“Trusts need to make more effective and informed use of their data” – Veena Raleigh, The King’s Fund, discusses organisational goals and the new report on trends in the inpatient survey
The King’s Fund are an organisation who need little introduction. An independent charity working to improve healthcare in England, and our partner in the recently published report on trends in the NHS inpatients survey; Patients’ experience of using hospital services, their work plays a key role in shaping and influencing health and social care in England. In the interview below, Veena Raleigh, Senior Fellow at the organisation, shares the key learning from the recently published research. Discussing how the organisation works to improve healthcare policy and quality and their overarching goals for the year ahead.
Why do you think the report on trends in the inpatient survey is so valuable?
The inpatient NHS survey is among the largest and longest running of such surveys internationally, and it offers rich insights over time into patients’ feedback on the quality of care they receive. To date, there has been no analysis of how individual trusts have performed over time and what, collectively, the patterns of change look like. Ours is the first such analysis. Furthermore, the data is under-utilised within the NHS (by trusts and commissioners), and for research purposes to inform policy and decision making. Our report makes an original contribution by offering new insights into how patients’ perspectives of the care they receive in hospital have changed over almost a decade. We also make suggestions for how more effective use can be made of the data.
Which “trends” do you find to be the most revealing?
That patient experience overall has shown only modest improvement over almost a decade, despite being a high priority for the government and the NHS, is an important finding. It is reassuring things have not taken a turn for the worse given the unprecedented financial pressures facing the NHS. We also found that in terms of the performance of individual trusts, the general pattern was of improvement in some areas of patient experience and deterioration in others, rather than organisations showing a consistent pattern in one direction. Our analysis also shows that pressures in the wider health and care system can impact negatively on the experience of patients in hospital e.g. in terms of timely discharge from hospital – which has implications for the role of policymakers and commissioners i.e. this is not just an issue for trusts.
What are the most important messages for trusts?
To make more effective and informed use of the data, taking the longer view i.e. closer monitoring of long-term trends in responses to individual questions. This applies equally to commissioners. In our report we’ve also identified messages for policymakers and regulators to consider and act on.
Do the results raise any new questions that need further investigation?
Yes. We’ve identified a number of issues that need further exploration. For example, why the performance of London trusts as measured by the inpatient survey results, is consistently poorer compared to trusts outside London. Also whether patient expectations differ between sub-groups of patients and whether they change over time i.e. could the lack of significant improvement reflect in part rising expectations over time?
What do you think it would take to improve inpatients’ experience of hospital care?
Additional resources are not an option for the NHS at this time, but more could be done to target existing resources to aspects of care for which patients report poor experiences. We recognise the competing demands and pressures on trusts in the current climate, but quality improvements will reduce costs and improve patient experience in the longer term. Leadership, staff engagement from board to ward level, dedicated time to review and make a coordinated response to the survey results are some key enablers.
What role does staff experience and wellbeing play in service user care and experiences? How can this relationship be optimised?
The quality of care provided to patients depends on the skills, commitment and compassion of staff, and engaging and supporting staff to improve care at a time of unprecedented financial and service pressures has never been more important.
If we want staff to treat patients with respect, care and compassion, all leaders and staff must treat their colleagues with respect, care and compassion. There are clear links between staff experience and patient outcomes. Staff views of their leaders are strongly related to patients’ perceptions of the quality of care. The higher the levels of satisfaction and commitment that staff report, the higher the levels of satisfaction that patients report. If leaders and managers create positive, supportive environments for staff, they in turn create caring, supportive environments and deliver high-quality care for patients. It’s an area of expertise of our leadership development team, who work with individuals and organisations to help create positive leadership cultures that encourage staff engagement.
What is the one thing you would want people to know about The King’s Fund?
We are an independent charity working to improve health and health care in England. We help to shape policy and practice in a number of ways: through research and analysis; developing individuals, teams and organisations; promoting understanding of the health and social care system; and bringing people together to learn, share knowledge and debate.
What is your role at The King’s Fund?
I’m a Senior Fellow in Policy, working on quality measurement and information issues – both from a policy perspective and undertaking research and (as an epidemiologist) data analyses into a range of NHS data sets e.g. patient surveys, HES, QOF. I also input to the Fund’s responsive work, and contribute to projects commissioned by Department of Health and NHS England e.g. the recent report on Measuring the Performance of Local Health Systems.
What drew you towards the organisation?
I’d been working for several years at Surrey University and then for eight years at CQC’s predecessors the Commission for Heath Improvement and the Healthcare Commission. I wanted a break from the regulatory environment and eagerly accepted The King’s Fund offer of a post in 2009. The Fund’s reputation for academic excellence, and the opportunity the Fund provides to combine research with influence on policymaking, was the major attraction, along with being able to work with high calibre professionals.
As an organisation, what has been your proudest achievement so far?
We know we make most impact when we can work on issues over a number of years – building evidence, influencing and making the case for change then working with system leaders and practitioners to ensure that change is driven by evidence and best practice. Our work over recent years on integrated care is a good example of this approach.
How do you work to support care quality improvement?
We have a skilled, knowledgeable and committed team of people who work in different ways to influence the quality and experience of care:
- through our research and policy analysis
- through the work we do with individuals, organisations and communities building their capability, supporting them to adopt best practice and share learning
- by bringing people together through events and networks to discuss and learn from evidence from the United Kingdom and across the world
- by promoting greater understanding of health and care policy and practice – helping people to make sense of a complex and rapidly changing environment.
What has been your stand out moment of the last year?
The first part of the year was dominated by our work to inform and make sense of the debate on health and social care in the run up to the general election. We produced a wide range of digital resources, hosted debates and produced two reviews of the NHS under the coalition government. In the second half of the year, at a time of unprecedented challenges for the NHS and social care, we’ve been doing lots of work around the spending review and the financial pressures on the system (http://www.kingsfund.org.uk/projects/new-gov/spending-review-2015). And alongside all of this, our Leadership Development team have been working with individuals, teams and organisations from across the health and care system to improve performance and support the delivery of high-quality care (http://www.kingsfund.org.uk/leadership).
As an organisation, what are your goals for the next 12 months?
We have just finalised our strategic plan for 2016-2019, which sets out four corporate goals that show how we seek to improve care and four areas of policy and practice that we will prioritise between 2016 and 2019.
Our four goals are:
1) We will have influenced (for the better) the policies of government and national bodies
2) We will work with organisations and communities at a local level to turn policies into practice, and our work with leaders will build capability for improvement
3) We will support all who are involved in improving health and social care by being a valued and sought-after source of commentary, explanation and information
4) We will work towards becoming a high-performing organisation.
Our four strategic priorities are:
- Funding and productivity
- Health and care systems
- Communities and population health
- Culture and leadership
A PDF download of the full report; Patients’ experience of using hospital services, is available here