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When patients are ignored, they are most at risk: that was the central conclusion of the report by Robert Francis QC into Stafford hospital. It has been at the centre of every NHS scandal – the quality of care is jeopardised if the patient voice is not heard and respected.
I recently met a former nurse whose daughter has severe learning disabilities. She was exhausted by the powerlessness and routine indignity of her experience: often she would turn up at the A&E department and wait for hours to be admitted and then wait again for a hoist to arrive by the bedside so that her daughter could be lifted from her wheelchair onto the bed. ‘I wish they would remember us,’ she says. She complains but her voice has not been heard; her experience as a customer and patient has not improved.
It’s not every day, everywhere, for every patient – most, by far, receive an exceptional service, but to ensure the NHS delivers high quality care for all, we need transparency of the patient and carer experience. It is the absence of this transparency that often allows poor care to go undetected.
So today (Tuesday) we are publishing the first results of the Friends and Family test – the first time a health service has reported a single measure of patient satisfaction for every hospital. Patients and carers have been asked to score (on a six point scale) the quality of service on inpatient wards and A&E in English hospital trusts on this basis: ‘How likely are you to recommend our ward or A&E department to friends and family if they needed similar treatment?’. Trusts are also encouraged to ask patients further questions allowing them to leave more detailed free text comments to give specific service feedback. From now on, results will be published every month on the NHS Choices website so that citizens can hold local services accountable for improvement. In most cases, nurses and doctors get the feedback weekly so they are able to target improvements as quickly as possible.
This is the boldest move yet to promote real openness in the NHS and to concentrate our focus on improvement in care. For a year, a pilot has been running in the Midlands and East region of the NHS in which more than a third of a million people have given their feedback. Frontline staff have been quick to embrace this data as a tool to change things for the better. People complain about standards of cleanliness, isolation, lack of communication and poor food. NHS workers have been able to respond: switch the heating up, provide fruit on the ward, take more time to tell patients what is happening to them – or simply have a bit of a chat. Mid-Staffs would not have had such tragic consequences if action had been taken on patient complaints far sooner. This kind of routine feedback enables a different kind of conversation between the patient and clinician.
We hope that many comments will be complimentary. In Chelsea and Westminster hospital, the vast majority of patients would recommend the A&E; one left a comment along these lines ‘I was drunk but the staff still treated me with respect’ – a reminder of the situations extraordinary NHS staff deal with on a daily basis.
This kind of information – user-generated feedback is the jargon – is now fundamental to the way we make choices as consumers in the rest of our lives. Trip Adviser was launched 13 years ago and has more than 100m hotel customer reviews on its site; customer ratings and comments on retail sites like Amazon have transformed the way in which many people buy things. In New York, more than 90,000 citizens each day feedback on local services and this, according to Mayor Michael Bloomberg, has become one of the most powerful tools the city has to target improvements.
The NHS is not a hotel chain nor a city authority: but there are vital lessons it can learn about the power of transparency and feedback. Unleashing the power of people in this way is going to be fundamental to improving outcomes across health care – and to the effectiveness and sustainability of the NHS.
Transparency is not universally welcome in this public service: there are those who will criticise the Friends and Family Test as a measure saying it is crude and not statistical, which is true, but this will be to miss the point – the NHS is putting the patient voice irrevocably into the mainstream of its activities. By October, we will have extended the measure to all maternity services and by the Spring of 2015 to every service which treats NHS patients.
Today we will learn some home truths about the NHS: some Trusts will be surprised by the number of patients who would recommend their services and they will need to take a long hard look at how they quickly transform their customer experience. We will all be watching their progress. We need a transformation in the quality of customer service in health and care: patients must be respected as people. The NHS belongs to us all.