Date Published: 26 March 2009

Watchdog calls on healthcare services to do more to act on the views of patients and the public

NHS trusts are increasing their efforts to listen to patients and the public, but now must go "the next step" to ensure these views are used to bring about change and improvement, according to a recently published study by the Healthcare Commission.

The Healthcare Commission study into public and patient involvement in healthcare brings together the views of hundreds of patients and members of the public and 139 healthcare providers.

The report includes some excellent examples of healthcare providers listening and responding to patients.

Many patients and service users involved in the study said they felt their views were not listened to or properly acted upon. Few trusts involved in the study could demonstrate that they routinely took account of people's views in their decision- making.

Last week in its report on the impact of regulation on healthcare, the Commission highlighted that the relevant national core standard, and the assessment of it, should be strengthened to make clear to trusts how they should involve people effectively when planning and improving services.

In carrying out the study, the Commission interviewed the lead for patient and public engagement at 47 NHS trusts and 31 independent sector organisations; surveyed people from 42 user groups; and conducted workshops involving 500 people from trusts, user groups, Local Involvement Network (LINk) members, overview and scrutiny committee (OSC) members, patients and community groups. It also examined evidence from the comments given by patient and public groups on the Commission's annual health check.

When the Commission asked organisations what changes they had made to services as a result of peoples views, it found people are least likely to influence areas such as quality of clinical care or choice of services provided in the local area. The study also showed that people in vulnerable circumstances or in poorest health often found it hardest to get their views and experiences heard by health services.

Anna Walker, the Commission's chief executive, said:

" There has been a sustained effort in recent years to increase the involvement of patients and the public in healthcare, but what we need now is to take the next step. Patients want action to be taken in response to their concerns, and we can see that this is not always happening.

The current standards require health and social care providers to ‘engage' with patients and service users. ‘Engaging' can be as simple as having a cup of tea with someone - but it doesn't mean changes will necessarily be made as a result.

Organisations now need to make a final push and really act upon the information given to them by patients and the public to improve services for the local community. Events at Mid-Staffordshire show what can happen when this does not occur."

The Commission found some examples of good practice at services included in the study. It found that:

  • Most trusts were increasing efforts to involve patients and the public and that people have influenced healthcare in important ways as a result. Patients and the public have been able to drive improvements in areas such as: the quality of information about services; appointment systems; opening hours; car parking and food choices.
  • Patient involvement in some PCTs was excellent. Some had well-established networks of community groups feeding people's views into commissioning boards. Some PCTs created databases of people with certain conditions, or in similar circumstances, in order to keep in regular contact. Some said they were undertaking mapping exercises to better understand the size and nature of the local community and their health needs.
  • Mental health services and learning disability trusts have well-developed systems for engaging users and carers. These services were doing more than others to improve the local community's understanding of their services and to reduce the stigma associated with using them. There were more examples of service users leading local mental health forums and engagement events compared to other service areas.
  • Patient groups representing people with specific conditions, such as cancer and diabetes, described the most positive relationships with trusts. They were more likely to have regular contact with specific members of staff and participate directly in planning pathways of care.
  • Acute and ambulance services show a commitment to improving their understanding of patients' experiences. Some ambulance services' work with the public focused on awareness raising programmes and working in communities to improve the use of their service. Some had conducted large consultations with local people, and others had gathered feedback from patient groups. Some acute trusts are gathering patients' views both during their stay and after they go home. They are also finding ways of using patients' and carers' stories about their experiences to improve services.
  • There is a strong commitment to assessing patient satisfaction and experiences across the independent sector. Some hospices and mental health providers in particular appeared to take a wider view of involving patients, making sure service users and their carers are involved in meetings. In some hospices patients and families were involved in service planning as well as advising on improvements.

However, the review showed many healthcare organisations involved in the study were not doing enough to ensure people's views had an impact on services. For example:

  • Patients and service users involved in the study generally felt they did not have enough say in their health services. They said they wanted more information about how to give their views and what changes are made as a result of their contributions. The Commission recommends trusts should strengthen the culture of being open and responsive with local people and give feedback on how their contribution has improved services.
  • Patients and service users involved in the study said they experienced problems when trying to make their views heard. Themes they identified included: poor communication; lack of openness; poorly designed local surveys and questionnaires; not enough opportunities to discuss views in an environment where they felt comfortable; no sense of NHS trusts building a relationship with them over time.
  • One in four comments from patient groups on NHS trusts' performance against the relevant core standard in the annual health check were negative. Most of these (80%) were about trusts failing to seek the views of patients and the public. About 50% were about how far, if at all, their views were taken into account.
  • People's views were not used routinely in planning and improving health services. Most trusts could provide some examples of using people's views, but few demonstrated they routinely took account of them when planning and improving services. In addition, few organisations described any evaluation of their work with patients to find out whether it made a difference to people or services. The Commission recommends trusts should be able to demonstrate that people are influencing their major service and commissioning decisions.
  • Some communities and groups are still ‘not heard'. Most trusts recognised they did not do enough to use the views of those in the poorest health or most in need of their services, and identified specific groups. The Commission found groups least likely to be heard include: black and minority ethnic communities, older people, people with learning disabilities, disabled people, children and young people. The Commission recommends healthcare organisations should increase efforts to reach these groups. It says organisations should undertake checks on whether they, and their local patient and community groups, have the staff, skills and resources in place to involve people effectively in decisions about services.

The Commission makes recommendations to healthcare organisations, the Department of Health and the Care Quality Commission to improve how people are involved in health services and to ensure their views are better used to provide services to meet their needs.

In its report the Commission gives practical guidance to healthcare services outlining what they need to do to make sure patients are involved effectively, including a performance checklist for PCTs, acute trusts, foundation trusts, ambulance trusts, mental health and learning disability trusts. It encourages healthcare organisations and local user and community groups to use its study to focus efforts on improving the way organisations engage with their local communities.


Source: The Healthcare Commission (England, UK).

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