Background
The need for patient care to be seen as responsive to individual needs and preferences is now seen as a cornerstone of quality. Improving patients’ experience is referred to in the NHS Constitution, which sets out certain NHS values including respect and dignity, compassion, and working together for patients.
From a policy perspective, patient-centred care was introduced with the Patient’s Charter, brought in by the Conservative government in 1991 and revised in 1995. It introduced, for example, the idea of a named nurse for every patient and although it was seen as weak overall, it helped to establish the importance of putting the patient at the centre of care.
In 1997 the incoming Labour government kept the Patient’s Charter, renaming and reforming it into a Charter for England. The new document outlined patients’ rights and expectations. For example, there was a right to receive health care on the basis of your clinical need, not on your ability to pay, your lifestyle or any other factor.
When the NHS Plan was published in 2000 it moved the concept further, adding patient responsibilities into the mix of rights and expectations. The Patient’s Charter was replaced with Your Guide to the NHS: Getting the most from your NHS, which also included information on the early performance targets and NHS complaints procedures.
By 2004, the NHS was approaching the mid-point of the 10-year NHS Plan. The Labour government set out its priorities for the next four years in the NHS Improvement Plan: Putting people at the heart of public services. This set out the next stage in the journey: ‘to ensure that a drive for responsive, convenient and personalised services takes root across the whole of the NHS and for all patients’. Patient choice was to be a mechanism for delivering this.
The theme continued in Lord Darzi’s NHS Next Stage Review, which says that health care will be personalised and fair, include the most effective treatments within a safe system, and help patients to stay healthy. In long-term care, this is to be delivered by innovations such as personal health budgets. In primary care, GPs’ pay is linked to patient satisfaction survey results under the Quality and Outcomes Framework of the GP contract.
A good example of policy, patient feedback and public outrage beginning to converge was in relation to the pledge (from the Patient’s Charter) to eliminate mixed sex wards. The Healthcare Commission included questions about mixed sex accommodation in its 2006 survey and found that one in five patients were still accommodated in mixed sex wards in acute hospitals. The coalition government is committed to eliminating mixed sex wards 'except where they are in the overall best interests of the patient' and is planning to amend guidance on capital schemes to improve the provision of single rooms (Revision to the Operating Framework for the NHS in England 2010/11)
Running alongside policy development was the process of measuring patients’ experiences. In 1994, Jarman et al conducted a national survey of patient experiences, arguing that such data could ‘help managers and doctors to identify and solve problems’. It highlighted what has become a recurring theme: patients had high levels of satisfaction even though their experiences of pain relief, communication, and discharge planning were problematic.
This seminal study led to regular national patient surveys, first by the Commission for Healthcare Improvement, then by its successor the Healthcare Commission and now by the Care Quality Commission, which is committed to including the views of people who use services and the public in its assessments of health and social care.
Measures of ‘patient experience’ make up an element of the new Quality Accounts that providers have been required to publish alongside their annual accounts since 2010.
A number of organisations are now helping patients to provide feedback on their experiences and supporting providers as they attempt to make sense of feedback and use it to improve services. This has been taken on board by the Department of Health, which has asked NHS organisations to explore ways to obtain real-time patient feedback. Several websites are exploring web technology to achieve this, including NHS Choices, iwantgreatcare.com and Patient Opinion.
A separate but linked development is the measurement of patient-related outcome measures, PROMs, which have been published monthly since April 2010. These are tools to capture what patients say about the outcome of clinical interventions, as opposed to their overall experience. Since April 2009, the standard NHS contract for acute services has required trusts to collect PROMs for four elective procedures: hip replacement and knee replacement operations, varicose vein surgeries and groin hernia surgeries. This information can be used for many purposes, including assessing the relative clinical quality of providers of elective procedure, researching what works, and assessing referral thresholds. It may help patients choose which specialist or hospital to attend and should help to make care more patient centred.
