OPINION: Listening is the key to the future of health and care


The NHS and local authorities are setting out the future direction of health and care for years to come with their sustainability and transformation plans. With The King’s Fund noting that patient and staff involvement in those plans has not been ideal, John Morley, CEO of Formic argues that listening to feedback from staff and patients should be an essential part of those plans

Many of the most successful organisations in the world aim to deliver high quality services that are built around the needs of the customer, informed by the voice of frontline staff. So why not so for health?

It is common sense: ask patients for their views on the care they receive, and use this feedback to inform the quality of care delivery and identify areas for service improvement. This was a key recommendation from a recent report by The King’s Fund on maternity services.

We also need to listen to staff to deliver the best health and care we can. The link between patient and staff experience and the quality of care was recognised by NHS Employers in 2014.

NHS England's director for patient experience, Neil Churchill, has pointed out that patients who have a better experience of care generally have better health outcomes. He has recognised that poor experiences generally lead to higher costs, as patients may have poorer outcomes, require longer stays or need to be admitted for further treatment.

The inspection regime of the Care Quality Commission reinforces the need to listen to staff and patients to inform quality and service improvement. This exercise takes data from staff and patient experience surveys, the Friends and Family Test, and other relevant sources of individual feedback to deliver a verdict on the quality of care received.

Listening to patient feedback can prove disconcerting to some. People may fear that mistakes be picked up, or negative feedback will dampen staff morale. Yet if we do listen to feedback, we know that most people think that the care they receive from the NHS is amazing. Nine out of ten people would recommend the care received by the NHS, as revealed by the Friends & Family Test in use across many care settings to gauge patient satisfaction.

There will be areas for improvement; there always are. But the NHS has access to an enviable depth of customer insight that can identify these areas, and even co-produce solutions to any issues. Many businesses would be envious of how many of its customers share a vast amount of positive feedback about the service as a whole, as well as providing helpful views on quality and service improvement.

The listening function needs to spread more widely, as the move to integrated health and social care takes shape

Listening is good, and this listening function now needs to spread more widely, as the move to integrated health and social care takes shape. As NHS England’s Churchill noted, listening to patients’ experiences must stretch across pathways. And the patient experience should be considered right at the start of the journey towards integrated care.

The views of frontline staff are equally important. They witness the good, the bad and the ugly on a daily basis. They see what should be improved, and most often will know what needs to happen to realise improvements.

Staff and patient views need to inform future care plans

It is essential that the NHS recognises that patient and staff views are central to the design and delivery of care. It is what the new models of care will be judged against, not only by inspectors, but the million-plus staff working in the NHS, and also the public at large.

So it is disconcerting that staff and patient experience are not given as much prominence in the sustainability and transformation planning (STP) guidance. Patient experience is mentioned three times in the STP guidance; staff experience is not mentioned at all. Add to this the tight timescale to turn these around, and further problems emerge.

As The King’s Fund has noted from interviews with those involved in STPs, there has not been enough time to adequately involve clinicians and frontline staff. Patients and the public have been ‘largely absent’ from the process.

Frontline staff see what should be improved, and most often will know what needs to happen to realise improvements

Whereas the Five Year Forward View emphasises the patient experience and integrated care, STP guidance appears to have jettisoned this in favour of a focus on affordable care in the light of a growing deficit and Treasury scrutiny.

The changes proposed by STPs will come out for consultation; that is the law. It is unfortunate, however, that the plans that have been drawn together do not make more of the views of patients and staff in designing how care will look for a generation to come.

Technology can help deliver patient and staff insight

It does not take long to gather patient and staff views. There are technology platforms available that enable paper and digital surveys to be distributed at scale and at pace, and results available in near real-time and presented in meaningful ways. Actionable customer insight is close at hand.

John Morley

John Morley

Data processing is also providing great opportunities. Advances in big data and predictive analytics mean that huge datasets can be analysed for sentiment and preference in moments. Understanding and acting on insights from positive and negative customer experience underpin some of the world’s most successful businesses. Healthcare can, and must, do the same.

The NHS delivers some of the best care in the world, and staff and patients consistently provide excellent feedback based on their experience. But they can also tell when things can be improved.

The STPs are not perfect, many policy makers admit. However we should work with them as they will set out the future health and care services we provide for years to come. Please let us ensure that the voices of patients and staff are central to these plans. Or we risk designing a future in which no one has a stake.

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