Book reviews

Hidden Assets – Valuesand Decision-making in the NHS

By Bill New and Julia Neuberger. King’s Fund,

2002, PB £17.00, 230pp. ISBN 1-85717-458-5

All the contributors to this collection of papers

are concerned, from widely differing perspec-

tives, with the ways in which the values embod-

ied in a health-care system conflict, and the

problems of choice that arise. Most of them

focus on the NHS, from a domestic or North

American perspective. Only three broaden out

the debate. Disappointingly, the individual

essays do not add up to a book, although some

of them are useful and thought-provoking.

Although many of the papers seem to have been

produced for seminars, there is no record of any

exchange of ideas, no attempt to drive the

discussion forward beyond the Tavistock prin-

ciples, which is more or less where the thinking

about values ends up. But these principles, like

the statement of values in the NHS Plan, are in

the nature of bland rhetorical statements that

are themselves conflicting, as Professor Alan

Williams comments at the end. If they are to be

of help in clarifying what is at issue in an

operational context they need to be thought

through and applied to real life situations.

This is a pity, as several contributors raise

questions of great importance, any one of which

would have merited fuller exploration. The

central assumption throughout is that whatever

list of values/principles one starts with, there are

inevitable incompatibilities that necessitate diffi-

cult choices and decisions. The two keywords

are trade-offs and transparency. In one of the

most interesting chapters, entitled �Managing

disappointment in health care�, two Americans,

Professors Jim Sabin and Norman Daniels,

describe the problems of determining and

explaining policy in two very different instances,

the availability of Viagra in an HMO and

developing a culture of accountability in the

purchasing and management of mental health

services in Massachusetts (where there is sub-

stantial public sector involvement in the provi-

sion of services). They also analyse the differing

approaches adopted by two large organizations

to the funding of �last-chance� treatments, using

the child B case as an example. They conclude

that what they characterize as �accountability for

reasonableness� in determining the best trade-off

of competing demands and priorities in a specific

situation can help to improve both the quality

and the acceptability of the allocation decision

that has to be made.

Measured against this study of the application

of principles in practice the work on organiza-

tional values in the NHS sponsored by the

King’s Fund has not yet got far, being still

mainly at the stage of sorting out linguistic

confusions and encouraging reflective question-

ing about organisational principles and objec-

tives among groups of staff in the participating

Trusts. This is not a criticism. Building a

coherent way of handling choices and dilemmas

within an organization takes time. But, and it is

a big but, there must be serious doubts as to how

far the open, painstaking approach that Sabin

and Daniels outline would or indeed could get in

the NHS of 2003. To succeed, an organisation

seeking to involve the public in making

� Blackwell Publishing Ltd 2003 Health Expectations, 6, pp.273–275 273

principled management decisions needs auton-

omy. Unless it can deliver what has been agreed

at the end of the day it will increase scepticism

and mistrust. In the months since the King’s

Fund group met to consider the papers pub-

lished here the scope for professional autonomy

in delivering care within the NHS structure has

shrunk further, despite the increasing resources

being directed at the system. Target-setting,

micro-management, NICE and PCTs are all

contributing to this state of affairs.

Somebody, somewhere, should start to probe

the question of what the �Hidden Assets� of the

NHS are, and if they are not in danger of being

outweighed by its liabilities. At present patients

and professionals alike are struggling with a

system superimposed on them by a centrally

driven bureaucracy, itself governed by short-

term politically driven directives, that they have

little power to influence. It is time to look at

alternative models for securing a socially just

health care system, one that puts the power and

the onus of making choices in the hands of

patients and professionals.

Caroline Miles

Ethox Foundation, Oxford

Producing Patient Information – How toResearch, Develop and Produce EffectiveInformation Resources

By Mark Duman, King’s Fund, 2003,

PB £20.00, 140 pp. ISBN 1-85717-470-4

Patient empowerment and involvement are at

the heart of the UK government’s plans to

modernize the health service. Providing high

quality patient information is seen as a key part

of this initiative. It better equips patients to

make informed choices and enables them to

actively participate in decisions about their

condition and treatment. As a result, more and

more health professionals are faced with the task

of producing good quality information for

patients.

Producing Patient Information is the updated

second edition of the POPPi guide and is a

valuable tool for both the novice and health

information specialist. Those starting out in the

field of patient information will find this book

particularly useful but others with more experi-

ence in this area will want to regularly dip into it

as a reference. Members of the commercial,

voluntary and public sectors should all find this

a useful resource.

Duman has produced a step-by-step guide to

developing effective communication resources. It

leads the reader through the process from the

reasons for providing information through to

production and methods to evaluate its success.

Producing Patient Information begins by

looking at the history and policy issues behind

patient information in the UK. It also explains

how public involvement is currently working in

the health-care system. Subsequent chapters

look at the importance of planning an informa-

tion strategy before you begin production as well

as outlining the need to consider other issues

that are often forgotten, such as legal liability

and patient confidentiality.

Identifying your audience and deciding how

the information will be resourced is key. Plans

for timescales, budgets, dissemination and other

resource implications are all crucial to ensuring

the success of the end product and these issues

are well covered in the guide.

As patients and carers are the recipients of

health information it is of particular importance

that they are involved in the development of

these resources. Chapter 4 of the guide high-

lights some of the methods which can help to

ensure patient views and needs are paramount.

Chapters 5 and 6 look at the content, presen-

tation and medium for information. How infor-

mation is presented can be just as important as

the information itself and making it clear,

accessible and easy to understand is essential.

Paper is not the only material to consider and

Duman explores the benefits of using other

media. He also provides guidance on producing

resources for those patients from minority

groups who may have particular needs when

accessing health related information.

The final chapters concentrate on how to

assess the quality of your information resources

Book reviews

� Blackwell Publishing Ltd 2003 Health Expectations, 6, pp.273–275

274

and how to disseminate them effectively, as well

as methods for updating them and evaluating

their success.

Practical examples and case studies are used

throughout the book to illustrate the successes

and pitfalls experienced by others. Action point

sections also provide a check list of activities and

questions to guide you through each part of the

process. In addition to the reference points in the

text, extensive lists of useful contacts, sources of

information and further reading have been

included as a valuable resource.

Providing Patient Information is a good and

accessible guide, especially for those new to

information provision. It is designed for a UK

readership, but it will provide a useful starting

point for people from other countries. It partic-

ularly highlights the need to create resources

that are patient centred, an important principal

wherever you live.

Danielle Swain

Picker Institute Europe, Oxford

Book reviews

� Blackwell Publishing Ltd 2003 Health Expectations, 6, pp.273–275

275