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New ways for patients and the public to express views emerge in response to NHS failures - Health Policy Today, 16 October 2008

Whether or not they are commensurate with increased levels of funding, there have been improvements in the NHS in recent years.  But one area in which the NHS has gone backwards is in engaging patients.

There are pockets of excellence, but being responsive to patients’ complaints, for example, has become less of a real priority across the service over the last ten years.  In response to these continued failings, new ways are emerging for patients to express their views on services

We have already seen the development of some new websites to capture patient feedback.  Patient Opinion which gathers free text comments and IWantGreatCare, which asks patients to score patients out of hundred in relation to trust and communication.

In the BMJ (11 October), Janice Hopkins Tanne noted that UK sites are causing a stir, but that these are being accepted in the US.  On one site, HealthGrades, doctors are not able to change the information offered, but they can add more.  “Some are giving photos and videos, like a three or four minute talk about their practice, their background, and their specialty.  

Another site DrScore was established by a dermatologist in North Carolina.  He says such sites can benefit doctors in two ways – feeding back information on non-clinical matters and with meeting doctors’ requirement to carry out patient information surveys.  It is cheaper to encourage patients to go to a general website rather than run isolated surveys in practices.

The continued failure of the NHS to respond to feeback may result in these sites becoming more popular.  One potential advantage of such sites is their potential to engage patients directly with doctors rather than via an administrative network.

There is evidence that patients are not happy with the administrative network behind the NHS complaints system.

Last Friday, the National Audit Office issued a report on NHS complaints based on an analysis of those received in 2006-7.  It noted that the NHS is failing to learn from the issues raised in complaints from the users of its services.  The problems have been around for a while and a bigger problem is that the NHS is failing to learn from a long series of complaints about complaints. For a number of reasons, the NHS needs to get better at it.

The NAO report only attracted a few headlines (in last Saturday’s papers) and yet it deserves a wider readership.  It notes that the NHS complaints system is to be redesigned and urges any change to be based on an evaluation of the current system.

A key problem with the NHS complaints system is that it is not geared to receiving feedback, only formal complaints that are put into an administrative process.  The NAO report found that two-thirds of complainents were no offered nay help to navigate the system.  

Many of those complaining about adult social services had to call in local authorities for help and there are moves from some health authorities to play a bigger role in complaints.

The NHS will have to get used to complaints from different sources if Kent County Council’s plan is copied by other health authorities. The Council says a new health phoneline will help patients to give feedback, be it ‘complaints, complements or comments’ about health OR social care staff.  The council call centre will also provide a signposting service advising patients how to negotiate the health services.

The HSJ today reports Council leader Paul Carter’s description of the service.  “Kent Health Watch gives the 1.3 million residents of Kent a service that allows the voice their opinions on both health and social care in the country.  “It is essential that the providers of health and social care listen and respond to the feedback – both positive and negative”.

The scheme has attracted Conservative policymakers.  Mr Carter spoke at the party conference, and the scheme is included in the party’s health policy documents.

Not all local authorities are so keen to get involved with health.  New arrangements for involving patients require all authorities with a social care responsibility to contract an organization to manage a local improvement network for health and social care.  The new LINks bodies should have been in place six months ago, but some have not been established.

An interim report to be published by the National Association of LINks Members accuses local authorities of failing in their duty to put contingency arrangements in place.  As a result they say there has been an “almost total loss of public involvement in healthcare”.

Also blamed are the Deaprtments of Health and Communities and Local Government which have £failed to provide adequate support” and are “reluctant to take responsibility”.

The head of policy and communications at Picker, Don Redding said that confusion over who should do what was setting back PCT public and patient engagement plans.  A DH person said they were confident all local authorities will have a LINk in place by the end of December.

Being cynical, the delay in LINks may be an aid to PCTs.  They will be in place too late to challenge the speedy reconfiguration plans that are being predicted, as PCTs are forced to knuckle down on spending and increasing effectiveness.

The Annual Health Check today has criticized PCT and promised greater scrutiny of performance.

It is worth reminding ourselves of the commitment made to patients in the draft NHS constitution, which has been out to consultation over the summer.  The document makes a strong commitment to patients and the public having their say and being involved in important decisions.

It says, "You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. The NHS will strive to provide you with the information you need to participate effectively to influence the planning and delivery of NHS services”.

Pressure is going to mount on local managers as a result of government’s will to drive efficiencies – some are predicting that PCTs will be asked to come up with reconfiguration plans and follow them through within two years.  Not only will local PCT managers be under pressure from central government, they will increasingly come under pressure from local authorities and from patients themselves, as LINks fit into place.