What’s changed since May 6th?
The new coalition government’s plans for the NHS may not be dramatically different, but the devil’s in the detail. Here we highlight some of the differences that the NHS will have to deal with under the new administration.
Serious funding challenges
The Conservatives’ promise to protect overall NHS funding “in real terms” was an essential part of their election policy. It effectively neutralised the NHS as an issue during the election. But, as any economist will have noticed, the promise to protect funding was never going to be a promise to leave the NHS alone. Given the increasing demands on the NHS from an ageing population and the rising costs of drugs, merely keeping the overall budget constant in real terms will require some serious cuts in parts of the NHS budget. One of the most surprising pledges by the new Government is to pay for all new cancer drugs – a commitment which is likely to require deep cuts elsewhere.
Bureaucracy will be challenged more than it’s ever been
The last Government claimed to see “bureaucracy” as getting in the way of delivering an efficient health service, and the new Government is no different. However the Conservatives characterise Labour’s administration as “top-down, bureaucratic mismanagement”, and they are promising to cut administrative costs much more deeply than Labour dared to promise. The Conservative manifesto speaks of “a culture where ticking boxes is more important than giving patients the treatment they need”.
The coalition’s Programme for Government says, “We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line”. This is a terrifically ambitious pledge and will be painful to achieve.
Targets will be abandoned
Many staff will be happy that targets are being abandoned by the new Government, who plan to focus on results “which really matter” such as survival rates and infection rates, rather than what patients moan about most such as waiting times. These health outcomes should be easier to measure and monitor, and this in turn will reduce paperwork and save some costs.
GP contracts will be renegotiated
Some are forecasting a “long and bloody battle” with GPs as the new Government intends to force GPs to take back responsibility for providing care at weekends and in evenings, which in effect means refusing to honour Labour’s 2004 contract with GPs that allowed them to opt out of out-of-hours care. The intention is good – to improve standards of out-of-hours care so that it is not provided by medics who are unfamiliar with the patient, and of course to improve patient satisfaction in the process. But to provide such care GPs will need to co-operate more as part of local groups, losing some autonomy, and making lifestyle compromises in the process, something they may not do happily.
Patient satisfaction will be improved by the carrot not the stick
Reading between the lines of previous years of policy statements, Andrew Lansley seems to be just as committed to patient satisfaction as Andy Burnham has been over the last few years. And in keeping with this, the Con-Lib Programme for Government contains a pledge to “enable patients to rate hospitals and doctors according to the quality of care they received”, as well as a commitment to transparency about performance and mistakes.
However the emphasis is likely to be less on meeting patient satisfaction targets, and more on allowing patient satisfaction to speak for itself by allowing competition to reward those who deliver higher satisfaction levels. Promises include “the right to choose your GP, hospital and even the consultant responsible for your care”, something that will make patient satisfaction important but without imposing targets.
What it means for us
At PatientPulse we can see continuing opportunities for our service to meet the needs of the new NHS. Our service allows GP practices and PCTs to save administrative time and money by automating their collection of patient satisfaction data and getting rid of time-consuming and fiddly paper surveys. And PatientPulse works out an awful lot cheaper than paying for the administrative time to run a paper survey, whilst offering the easy-to-use reports which keep practices on the right track to grow patient satisfaction, and ultimately to grow patient numbers in the more competitive world where resources will be spread more thinly.
Published May 31, 2010 by Helen under Homepage, NHS news, Opinion, Patient Pulse.Outpatient satisfaction riding high and unlikely to suffer despite budget cuts
A survey by the Care Quality Commission has concluded that increases in outpatient satisfaction will be sustainable even after expected cuts in budgets in 2011.
The survey reveals that patients are waiting less than six weeks to get an outpatient appointment, and are rarely delayed for longer than 15 minutes on the day. Further, patients are reporting that hospitals are cleaner and more welcoming places to visit.
The biggest shift in satisfaction scores however can be attributed to the manner in which healthcare professionals are treating patients. Patient led care is becoming ingrained in the health service, resulting in patients that are happier with the care they are receiving from NHS staff. Patients feel more involved in their treatment decisions, and their opinions are increasingly treated with consideration and respect. Good communication plays an essential role in patient satisfaction.
Health minister Ann Keen said: ‘NHS staff should be pleased that 95% of outpatients rate their overall care as good, very good or excellent. This is a testament to their hard work and dedication.’
With the improvements being attributed to greater professionalism and changes in practice, the results should be more sustainable.
However public perceptions of the healthcare service can be easily dented by high profile failures, such as those highlighted by the independent inquiry into poor practice at the Mid Staffordshire NHS Trust.
But the public and patients can be very different groups. With an increased focus on patients’ satisfaction, healthcare professionals are delivering a better quality of care at the point of experience – and that’s what really matters.
Published March 1, 2010 by Paul under NHS news.Tags: Care Quality Commission, nhs, Outpatients, patient satisfaction
Why patient satisfaction shouldn’t drive 10% of NHS funding
Up to 10% of NHS trust funding could rely on good patient satisfaction scores. Perhaps surprisingly, we disagree with this policy and suggest a more appropriate use for patient satisfaction data.
So it seems that up to 10% of individual NHS Trusts’ funding could depend on patient satisfaction scores! This was the announcement made back in December by the Health Secretary Andy Burnham, as he sketched his vision for the NHS over the coming 5 years (assuming he’s still in government after the election, of course).
You might expect Patient Pulse to be strongly in favour of this development – after all, we want the healthcare sector to take notice of patient satisfaction. It’s our business. And we believe that measuring patient satisfaction, and putting in place incentives to improve it, leads to happier patients.
However we’re not in favour of allocating health care resources on this scale (a massive 10% of budgets for goodness sake!) on the basis of patient satisfaction.
Here are the two biggest reasons why we’re not in favour.
10% is too much and will divert resources from struggling hospitals
If a hospital or trust is struggling to give good patient care, to take away as much as 10% of funding based on a low patient satisfaction score is likely to lead to the deterioration of care rather than improvement. In other words, it’s counter productive. 10% of funding is likely to make the difference between a hospital being well equipped to give good care and being poorly equipped. Financial incentives are important and can drive behaviour, but we’d argue for a direct incentive for particular staff who can make the difference to patients – in the form of variable staff bonuses, particularly focused on the management layer, to drive patient-friendly behaviour and processes rather than the blunt instrument of withdrawing overall funding, which risks reducing a hospital’s ability to carry out vital patient care tasks.
Comparing patient satisfaction across hospitals is an unreliable way to allocate funds
Secondly, we agree with the NHS Confederation (which represents NHS trusts) who have rightly commented on how “challenging” it would be to calculate payments to providers on the basis of patient satisfaction, considering the large differences in the demographics, socio-economic profiles and therefore expectations and judgements of patients in different areas of the UK. These differences mean that it’s dangerous to compare patient satisfaction measures crudely between hospitals.
We’d go further than this, and say something that might surprise you. Patient satisfaction will almost certainly be unreliable as an absolute measure of the quality of care that’s provided. Patients can be satisfied with the outcome – for instance, the fact that their life is saved by emergency staff – but dissatisfied with aspects of the process, for instance the way their life was saved or visiting hours afterwards. What crude patient satisfaction measures don’t tell you is what’s most important – the saving of a life, or satisfaction with the peripheral elements of service around that. This doesn’t mean that patients’ dissatisfaction with elements of the process or service is irrelevant – just that it’s probably not nearly as important as their satisfaction with the outcome. Levels of patient satisfaction need to be weighted by the importance of what they’re rating. This will vary from patient to patient and is highly subjective.
In addition, patients are not all well-informed about what great care looks like. Unlike in consumer markets, they are unable to compare directly between providers at the point of delivery (when they are receiving treatment), and their satisfaction scores are highly dependent on their expectations of the service, which may bear little relation to what great care and best practice actually mean today.
Comparing one hospital or NHS trust with another when they have very different patient profiles (whether older/younger, wealthier/poorer, well informed/poorly informed), and when their patients are therefore likely to have quite different sets of expectations and priorities, seems like a dangerous way to allocate critical resources between areas.
So why measure patient satisfaction at all?
Let’s not throw the baby out with the bathwater. Patient satisfaction may not be a good basis for allocating funding but this doesn’t mean that measuring it is a waste of time. Within a hospital, and within a service, it’s a very valuable way of measuring improvement over time, and identifying opportunities to improve service. Comparing today’s results with yesterday’s results within a hospital is a helpful and valid exercise and should be encouraged and supported.
Instead of the announced policy, we would rather see Andy Burnham encouraging the collection of patient satisfaction measures, and encouraging the use of this data to incentivise improvements within a trust, a hospital or a service through creating a link between improvement in patient satisfaction and staff bonuses, at the margins where it makes a difference to staff but not a critical difference to overall hospital resources.
Published January 16, 2010 by Helen under NHS news, Opinion.Tags: Andy Burnham, Government policy, NHS funding, patient feedback, patient satisfaction
Patient satisfaction 2009 – A year in review
More measurement, and more reasons to measure… Here’s our roundup of 2009’s top five developments in the world of patient feedback and satisfaction.
As we begin to look back on the year nearly finished, what developments stand out as important in the patient satisfaction and feedback field? Here are our top five.
1. The GP Patient Survey gets teeth
April 2009 saw the GP Patient Survey, run by the Department of Health, go compulsory, and begin to take place quarterly rather than annually. The results of the survey are now explicitly linked to practice funding (for those practices opting into the Quality and Outcomes Framework), with good ratings potentially being worth £8000 in hard cash to practices. All of which “ups the ante” on the need to get great patient satisfaction ratings.
2. The DoH drops heavy hints about the importance of instant feedback
In May, the DoH published its guide ‘Understanding what matters; A guide to using patient feedback to transform services’, setting out best practice in collecting and understanding patient satisfaction data and using it to make improvements. It stressed the importance of collecting ‘real time’ measures rather than relying on snapshots such as the GP Patient Survey. A strong indication that collecting instant feedback from customers is the way the sector is heading.
3. Practice boundaries look set to be abolished
In September, Health Secretary Andy Burnham announced that Labour would abolish GP practices’ catchment areas, to give patients the right to choose between practices. Despite some scepticism from the BMA and downright opposition from some GPs at the RCGP conference in November, the move seems to have momentum and is also strongly supported by the Conservatives, who have described the boundaries as “a solid wall of defence against real choice”.
The removal of practice boundaries will lead to increased competition between practices for patients – something practices haven’t had to face on this level before. Yet another development that adds to the list of reasons for practices to invest in understanding patient satisfaction in order to improve it.
4. Patient Participation Groups go mainstream
2009 saw a campaign called ‘Growing Patient Participation’ set up by a number of bodies (the RCGP, the BMA, the NHS Alliance, and NAPP, the National Association for Patient Participation). The campaign was all about encouraging GP practices to set up Patient Participation Groups (PPGs), partly in order to represent patients’ views and feed these views into the practice management. Such strong official support should encourage more practices to take action to get closer to their patients’ views.
5. NHS Choices starts publishing the public’s views on GP practices
In November, the popular NHS Choices website started to allow patient ratings and comments to be published on their website for individual GP practices. The service got over 3,500 comments in its first 14 days, with negative feedback unsurprisingly common on the site. Protecting their online reputation is now a powerful reason for GP practices to capture patient satisfaction information themselves, in ‘real time’, before it gets published online.
Published December 4, 2009 by Helen under NHS news, Opinion.Tags: Andy Burnham, Government policy, NHS Choices, NHS funding, patient feedback, Patient Participation Groups, patient satisfaction
UK primary healthcare is best (according to those who deliver it, anyway)
Primary healthcare in the UK comes out top in an international comparison survey – according to practitioners. But who’s asking the patients?
UK GPs seem happy about waiting lists and the rate of improvement
The Commonwealth Fund survey (full details here) compared 11 countries’ primary healthcare, by surveying a large sample of each country’s primary care practitioners.
Health secretary Andy Burnham will no doubt be very pleased that only 22% of UK GPs reported that patients “often” suffered long waiting times to see a specialist – a result not matched by any of the other 10 countries in the study. (USA came second with 28% but 6 out of 11 countries scored over 50% including Canada, Germany and France). So our GPs seem happy with waiting list times.
Perhaps even more satisfying for Mr. Burnham, a whopping 51% of UK doctors thought that the overall quality of care had improved over the last 3 years. The UK outperformed every other nation significantly on this measure (most countries lingering within the 15-35% range).
He should also be delighted that 81% of UK doctors are satisfied (or very satisfied) in their job, a score only beaten by New Zealand, Norway and the Netherlands.
Not surprisingly, his reaction to the survey was, “This is fantastic news for the NHS and a worthy recognition of the professionalism of NHS staff”.
Hold on a moment.. who’s asking the patients?
These high scores are all very well. It’s great that our GPs seem happy and report high levels of improvement and fewer problems with waiting lists. But aren’t we at risk of being somewhat self-congratulatory? The survey is completely based on the responses (often to rather subjective questions) of healthcare practitioners – not on the opinions of the patients themselves.
We’d like to see a proper international comparison of patient satisfaction levels. Are UK patients really the happiest in the world with the quality of care they receive? What’s the correlation between patient satisfaction and practitioners’ reports of how things are going?
UK GPs are the most interested in patient satisfaction
Of particular interest to us at PatientPulse was which countries’ healthcare practitioners were taking the most notice of patient satisfaction data. Again the UK came out top, which we think is the most encouraging sign that UK patients stand the best chance of seeing continuing improvement.
96% of UK GPs said that they “routinely receive and review data on patient satisfaction and experience”. That should have come as no surprise at all. After all, the GP Patient Survey is now compulsory and regular.
What was surprising, however, was how low the level of engagement with patient satisfaction was in other countries. In most of our European neighbour countries, less than 25% of practitioners regularly reviewed patient satisfaction information – with France particularly clueless as to what their patients think, at a pitiful 2%.
Another key difference between the UK and other countries was the high percentage of UK GPs aware of financial incentives for high patient satisfaction ratings (49%). Again, no other nation came close to this, with less than 5% of doctors in most other countries reporting any kind of financial incentive to improve satisfaction.
Even though we seem to be ahead of the game, we are being encouraged to go even further with the measurement of patient satisfaction. The aforementioned Mr. Burnham said, in a speech to the King’s Fund back in September, “I want to see patient satisfaction measured service by service … Making this information readily available will empower patients and put commissioners on the spot.” We can’t help but agree with that.
We’re firmly of the belief that the measurement of patient satisfaction is key to improving that satisfaction. Which brings us back to our suggestion of an international survey of patient satisfaction levels. Wouldn’t it be interesting to prove the link between the measurement of satisfaction, and satisfaction itself? Testing the truth of the old adage – “If you don’t measure it, you can’t improve it” (and, by implication, if you do, you can).
Published November 21, 2009 by Helen under NHS news, Opinion.Tags: international patient satisfaction
NHS Choices : 3,500 comments in 14 days
Two weeks in and the Department of Health’s decision to publish online feedback for NHS GP surgeries is already creating waves. Within 14 days over 3,500 comments have been posted, with negative feedback being the clear winner.
Not long ago we blogged about the launch of the new NHS Choices online ratings site for GP practices (here’s our original blog post).
More complaining than expected
Now it’s two weeks later and the site has seen over 3,500 comments. It comes as no surprise that the majority of patients using the service will have arrived there looking to vent their frustrations. Taking the time to look up your practice online requires a clear goal – and while many will be in search of opening hours and other specific information, a large proportion will be looking for a way to complain. It’s not surprising there appears to be a marked disparity between the ratings that NHS Choices is attracting and those of the GP Patient Survey.
Just as concerns have been raised about the validity of online ratings in other areas – namely food and travel, so there is concern that NHS Choices provides a survey snapshot of the disgruntled.
With just 14 days’ data it’s too early to tell how useful the service will become. However, it’s for patients rather than practices. And as a patient-focused initiative it may even inhibit the efforts of a management team trying to turn a practice around.
So what’s the alternative?
“Real-time” data collection, initiated within the surgery so that it invites all to participate, remains the most immediately useful way of polling the opinions of patients. The practice can ask questions to which it wants, and needs the answers. Further, we believe that patients given the on-the-spot opportunity to take part in such surveys feel less inclined to make complaints in other ways – including posting reviews on NHS Choices! Services like PatientPulse put the practice back in the driving seat, and help divert complaints to the practice management, who are able to react immediately to them without risk to the reputation of the practice.
Published November 3, 2009 by Paul under NHS news, Opinion.Tags: NHS Choices, patient feedback
Dept of Health launches online patient feedback
From this month, your GP practice can be reviewed online in a new public ratings system announced by the Department of Health. You can find the online reviews on the already-existing NHS Choices site.
New initiative by the Dept of Health
The popular NHS Choices site, which already receives seven million hits a month, now allows patients to rate practices by answering a few questions (eg how easy it was to get through on the phone, whether they could get an appointment and whether they were treated with dignity and respect).
Why a high rating could be essential to a practice’s success
This new initiative continues the NHS trend towards collecting patient feedback and measuring patient satisfaction. But this feedback isn’t just for the benefit of practices themselves. Ratings will be published online so that practices can be compared by prospective and existing patients. Now that GP catchment boundaries are set to be abolished in less than a year’s time, it will soon be possible for patients to choose from a much wider range of practices. And NHS Choices already gets 350,ooo searches for GP practices per month. So these public ratings could become critical for practices that want to keep patients or grow their patient base.
In addition to submitting ratings, patients can submit comments which will also be published. Everything’s out in the open – including any responses that GP practices may have for patient comments. The site could end up being as rich in feedback as TripAdvisor, the successful hotel ratings system.
But could it be open to abuse?
The main criticism of the system is that it is open to abuse. Patients are asked to submit their email address so that the address can be validated, but otherwise there is no guarantee that feedback is from actual patients. Despite efforts to ensure that individual GPs or staff members cannot be targeted with negative comments, the system could be easily corrupted. For instance, it would not be impossible for irresponsible GP practices to target their local competition with negative comments – in order to capture greater patient market share.
And will it capture everyone’s views?
Being a wholly online feedback system, it is also in danger of being unrepresentative. The British Medical Association doesn’t seem to be a fan of the idea, calling it “not the best way to deliver patient feedback”. The association has been working with the DoH to try to make the system “as fair as possible”. But Dr. Laurence Buckman, Chair of the BMA’s GPs Committee says, “we remain to be convinced how much value this will have for patients… Such feedback will always be from a self-selected population motivated to post feedback… Our highest users, the elderly and the long-term sick… have the lowest rate of accessibility to the internet”.
Proactive practices will make the most of this opportunity
Given how important these ratings could become, practices that want to compete for patients will need to be proactive in making sure that ratings are as positive as possible. One way of doing this is to capture “real-time” feedback via other methods – ensuring that practice management are quick to spot any worrying trends in patient satisfaction levels, and quick to turn around any problems reported to them. So when patients rate their practice online, it is more likely that rating will be positive.
And for those practices that are already confident of being rated at the highest level, it will be in their interests to encourage patients to use the service. One way of doing this is by real-time patient engagement through short text message surveys on the day they use the practice, which then direct the patient to the NHS Choices site at the end to give more detailed feedback.
Read our update NHS Choices : 3,500 comments in 14 days
Published October 17, 2009 by Paul under NHS news.Tags: NHS Choices, NHS surgery review, patient feedback, patient reviews
