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Jim Mackey, chief executive of NHS England, recently said the quiet part out loud: the NHS can sometimes see patients as an inconvenience.1 It’s a stark observation, but it resonates deeply with anyone who has struggled to get care. Disempowerment is woven into the fabric of the patient experience and, despite promises to change this, we may be heading further in the wrong direction.
Reading between the lines of the government’s 10 year plan for the NHS in England, the reforms feel less like genuine power sharing and more like restricting access further. Increasingly, patients seeking care are being directed towards digital or AI generated advice—the so called “doctor in your pocket” apps. This may suit some of the people, some of the time—but for many, especially those with complex needs or low digital literacy, it risks becoming a barrier rather than a bridge to care.
The plan’s assertion that two thirds of outpatient appointments could be replaced by automated information and digital advice is particularly troubling. This is not empowerment; it’s quiet exclusion. It reflects a system more focused on managing demand and meeting targets than on improving care. While reducing hospital waiting lists is important, doing so by diverting patients away risks leaving many with unmet, often complex, needs.
When patients are repeatedly screened out by algorithms, where do they turn? If they’re not “in the system,” can they even provide feedback on their experiences? And among those who can, many lack the confidence, health literacy, or psychological safety to speak up—especially when unwell. Others worry that giving negative feedback might jeopardise their care. For the few who can and will provide feedback, does the opportunity to do so through an app feel like a tokenistic gesture? And who will respond to this feedback now that we’re stripping back NHS managers? Please don’t tell me there’s another AI solution.
So, when we talk about patient power, we must ask where that power actually resides. This is why organisations that advocate for and amplify patient voices remain essential. The health secretary, Wes Streeting, recently suggested that patients didn’t need “ventriloquists.”2 But without formal support structures, many voices will simply go unheard, and the years of investment in improving patient safety may be undone. Dismantling agencies such as Healthwatch England, the Health Services Safety Investigations Body, and the National Guardian’s Office risks silencing those the NHS needs to listen to most.
If we’re serious about returning power to patients we must create more, not fewer, routes for them to influence and shape their care. Reform doesn’t have to come at the expense of inclusion. Data can be curated and metrics gamed, but patients’ stories are harder to ignore. We must preserve and listen to them as this next era of NHS reform unfolds—ensuring that the system works not only on paper but also in practice, for everyone.
