From Good to Great

NHS 2010 – 2015: from good to great. – Patient Involvement aspects

Introduction

For all its strengths, the NHS can, at times, put its own convenience before that of its patients. It is not yet as good as it could be at promoting good health. And, in places, care has fallen below the standards all patients have a right to expect.

This strategy is about creating a people centred, prevention focused, productive NHS.

From Good to Great strategy will see widespread change to the way that the NHS looks and feels. More care will be provided closer to people’s homes and those services must be better integrated around people’s needs. Hospital-based care will be re-structured to support this change and concentrate on providing care for the sickest patients. Patients and the public will need to engage in a debate around the future shape of the NHS and the need for services to change in order for the NHS to deliver increasingly preventative, people-centred and productive services. This will be backed up with more use of information-based technologies to design new models of care as well as improving the performance of existing services. NHS will integrate information around the patient, deliver relevant information at the right time to clinicians and use technology to drive efficiency for both patients and clinicians.

Chapter 2 deals with patients

The deal for patients: Patients and the public will have a clear set of rights. They will have full choice of primary and secondary care services. We have proposed that critical waiting standards will become legally enforceable entitlements, with the offer of alternative provision wherever possible if the NHS fails to meet these entitlements. Early diagnosis of cancer and other life-threatening conditions will be much improved. More services will be provided in the community or in the home and at more convenient times (for example through availability of GP appointments in the evenings and at weekends). These improvements will mean changes to local services, particularly in hospitals. People will be expected to use services responsibly at all times – a high-quality NHS for all is only affordable if we take out just what we need. And we will ask people to take more personal responsibility for improving their own health – taking advantage of new opportunities to become more physically active, eat healthily and stop smoking.

Commitments made in strategy to improving patient experience and engagement

  ·         The NHS Constitution will be a living document, with new rights and entitlements added over time following consultation (see appendix one for current NHS Constitution patient rights)

·         NHS will make information on patient and carer satisfaction and experience much more widely available, service by service, in real time, within hospitals. Giving patients and the public a clear understanding of the quality of experience offered by their local providers is crucial to improving quality and informing choice. This will mean  over the coming years we will greatly expand the measurement of patient satisfaction on a service by-service basis within each hospital. Without clear measurement, staff cannot improve the service they provide to all patients and their carers. They need to know who they have treated and how. So we need a wider range of clear and simple measures of patient satisfaction, and we need these to cover individual services as well as providers as a whole.

·         Additionally providers will include a wide range of patient satisfaction measures in their Quality Accounts, required by law for NHS trusts, ambulance trusts and mental health trusts from next summer. These Quality Accounts will be assured so that patients and the public can rely on them as a fair and accurate assessment.

·         DH will also continue to expand the information available on NHS Choices, including exploring the use of international benchmarks. NHS will expand the range of direct patient and carer feedback available via NHS Choices. For maternity, as well as two national surveys of women’s experiences planned for 2010, this will include piloting arrangements to enable parents to give instant feedback by text message, and working to extend NHS partnership with Mumsnet to allow its users to supply feedback on the maternity care they have received, building on the scorecard of choices that NHS Choices already provides.

·         DH will link a significant proportion of provider income to patient experience and satisfaction. This will give providers real incentives to understand and improve, and will ensure that commissioners have the power to act when patients have a poor experience. This will mean directly linking patient satisfaction with payment to hospitals for the first time next year, and significantly expanding the proportion of payment linked to satisfaction in subsequent years. Over time, up to 10% of trusts’ income could be dependent on patient experience and satisfaction. This represents a clear shift from a commoditised, production-line NHS to one that is people-centred, where staff are at all times encouraged to see care through the eyes of their patients and their carers. Over time we will consider extending this approach to other settings.

·         DH will give patients greater choice and control. The choice of which hospital to be treated in is now guaranteed through the NHS Constitution. The plans set out in the next section for better management of long-term conditions, end-of-life care and urgent and emergency services will give patients more choice and control.

·         DH will ensure patients have the right information, at the right time with the right support through the Information Standard accreditation scheme, which guarantees the quality of information for patients, and information prescriptions, tailored to the needs of individual patients.

·         DH will ensure patients have the right information, at the right time with the right support through the Information Standard accreditation scheme, which guarantees the quality of information for patients, and information prescriptions, tailored to the needs of individual patients.

·         DH has already launched a pilot programme to explore the potential of personal health budgets, to give patients more control over their care. We are exploring the potential of individual budgets to give control and power to patients to build the care and support that best suits them. Individual budgets could transform the lives of many people, allowing them much greater choice over the services they can ask for. Around 70 areas are developing proposals to pilot these personal health budgets across a wide range of different NHS services, including long-term conditions, mental health and end-of-life care. DH will now offer other parts of the NHS another chance to join the pilot programme. The pilots, which will run to 2012, will be used to inform the right way to develop and offer a personal health budget. Our ambition for the longer term is that all people who could benefit from a personal health budget should have the right to be offered one. Ultimately this could mean that millions of NHS patients will enjoy this right.

 Links between system reform (chapter  4) and PPI agenda

  ·         Legislation will be in place from 1 April 2010 requiring NHS providers to be registered for a full range of 16 registration requirements relating to all aspects of the patient experience in a safe and quality service.

·         DH will look at what more needs to be done to align incentives, so that organisations work more effectively together in the interests of patients,

·         DH expect Foundation Trust members to play an important role in advocating for change and improvement.

·         Change should only happen when it will deliver quality improvements for patients. DH wants the process of change should be led by local clinicians and local commissioners and include consultation with local people and a continuing role for local government (through Overview and Scrutiny Committees (OSCs)). The NHS must continue to work to improve the way such changes are developed and led, including by involving patients and the public. DH will also consider how the NHS could better engage with local people and OSCs to ensure that change which benefits patients and taxpayers is delivered as smoothly as possible.

·         Services will be expected to integrate around patients (not the other way around).