Domain 4: Ensuring that people have a positive experience of care

NHS Commissioning Assembly logoThe content on this page has been co-designed and developed by NHS England’s Clinical leaders and local commissioners, who are members of the Quality Working Group and tasked with leading the development of the Quality agenda for the NHS Commissioning Assembly

Key issue

Positive patient experience is common in NHS. However, care is inconsistent, as seen in recent examples of wholly unacceptable care documented in the Francis and Winterbourne View reports. The poorest care is often received by those least likely to make complaints, exercise choice or have family to speak up for them, and there is evidence of unequal access to care.

Patient experience is everybody’s business, yet evidence suggests the NHS does not consistently deliver patient-centred care, and that there are particular challenges in co-ordinating services around the needs of the patient (rather than passing the patient between services).  Good patient experience is associated with improved clinical outcomes and contributes to patients having control over their own health. We also know that good staff experience is fundamental for ensuring good patient experience.

Care and treatment in the NHS should consistently include: compassion and respect for patient’s preferences and expressed needs; equal access to services; good communication and information; physical comfort; emotional support; welcoming the involvement of family and friends. The NHS should seek out, listen to and act on patient feedback, ensuring the patient and carer voice is heard and directly influences improvements in NHS services.

Areas of action

We have identified a set of key areas for action.  These are actions which will need to be taken forward in partnership between NHS England, Clinical Commissioning Groups across the whole commissioning system, and other partners such as patient representative groups

Local case studies

Please click on the links below to access examples of good practice that area teams and local CCGs have supplied. Note:  we will be continually updating and building this list of case studies with examples of good practice supplied by local CCG.

  1. Wolverhampton: Quality matters – patient feedback
  2. Nottingham North & East: The Health Inspectors
  3. Rushcliffe: Patient & Public Involvement
  4. Shropshire & Staffordshire,Telford & Wrekin: Improving Peoples experience of integrated care
  5. Stoke-on-Trent & North Staffordshire: Creating a Quality Culture
  6. Lincolnshire East: NHS 111
  7. South Norfolk: Patient Choice
  8. Norwich: Early Warning System
  9. South Worcestershire: Primary Care
  10. NHS England: Patient & stakeholder Involvement in Developing Models & Standards

Key resources to support local plans

  • NHS Indicator portal – access CCG outcome indicators data here, for each domain
  • CCG outcomes tool and explorer – The CCG outcomes tool allows users to view maps, charts and tables of individual outcome indicators across CCGs, and to view a spine chart of all the outcomes for one or more CCGs. The CCG outcomes explorer allows the user to explore the relationships between two outcomes or between demographic information and outcome

Further resources are currently in development and will be coming on-line here from mid-October


Improving the experience of the most vulnerable and reducing inequality

A raft of national surveys, the Friends & Family Test and local approaches to evaluating the patient experience are currently employed to measure the patient experience. The information this provides gives in-depth insight into some areas of patient experience. However overall there is an incomplete picture of the patient experience across the range of services and breadth of patient groups.

There also a challenge in moving the measurement of patient experience from a policy recommendation to a driver for change, with accountability for improvement of patient experience.  Failure to act on feedback will jeopardize the confidence of patients. To improve patient experience, the NHS must build capacity and capability in both providers and commissioners to act on patient feedback. It must also build the skills and tools to enable local NHS organisations to analyse different sources of feedback, identify key issues that need to be addressed and then put in place improvement plans that deliver an improved experience.

The poorest care is often received by those least likely to provide feedback, make complaints, exercise choice or have family to speak up for them.  There is an immediate need to address the significant disparity experienced by people from disadvantaged groups in society, including the frail older population, people with mental illness or learning disabilities, black and minority ethnic groups, and vulnerable children and young people. People from lower socioeconomic groups can also have lower aspirations of care and receive less access and have worse experiences.  We currently have insufficient evidence to evaluate the experience of some protected groups, such as lesbians, gays, bisexuals and transgendered people. The NHS has a duty and opportunity to ensure that all patients are given the highest standards of care.

Commissioning for good patient experience

Patient experience should be on a par with the other elements of quality, with clinical effectiveness and with patient safety, and be embedded  across all work to improve quality outcomes.  There is clear evidence that where patients are engaged in their own care and have a good experience of care and treatment , clinical outcomes are better.  NHS commissioners will be supported to commission for good patient experience, including collaboration with providers across local health systems and supporting the development of health organisations that are much more responsive to patient feedback, and insight.

Evidence also demonstrates where there are high levels of co-worker support; good job satisfaction, good organisational climate, perceived organisational support, low emotional exhaustion and supervisor support, there are links to good patient-reported experience. However poor staff satisfaction is associated with worse standards of care. The Friends & Family Test for staff will therefore be to some extent also a barometer of patient experience. NHS England will seek to systematically enhance staff wellbeing as it is not only important in its own right but can also improve the quality of patient experience.

Measuring patient experience for improvement

A raft of national surveys, the Friends & Family Test and local approaches to evaluating the patient experience are currently employed to measure the patient experience. The information this provides gives in-depth insight into some areas of patient experience. However overall there is an incomplete picture of the patient experience across the range of services and breadth of patient groups.

There also a challenge in moving the measurement of patient experience from a policy recommendation to a driver for change, with accountability for improvement of patient experience.  Failure to act on feedback will jeopardize the confidence of patients. To improve patient experience, the NHS must build capacity and capability in both providers and commissioners to act on patient feedback. It must also build the skills and tools to enable local NHS organisations to analyse different sources of feedback, identify key issues that need to be addressed and then put in place improvement plans that deliver an improved experience.

Systematic approaches to seeking out, listening to and acting on patient feedback

Following the publication of the Francis report there is heightened awareness and concern about the patient experience. This opportunity must be maximised to embed accountability for the patient experience systematically throughout organisations commissioning and providing NHS services.  Provider organisation executive boards should be held to account for the patient experience e.g. through existing Quality Surveillance Groups, Monitor and CQC reporting processes. Information about patient experience should be made publically available.