Patients need power within the NHS It is time to reject paternalism and protectionism in Britain's health service, writes Nigel Crisp Recent healthcare scandals have proved horrific for patients and shaken Britain's confidence in the NHS. They have damaged its reputation and the morale of its staff and shamed those of us who were in leadership roles. They also reveal that, as in other sectors, regulation is not enough by itself. Even when done well, national regulators cannot reach everywhere. The NHS needs the constant scrutiny of patients to stay alert and vital. Successive governments have stressed the importance of patient power but none has done what is needed to make this a reality. As we saw in Mid-Staffordshire and Morecambe Bay, two NHS Foundation Trusts heavily criticised for their lack of care, patients" voices are far too weak. They simply are not heard when they tell staff and organisations that something is going wrong or that something needs to be done. We have all felt powerless when confronted by large organisations run by professionals with their own way of doing things. It is time to make overturning this the top priority and to reject the paternalism and protectionism that so often characterises the NHS. If the NHS targeted patient empowerment as effectively as it tackled waiting lists and hospital "superbugs" the result would be truly radical. It requires the same approach: clarity of aim combined with changes in systems, incentives and behaviour. When I became NHS chief executive in 2000, about 4 per cent of patients waiting for a heart operation died before they could get treatment. We fixed the problem with precisely these methods and the same could be done here. If patient empowerment, for want of a better name, became the top priority it would go far beyond culture change and be about a complete reversal of the power hierarchies in the NHS. This is not about taking a narrow consumerist or a simple market approach. Patients are far more than mere consumers. As the prevalence of chronic diseases increases, it is clear that we are also actors in our own care - participants in, partners with and owners of the NHS. The public requires more than mere consumer rights. It expects doctors and nurses to be on their side and to do their best for them wherever they can. This is about a social contract not a commercial one. It is about trust and ultimately the legitimacy of a whole system. Empowering patients would mean they own their health records, rather than merely having limited rights to see them. It would mean not just openness of data but the collection and publication of the information patients themselves want. It would involve recognition that patients have different needs from each other, that they may want to make different choices about treatment, and need to be able to give consent knowledgeably to that treatment. Patients are individuals who know best what is important to them. As Professor Don Berwick, the US health expert who led the review into patient safety after the Mid-Staffordshire crisis, has said, professionals "are guests in their patients" lives." It too often feels as if patients are inmates. We also need a systematic approach to the education and engagement of the public in health promotion and disease prevention. Most patients are experts on their own needs and many want to do more for themselves and to understand better what they can do. This needs to be supported by shifts in power and incentives with patient and citizen representation at all levels in the NHS and with staff and organisations rewarded according to public satisfaction. The greatest shift, however, will come through changing behaviour. The biggest issue here is the continuing development of professional and management education. The training of all health workers must ensure that the empowerment of patients and recognition of their views is key. Change will truly be with us when these concepts become core business and not just desirable additions. The writer is a member of the House of Lords and was NHS chief executive and permanent secretary at the Department of Health from 2000-06