, one of which is ‘to ensure high quality and sustainability of health care’. In order to do this member states should:
Contribute to improve the efficiency and effectiveness of health systems so that they achieve their objectives within available resources. To this end, ensure that medical knowledge is used in the most effective way possible and strengthen co-operation between Member States on evaluation of policies and techniques.
Ensure access for all to high quality health services and reduce health inequalities.
Strengthen support for long-term care of frail elderly people by providing appropriate care facilities and reviewing social protection cover of care and providers.
Focus on illness prevention and health protection as the best way to tackle health problems, reduce costs and promote healthier life.
Although this does not directly address the review’s questions it gives an idea of the priorities which healthcare systems should be addressing in meeting the expectations, wants and needs of their populations.