Creating a patient-led NHS: some ethical and epistemological challenges

This article responds to the Coalition government's recent Open Public Services White Paper and to proposals which call for the creation of a 'patient-led NHS' which will, wherever possible, seek to give patients direct control over the services they receive, through a greater degree of choice and participation. Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs, values and agendas of patients, as well as those of medical professionals and policy makers. Since it cannot be assumed that professionals and patients will share the same beliefs, values and agendas, the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head, particularly within the consultation and commissioning processes. Thus, a set of complex epistemic and ethical challenges accompanies the proposed creation of a 'patient-led NHS', greater awareness of which will be necessary for the successful implementation of such reforms.