Patient and public experience in the NHS

Shortly after coming to power in 1997, the Blair government outlined a ten year quality agenda for health, promising to put quality at the heart of the NHS. During the development and implementation of that agenda, we have monitored and reported on the quality of healthcare in England.

Unlike much of our previous work, which examined quality of care very broadly, this chartbook focuses on a particular facet of quality: patient and public experience. It concentrates on the responsiveness of the NHS to the needs and desires of the patient and public, and assesses the degree to which patient centredness - an explicit policy goal -  has been attained. Numerous government policies have sought to elevate the importance of the patient experience through a wide range of reforms: improving access, offering choice, improving amenities, etc. The heightened emphasis on the needs and expectations of individual patients has resonated across a broad spectrum of issues, including personal choice of providers, technological advances (such as a patient accessible medical record) and greater emphasis on patient views and feedback within regulatory and performance management frameworks.

The government sought to establish a ‘patient-led’ NHS, but what exactly does this mean? General surveys indicate that the NHS provides a service that is valued by patients: results consistently show that about threequarters of patients rate the care they have received as excellent or very good. Such overall evaluations give a valuable picture of quality, but are often too general to be useful either in delineating where quality of care is deficient, or in shaping future policy and direction. Fortunately, there is a considerable amount of data available to help better understand and respond to specific patient and public priorities for the NHS. A distillation of data from multiple sources shows that patients and the public prioritise:

•  information and involvement in decision-making about care
• being treated as an individual
• choice where it makes a difference
• predictable and convenient access
• equitable treatment and health outcomes
• being safe and protected from harm in healthcare settings.

Using a wide variety of sources, this chartbook presents data relevant to each of these priority areas. So what does this information show? As ever, the available quality data provides a mixed picture. Relative successes include the following:

• improved access to care for inpatients, outpatients and primary
  care
•  the vast majority of patients feeling that they are treated with
  respect and dignity
• cost concerns not inhibiting patients seeking medical care when
  needed (an accomplishment compared with other countries)
• systems being in place to deal with adverse events.

The following areas of improvement are needed:

• more predictable access to timely and technologically advanced
  clinical interventions
• better engagement of patients in decision-making and self-care
• decreased variation in healthcare outcomes such as life
  expectancy and infant mortality
• increased patient safety, in particular prevention of hospital acquired infections.

The NHS has conscientiously conducted various polls and surveys to understand the needs and desires of the public and patients. However there appears to be a mismatch between what the public and patients say are priorities for quality and what the government has chosen as being most important in policy initiatives. In May 2007, the Picker Institute released the findings of a survey that sought to identify which aspects of care hospital patients regard as most important in England (Boyd, 2007). The survey asked patients to score the importance of 82 different aspects of care. The results suggest that a truly ‘patient-centred’ NHS would place a high priority on communication, patient–professional interactions, and treating patients as individuals. Patients rated many of the key components of the current patient choice agenda – such as choice of hospitals or admission dates – among the least important aspects of care.

Clearly, the government’s intention and actions to make the NHS more responsive to patients and the public has been a fundamental and muchneeded change. A great deal has been done to reinforce the obvious commitment of the public to the institution of the NHS. However, it appears that there are several areas that are both meaningful to patients and where immediate policy, managerial and professional attention could realistically be focused:

• better provision of information to and communication with
  patients
• engagement of the patient in shared decision-making about
  treatment options
• geographic convenience and ease of transport to health
  services
• improvements in patient safety.

In the past ten years, credit is due to the NHS as it has purposefully developed policies, strategies and initiatives to support, listen to and engage with patients. There are challenges ahead in providing healthcare to an ever-more sophisticated population that has increasing awareness of and expectations for quality, perhaps as a result of political rhetoric, government promises and exposure to the publicly released data on NHS performance. The challenges ahead are significant, but those who strive for improved quality in healthcare have a great asset – the patients and public – to guide future policy and direction.

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