NHS monitoring systems

Patient experience - solving the problems of todayʼs failed monitoring systems.

Existing methods of measuring and monitoring NHS quality and safety are repeatedly shown to be slow, insensitive, inaccurate and misleading. The Care Quality Commission relies on expensive, centralised, backward-looking data collection which does not drive the change needed, nor build confidence amongst the public.

After further hospital disasters in Mid-Staffordshire and Basildon (and, we are told, more to come) we need new approaches that actually work and win the support and confidence of the public, professionals and the media. Harnessing the user-voice to understand patient experience has the ability to:

reduce costs,

raise quality,

empower patients,

increase safety.

Using innovative technologies (well proven in other industries) makes it easy for patients (and their relatives and carers) to provide feedback in a valid, robust, structured manner, thereby delivering accessible, meaningful information about the things that matter to users.

To deliver this change requires vision, resolve and a willingness to absolute transparency in public services. It will reveal some difficult truths about the variation in quality across the NHS - but ultimately all patients, all staff and all NHS organisations will benefit.

Service improvements or simply closed hospitals?

The NHS needs to save money, Huge amounts of money. This requires fundamentally changing how things are done, not merely making current practices more efficient.

However, whenever PCTs embark on what is claimed to be service-redesign to deliver better, modern care in new ways that also save costs, they are rapidly attacked by their regional media and "angry, local people". For example, NHS Surrey told HSJ:

"...the campaigners were completely focused on “bed closure rather than service improvement” and invitations to come and see how new services were being delivered had so far been shunned."

This is of course not surprising and requires PCTs to re-engage with their public in innovative, open and transparent ways. Again, a whole new way of operating. iWantGreatCare is working with PCTs to address this problem, using real-time patient experience as a "barometer" of opinion, whilst also showing service-users that current structures and services are not only financially unsustainable, but also frequently deliver mediocre patient experience.

Real-time monitoring through iWantGreatCare allows PCTs to demonstrate that patient experience with existing services is far from satisfactory, and then to show that redesign has not led to a worsened patient experience. Only systematic, quantitative systems (implemented before redesign) have the potential to counter the problems that NHS Surrey and others are already facing.

It is hard to tell people their local hospital has to close. It is not quite so hard if you show them that real people - their peers - prefer the new provision and that the solutions deliver happier, healthier patients. That is the level of patient engagement needed not just locally, but also at a national level as we battle to reshape the NHS into a high quality, cost-effective, patient-centric service fit for 2010.

Use internet sites to rate care and prevent abuse, says Dignity Ambassador

Department of Health's Dignity Ambassador urges patients, relatives and carers to use internet reviews and ratings to support elderly care: ‘Sir Michael Parkinson: Blow the whistle on poor treatment of elderly’.

The Daily Telegraph reports how Sir Michael Parkinson, the Department of Health’s Dignity Ambassador for the past year, has being appalled at stories of poor treatment in care homes and the NHS, with the elderly left exposed and unable to eat food put before them. He urged the public to get involved and report unacceptable treatment of the elderly but also to praise staff who go the extra mile and provide care with dignity and compassion. He made specific reference to using quality internet sites which give patients, visitors and carers a new way to record their gratitude or raise concerns of dissatisfaction.

The public must appreciate the very real power that they have in making changes happen at the front line in care homes. This power comes from using internet sites that transparently show the experience of other users, their visitors and their families. This ‘power’ to affect change is, however, not a dictatorial power; it has two important dimensions. Firstly it allows care home staff to have a 360 degree assessment of their performance, adding a vital component to assessing what is good performance and how this should be rewarded and what is poor performance and how this can be actively managed to improve. Secondly, and probably most importantly, the power is in making services better and safer for the elderly. Families and carers continuously rating and reviewing care provides a uniquely sensitive barometer for frontline staff and managers to assess when quality of care is starting to slide. When managers have early access to this information the public rating and review has the power to prevent the often disastrous human impact, and expense, that comes from poor quality care.

This is a new age and provides hope for real improvement. Online, real-time, continuous ratings - with all feedback being openly available - gives families of the elderly transformational power to effect enormous change in the frontline services that are delivered to their relatives. As one famous elderly person would have said, "Use the Force".

How can patients (or the NHS) know what is going on in hospitals?

“Hundreds of patients died at an NHS hospital after suffering appalling standards of care.“
Conditions described as “third world“.
Four hundred avoidable deaths in a single year.
These are shocking headlines and each one represents an awful personal tragedy to families. But of course they are just the tip of the iceberg. For each patient that dies unnecessarily, there will be many, many more injured, damaged and poorly treated.

Unfortunately the only people who seem to be surprised by this are the government and their regulators the Care Quality Commission (CQC), which described the Basildon and Thurrock University NHS Hospitals Foundation Trust as “good” just last month - indeed patients using the Care Quality Commission website to help them choose great care will see that assessment there today.


Despite all the noise around Bristol a decade ago, and Mid-Staffordshire just this year (“up to 1,200 avoidable deaths“), and despite promises that “this will be the last” - patients still have no way of knowing whether they and their families are being treated in safe, efficient, caring hospitals.

But real questions need to be asked about what the staff at Primary Care Trust in Basildon were doing during this time? The PCT has been commissioning care from the Basildon and Thurrock University Hospital and sending patients to a dangerous and (according to the Royal College of Nursing) “third world” hospital. The PCT is supposed to be the advocate of the patients, to take into account the experience and preferences of patients in all their commissioning decisions and to only choose care which delivers high quality and excellent experience. Why did the PCT not know what was going on just down the road?

Of course the reason that the PCT had no idea what was going on in Basildon is the same reason that most PCTs and the CQC have no clear understanding of the quality of care delivered by Trusts across the country. If you keep using the same, outdated, disproved methods and approaches for measuring quality you will keep getting the same results. Archaic systems of annual reviews, self-assessment with internal review at Trusts, and sending in CQC inspectors after people have died is unacceptable and would not be allowed in any other industry.

So what is the answer? The CQC, PCTs and government have to move to completely new ways of assessing, monitoring and understanding quality and safety. Existing systems are broken, do not work and provide (as Basildon so clearly shows to even the most casual observer) false reassurance.
The experiences and opinions of patients have a central role to play here. It is known that patient experience is a powerful way to monitor the quality of care delivered by hospitals. This needs to be captured on a huge scale and in a fully transparent way. This has to be done systematically, continuously, in real-time and in detail across all of health and social care. No individual or organisation delivering care should be free from such scrutiny and the system must be standardised to ensure comparable data are available - this is the only way to rapidly identify outliers without having to wait until their patients die unnecessarily for the investigations to begin.

Other sectors have shown us the way: harnessing the wisdom of crowds by using “armchair auditors” in a systematic, structured way will allow the truth about quality in the NHS to be laid bare for all to see. Who will be brave and honest enough to uncover the reality?

What’s so good about the NHS?

“When the NHS is working well, its service is excellent”, says Chris Bond in the Yorkshire Post this week. Well done to all the staff at Leeds General Infirmary for delivering great care.

He recounts a story of his minor illness and how it highlighted (to his surprise) the excellence within the NHS. The author talked to Dr Shaibal Roy (Managing Director of iWantGreatCare) about this experience and how understanding the input of patients is at "the centre of care" because it helps staff to understand what patients want and where they can improve.

"Understanding the human aspect of hospital care isn't new, but I think the idea of harnessing it and trying to get feedback from every patient definitely is. It's not about being touchy-feely, but if you engage with a patient, if you get them involved and treat them with respect and dignity then they are more likely to listen and follow what the doctor, or surgeon says." says Dr Roy.

Above all, he says, the experience of patients is crucial. "Whether people are being treated for an injured finger or a life-threatening illness, we want to make the kind of experience you had routine, we want everyone to get that level of care and that's the challenge."

An elegant explanation of how iWantGreatCare helps patients, doctors and organisations.

Milton Keynes doctors highly rated

Today Heart 103.3 reports that iWantGreatCare has partnered with the local NHS to allow the public in Milton Keynes to give web-based feedback and reviews about their local doctors. All patients and their carers in and around Milton Keynes are able to visit iWantGreatCare’s website and provide direct, honest views about the care their GP gives.

The realtime opinion of patients goes directly onto the web and can be used by others looking for the very best GPs. It is also shared with the doctors themselves to help continuously improve the experience they deliver to their patients and constantly drive up the quality of services in the area. The doctors of Milton Keynes are innovative leaders, who are setting new standards in openness and communication with their patients.

Milton Keynes is the only PCT in the country where patients can see detailed, honest feedback such as this on those who care for them.

Finding great GPs and fantastic hospitals

[Today's announcement by the Health Secretary will be of interest to all those using, following, or already working with, iWantgreatcare. As you are aware, the iWantgreatcare service is the only way for the UK public to get information on individual doctors to help them choose great care for themselves and their families.]

As Andy Burnham said today, the NHS is good, but needs to be great.

In fact, much of the NHS is not even good - but parts of it are fantastic.

Harnessing the experience and views of patients and their relatives is the key to driving out the poor, building on the good, and identifying the fantastic - this is the central truth underpinning iWantGreatCare.

But today's speech by the Secretary of State is important in announcing the overdue policy change that will allow the power of patients to drive the quality improvements that can make the NHS great. By giving patients the ability to choose who cares for them, and by linking hospital budgets to patient experience, those delivering care who do not focus on the total satisfaction and experience of their patients will be exposed, will lose patients and will lose funding. They will improve - or be replaced by better services, delivering better quality care.

With free choice over who cares for themselves and their family, patients will seek out the information to make informed decisions. NHS Choices, iWantGreatCare and others will meet this need, empowering patients and allowing them to find truly great care. Indeed, the thousands of patients already using iWantGreatCare shows the scale of public demand for transparent, independent knowledge about the quality and experience of healthcare - and the unique way in which users value the views and experiences of their fellow patients.

The best NHS Trusts, doctors and hospitals know this already and are using new ways to capture, understand and use patient experience to improve quality, reduce costs and ensure total focus on the needs of their patients. iWantGreatCare already works with some of the UK's most innovative healthcare providers; NHS Trusts who know that continuously capturing and understanding real-time patient experience from thousands of users, every day of the year, across all the services they deliver is the key to quality improvement. These are organisations not afraid of the suggestions and criticisms of users, but who actively encourage and facilitate such feedback, seeing all comments as opportunities to correct and improve everything they do.

Today's announcement shows that they (and their patients) will be the winners.