A patient-led NHS - it's an often-heard phrase, but how many people actually know what it means and what needs to be done to put policy into practice?

A new report "aims to equip decision makers with techniques to improve how they engage with and listen to their patients so that services are centred on the needs of those using them, rather than those delivering them".

It sounds simple, but faced with the complexities of health and social care, many people become mired in reasons why patient and public involvement ought to remain at the bottom of to-do lists.

Leap of faith

Shahid Sardar, Newham University Hospital trust membership and involvement manager and Patient Insight steering group member, says: "I know this is a difficult step to take, but the day-to-day relationships we create between services and patients offer huge potential for service change.

"The sole requirement for making use of that knowledge is a leap of faith. We need to decide that we are happy to trust the patient in order to make the changes necessary."

Developed by a steering group of professionals with broad patient and public engagement experience, Patient Insight: harnessing the power of public opinion presents a set of guidelines organisations can use to implement involvement strategies. A survey of acute trust board directors in 2007, a year after the publication of The Intelligent Board report (on supporting strategy development), found customer insight was the area of information directors wanted to improve most. This new report is trying to help fill that gap.


Patient experience is important not only for the external checks on quality, safety and efficiency the feedback provides. As Harry Cayton, chief executive of the Council for Healthcare Regulatory Excellence, says in his foreword to the report, services designed with input from users "will have endurance and can adapt to their users' needs".

The ability to adapt to changing needs is an implicit cornerstone of the information framework provided by the report. It states that "organisations should benchmark their performance wherever possible according to either case mix or local population make-up" and that "trends should also be reviewed over time", allowing any variations in performance to be assessed and managed.

Mr Sardar says: "One of the first things I think organisations need to do is identify the gaps. If they are too big to tackle in full, an overall examination of the patient and public engagement processes should be undertaken and, in the meantime, consider how you can bring together the available data and cross-examine different sources to get the best possible picture of general patient experience."

Best practice

One of the first conclusions the nine-member steering group came to in their initial research was that little use had been made of sources beyond national surveys and complaints. Patient advice and liaison service groups are available nearly everywhere, yet what benefit is that expenditure of resources providing for the NHS if the recommendations and knowledge provided by such groups are routinely ignored?

As with many aspects of healthcare, the steering group noted considerable variation across the country in terms of how patient and public feedback is being used, and several examples of good practice are highlighted in the report.

Patient Insight bases its recommendations around the commercial sector's dependence on customer insight as a basic requirement of business. The report suggests that this could and should be adopted by the NHS. Three initial steps that organisations could take to start the process are to:

  • be proactive in customer relationships;

  • encourage an ethos of customer care;

  • follow up feedback with specific responses and plans.

"I think everyone needs that moment - that epiphany - when it becomes clear to them how valuable it is to the organisation to understand the patient experience. It could be anything from a 'back-to-the-floor' exercise for directors and senior managers to a focus group or a patient-staff mentoring scheme," concludes Sardar.

The table at the end of the report provides a guide to sources of patient insight, as well as a checklist to help organisations identify potential areas of improvement for patient and public involvement.

We can only wait and see if these suggestions become reality, but we do know who to ask when we need to find out.