Where does the newly elected Conservative government need to focus to tackle the issue of delivering high quality care for all?
In attempting to realise a high quality, sustainable, health service we must take a person-centred approach, embedding service users’ experiences and knowledge in the foundations of each and every care process. As it stands we are a long way from this and major challenges need to be addressed if we are to ever come close to achieving it.
Staff are intrinsically linked to and play a key part in the patient experience – you cannot have a quality patient experience without enough skilled staff members to enable the care to be delivered, and to support the pursuit of excellence. But in addressing staff ratio issues, it is not just enough to budget for and then employ more staff. A number of other considerations come into play in sustaining such changes, for example, infrastructure issues like staff parking facilities or public transport links to enable healthcare staff to travel to work without excessive costs being a barrier. Equally staff wellbeing must be prioritised at all times. Doing so consistently will go a long way towards diminishing an organisation’s sickness rate, increasing staff productivity, cutting waiting times, and, in turn, delivering better care for patients. In committing to this approach there needs to be a continued and consistent commitment to understand what matters to staff, to measure their experiences, and to act on the findings.
Patients need not only to be consulted about their care, but included and involved in it. At each level of the system, from government officials and Ministers, to commissioners, providers and clinicians, systematically engaging with and involving patients in decisions about their care as well as in the design and delivery of care process unlocks a raft of potential benefits. Whilst clinicians are experts in diagnosis and treatment, it is often those living with specific conditions, their families and carers that are the experts on what is actually needed to improve care: increasingly patient and family involvement is providing more innovative and efficient solutions. These solutions often result in an increased understanding of specific conditions and more effective self-management for those living with them.
We are already seeing local initiatives where effective involvement practices have reduced hospital readmission rates, alleviated A&E burden, and supported service saturation in the process; this must be continued alongside us finding ways of realising benefits on a national scale. This is where initiatives such as Always Events™ can really help, setting the tone and standard for what makes a quality patient experience, both for staff and service users. It is fantastic that NHS England have so openly put their support behind the initiative, but for it to truly be effective and promote excellence in both patient care and experience, it will take not only national support but commitment to making it a reality at all levels of the health service. It’s not enough to say that patients need to be involved in the commissioning process or have closer contact with providers, there needs to be evidence of it in action.
It is often said that effective communication is vital to the delivery of high quality care, yet clinician to service user communication is consistently flagged as an inherent issue in patient, relative and carer feedback. Last year’s national inpatient survey, for example, showed 31% of inpatients as saying their doctors did not “always” answer questions in a way they could understand.* The only way to ensure that such issues are addressed and improved on, at all levels of the system, is to establish communication as a core clinical skill, that staff must possess and understand. The Individual Clinician Feedback initiative has and is supporting progress in this area among doctors, but for improvement to truly be made, high quality communication must be prioritised and adopted by all healthcare professionals. Here there must be both implementation at a national and organisational level, with central backing, but we must also look to the future generations of health care professionals ensuring that teaching curricula and early work experiences include training and education on the importance and ability to communicate effectively in a health and social care setting.
Readmissions due to flaws in the discharge and transition between services are far too frequent and are a major drain on NHS resourcing. Indeed, in the 2013 national inpatient survey 61% of patients were not ‘completely’ told about medication and side effects when leaving hospital – and 39% reported that hospital staff did not take their home or family situation into account when planning their discharge.
So what’s needed to really make progress here? One change that would be highly beneficial is accessible patient care plans. People need, and should be freely able, to engage with their care plans. Whether through real time digital access or physically carrying them with them, whenever a patient moves to another stage of their care journey, both they and their new care team must be aware of and understand what is happening and why. Awareness and understanding are two very different factors of equal importance that must be considered alongside each other to be effectively achieved. People must be spoken to, and their care plans shared in plain English, repeated if necessary until both staff and service users feel secure and confident that information has been provided effectively and that recovery can be maintained.
If excellence in care is to be delivered and person centred care achieved, these four areas must be addressed with equal priority as core financial commitments. A government that commits in this way may just find that, in delivering a person centred health and social care system, they are able to unlock the solutions to the conundrum of high quality sustainable care for all.
*NHS inpatient survey 2013; http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys/inpatient-survey-2013 *