'No decision about me without me' becomes reality

The principle of 'no decision about me without me' is official Government policy. Nurses have a potentially crucial role to play in assisting patients to exercise their right, which could affect demand for interpersonal skills in the workforce.

The principle of 'no decision about me without me' is official Government policy. There has been particular concern to ensure patients have their wishes respected and are treated with dignity and consideration. Evidence in polling shows the public cares about the NHS: an average of 35.5 per cent from June 1997 to 2011 identified the NHS as among the most important ideas, and while this figure has declined to 18.75 per cent since January 2008, the NHS as of August 2012 is considered the fourth most important idea, behind the economy, unemployment and immigration. Given these statistics, one should expect the public to be firmly behind the principle of ‘no decision about me without me’. The current reality, however, is patchy, though some areas of nursing (such as cancer care) have a good track record of having specialist nurses discuss and agree patterns of care with individual patients. The demand for this right to be a reality across all settings will become stronger as cultural attitudes, most notably individualism and concern about the NHS, continue to shift in this direction. Nurses have a potentially crucial role to play in assisting patients to exercise their right. This could affect demand for nursing skills, notably in requiring nurses to have a greater level of interpersonal skills for dealing with patients. Similarly, if the public decides to fully embrace the principle of ‘no decision about me without me’, this could affect demand for services and eventually supply, with the public potentially expecting more services to be delivered. This could have an upward effect on overall costs. Therefore, decision makers may consider whether personalisation of services will have effects on deployment of nurses and on financing of services, with the potential that both the role of nurses and financial expenditure on health and social care may need to change in response.

Sources or references

• Suggested by number of stakeholders in interviews and workshops during CfWI research on nursing.
• From unpublished CfWI report (report available on request),
• Robert G, J. Cornwell, et al. (2011). ‘What matters to patients’? Developing the evidence base for measuring and improving patient experience. Project Report for the Department of Health and NHS Institute for Innovation & Improvement ,NHS Institute for Innovation and Improvement
• Department of Health 2012. A framework for NHS patient experience
• Care Quality Commission 2011. Dignity and nutrition inspection programme: National overview
• Commission on Dignity in Care for Older People, 2012. Delivering dignity.
• IPSOS/MORI, August 2012 Ideas Index
• IPSOS/MORI, Most important ideas facing Britain today, Archive 1997-2011

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.