Spotlight on... Mark Duman

Mark is a clinician, management consultant and patient advocate, working in consumer health information and patient experience.

How would you describe your role?

I have two main roles: I am Director of Monmouth Partners where I help to understand and use patient data to improve healthcare services.  I am also Non-Executive Director of the Patient Information Forum, which was set up in the late 1990s under the King’s Fund, to share good practice and high quality information for patients and the public.

What are your main challenges and how do you overcome them?

In these two roles I use data as a vehicle to answer questions and then challenge the system to pinpoint where the patient is in the system.  For example, I was invited by the HSJ along with 13 other professionals in healthcare to look at workforce issues and what the NHS is here for. My viewpoint is that the NHS system does ‘to me’ and ‘for me’ but rarely ‘with me’.

I don’t believe the NHS will ever meet demand so we need to change the model so patients are part of the supply chain by managing their own healthcare as much as possible.  That is, encourage patients to be active participants, not passive recipients.

So within that there’s a challenge.  There are new models of redesigned care everywhere, but we’ve not seen enough rhetoric turned into delivery. It’s too slow and much of it’s down to training and cultural barriers.  We’ve become governed and protocol-driven at the cost of the human side of our quest for quality.  At the extreme I envisage a health professional (clinician or manager) apologising to a patient sitting in front of them for having to fill in the required patient experience metrics (the proxy measures) rather than pay attention to the person!

Challenging the culture comes from leadership and mentors. We need to change the way providers provide care and commissioners commission care.  Some medics espouse this, but often default to what they’ve been trained to do rather than what they should do. 

For example, I was trained to care for patients not to coach them.  Our challenge is to train and coach individuals to manage their own healthcare; it’s cheaper and more effective in the long run, particularly in terms of developing resilience.  We need to change clinical training because what we have is a very medical model. It does ‘to’ or ‘for’ people, rather than ‘with’ people.

Around 50% of an individual’s health determinant is dependent upon changing health behaviour. Yet only 4% is spent on health promotion, while 88% is spent on clinical intervention.  We have built up a dependency culture.

It’s now time to change from rhetoric to reality. We need to see our leaders change their attitudes to patients, and see them as assets. It’s too expensive to spend time and funds in the way we do.  We need to engineer a new system where patient-centredness really comes back into focus and re-educate patients about what good healthcare looks like so they demand more – as they do in other sectors.

We do metrics within the system to measure impact. But let’s not lose sight of our humanity.

What do you wish you had known 10 years ago?