Feedback from patients is helping local boards to see what the public really thinks about the services they provide, which can then be used to drive improvements in care, writes Neil Churchill
Feedback and performance
In the past two months, 600,000 people have given the NHS valuable feedback on their hospital care. The friends and family test makes patient experience an integral part of the care we deliver; and in doing so is bringing about a cultural change in the NHS.
‘The importance of feedback is not what we collect but what we do with it’
Such feedback cannot be reduced to a single metric to judge performance but it can be used to drive improvement. That drive is especially powerful locally, where hospital boards can see what their public is really feeling about their service.
Providers, but also commissioners, need to get feedback wherever they can, not just from one source. Good as it is, real time feedback like the friends and family test works best when set alongside patient surveys, enabling trusts to test initiatives as they are implemented.
Surveys get beneath the headlines, explaining why test scores are moving. But such data only becomes insight if it sparks conversations between managers clinicians and patients about what needs to change.
Focus on improvement
The importance of feedback is not what we collect but what we do with it. There has rightly been a focus on getting better measurement of experience and there is further we need to go to achieve this. We know too little, for example, about the experiences of children and young people, who make up 22 per cent of our population.
But I think the time has come to move the focus on from measurement to improvement. There are some pressing areas in need of attention.
‘Commissioning needs to encourage providers to overhaul clunky systems and overcome the barriers to coordinated care’
First, we need to improve the experience of the most vulnerable. The Winterbourne View and Francis reports underscored what we already knew: that vulnerable patients can be at risk of poor, or even unacceptable, standards of care. People with learning disabilities can be treated without respect, their health needs ignored.
Frail older people can be left without food and drink in hospital wards. The latest Cancer Patient Experience Survey demonstrated that older patients are less likely to have a specialist cancer nurse − a lynchpin in good care. There is an overwhelming case to do better for the most vulnerable and if we are mindful of the most vulnerable, we are more likely to improve care for all.
Smoother care transition
Second, we need to improve patient experience at transition points between services. The failure to coordinate care can delay and undermine the process of discharge from hospital. The journey from specialist care back into primary care can set some patients back irretrievably, in terms of their recovery.
Children still point out failings in the transition from children’s services to adult services. Many of these issues cause be as frustrating to clinicians and managers as they are for patients
Commissioning needs to encourage providers to overhaul clunky systems and overcome the barriers to person centred, coordinated care.
Third, transformational change will only come when we stop treating all patients the same and introduce personalised care that supports self-management for many and risk based targeted interventions for others.
In five years’ time, not only should there be no place in the NHS for very poor standards of care but more patients must be in control of their care, through informed decisions, care planning and support from digital services and peer groups.
‘Learning based on feedback and dialogue will allow us to address problems in the short term’
We can’t achieve this by reducing the experience of care to a single metric we can commission. The Keogh review demonstrated that poor experience can easily be masked in data, if unaccompanied by interrogation. Instead, we need to commission learning organisations that demonstrate excellent patient understanding and engagement as well as excellent clinical leadership.
Platform for change
Learning based on feedback and dialogue will allow us to address problems in the short term, and build a platform for change in the medium term. Commissioners need to know that providers are engaging patients and involving them in quality improvement.
‘Every positive experience of patient care builds consensus for our NHS, and helps to secure it for future generations’
They need to assure themselves that patients can see and articulate improvements in care standards. Learning organisations do more than consult. Their values are demonstrated to patients. They use sophisticated techniques, such as experience based co-design, to drive improvement. They show clear insight into the needs, preferences and views of different patient groups, especially those who are vulnerable. And they participate in collaborative learning to share good practice.
Until now, providers have led the patient experience agenda. Now it is time for commissioners to build on that learning and apply it across the new health system. Collectively we need to commission for experience as much as for other parts of the outcomes framework.
To do that we will need to know we are commissioning from responsive, learning organisations with a deep engagement with diverse patient populations.
Change is happening. Not because the friends and family test is in the NHS mandate, but because patients and the public demand it. The NHS needs to recognise and meet this demand to maintain its unique position in the hearts and minds of the public. Every positive experience of patient care builds consensus for our NHS, and helps to secure it for future generations.
Neil Churchill is director for improving patient experience, NHS England