Listening to staff and patients: it’s not just a numbers game

As the 2019 NHS Staff Survey is published, Dr Neil Churchill reflects on the value of feedback and the ongoing challenge to ensure that the NHS acts on the patient experience insight it gains.

Feedback is crucial to the NHS and, over the last six years, we’ve worked hard to make sure that we routinely ask patients and service users about their experiences of care. A mixture of surveys and real-time feedback can help teams improve quality and also provide transparency about how well the NHS is doing in areas like inpatient care, maternity services and general practice. The Friends and Family Test has helped us increase the amount of feedback from the hundreds of thousands into many millions every year.

Yet asking for feedback is just half of the picture. We also need to act on what we hear. We can glean crucial insights from large scale surveys, which enable us to compare similar services as well as spot trends over time. Making the Friends and Family Test routine has helped NHS organisations improve. But in addition to these quantitative methods, we also recognise that some of the most powerful change comes from working with small groups of patients to find out what matters to them and design changes.

The NHS has to balance asking for feedback with acting on what we hear. The number that matters most to me, therefore, is not the percentage of patients asked for feedback, but the regularity with which that feedback is used to inform improvement. We’re not always very good at telling patients what we have done as a result of their feedback and so I am always pleased to see ‘you said, we did’ posters in services and on wards or meet service users involved in quality circles or improvement programmes. We are introducing changes in the Friends and Family Test from 1 April so that NHS organisations can ask for feedback in the way that best supports local learning and improvement.

There are some wider indicators of success, however, some of which were published in today’s NHS Staff Survey. During a year when staff have been stretched on busier wards and services, I was pleased to see a significant percentage point increase in the number of staff who said that patient feedback was used to inform decisions (up to 58%) as well as increases in the percentages who believe that their organisation acts on the concerns of patients (74%) and acts to avoid repeats of errors and mistakes (71%).

We can see similar evidence from patients too. The National Cancer Plan was developed after the financial crisis and patients and cancer charities were keen that we signposted people to financial information and advice. And over the last five years, this has been one of the fastest improving areas of the national cancer survey (reaching 60.5% in 2018).  We know that there is much more to do. Many patients have consistently wanted greater involvement in their care and yet surveys suggest that progress is slow, although the coming investment in personal health budgets and personalisation should make a big difference.  And good average patient experience scores can mask poor experiences for smaller sections of the patient population such as people with learning disabilities.

A modern healthcare system uses a variety of sources to understand and improve experiences of care. Stories and conversations matter as much as numbers. What matters is whether this insight is being used to improve care and, in many cases including today’s data, the evidence suggests that it is.

Dr Neil Churchill

Neil is Director for People and Communities at NHS England, having joined the NHS after a 25-year career in the voluntary sector. His work includes understanding people’s experiences of the NHS, involving people and communities in decision-making and leading change to improve the quality and equality of care. He has a particular focus on strengthening partnerships with unpaid carers, volunteers and the voluntary sector.

Neil has previously been a non-executive director for the NHS in the South of England, is a member of the Strategy Board for the Beryl Institute and Chair of Care for the Carers in East Sussex. He is himself an unpaid carer. Neil tweets as @neilgchurchill