Delivering Patient Centred Care in a Rationed Market: An Impossible Dream?

Authors: Wale, J.

Start date: 13 June 2019

Recent events and decisions have demonstrated that law makers and professional regulators are placing increasing emphasis on the importance of patient autonomy and choice. The NHS Long Term plan has signalled a continuing desire to embrace shared decision-making and patient centred care. However, there is also recognition that successful collaborative processes require professional support, adequate resourcing and active patient engagement. Hurdles to collaboration include continued patient deference, lack of trust and inevitable demographic variations in knowledge and education. In addition, there are a range of professional barriers (eg lack of training) and structural hurdles (eg continuity of staffing, public rationing of treatment choices) impeding functional change. Although technological innovation creates new possibilities, it may not result in better treatment choices for patients; and may increase pressure on public funding and exacerbate tensions for those working within the healthcare system. How we accommodate patient expectations around choice/ innovation, whilst maximising patient safety and preserving adequate professional discretion remains an elusive dilemma for policymakers and regulators alike. This paper examines these issues, draws upon qualitative research interviews with professional stakeholders and offers a range of possible regulatory solutions.

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