Will empowered patients be the cure for the NHS?

December 06, 2013, 9:45 AM GMT+0

(Crosspost) Transparency won't be enough to make hospitals safe and on its own can make matters worse.

A recent YouGov poll showed that 48% of people think the NHS has got worse over the last five years. Just 8% thought it had got better.

With the scandal of Mid-Staffordshire, the 11 trusts placed into 'special measures' and the fact that a quarter of hospitals are currently described as 'high risk', perhaps this isn't surprising. There is a growing sense that we're not doing enough to get the highest standards in our hospitals.

In a climate like that, the first instinct of many politicians is to increase transparency. Laudable though that it is – on its own, it won't do enough to make our hospitals safe.

At Circle, we publish every item of patient feedback we get – good and bad – verbatim on our website. We are committed to giving patients as much information as possible so they can choose where and how they want to be treated and vote with their feet if standards fall below their expectations.

But there are two problems. Firstly, transparency alone is not a cure. Indeed, on its own, it can make matters worse. The Freedom of Information Act has revolutionised transparency, but we know all too well that some people go to great lengths to subvert the Act and ensure discussions aren't written down. Transparency, if poorly managed, can lead to more cover-ups.

Secondly, patients rarely act like the empowered consumers we need them to be. Too often they feel trapped into being grateful for the services they are given and have little knowledge of the power they have.

We run two state-of-the-art independent hospitals in Bath and Reading. Despite glowing CQC reports, some excellent clinicians, and a Michelin-trained head chef, 80-90% of our NHS patients come to us exclusively because of a GP recommendation.

So the question then becomes: how can increasing patient power help if they don't always choose to use it, and how can we improve transparency without people gaming the system? The answer lies in transforming culture.

When we first took over the management of Hinchingbrooke hospital, a severely distressed NHS trust facing closure, we would typically get 1,200 items of patient feedback per year. We introduced a shortened questionnaire and pursued patient feedback constantly. We now get 24,000 a year, and every return is published on our website.

Doctors, nurses and managers on the frontline go through the feedback together every month and take action to improve services. Far from this cycle being resented, feared or hushed up, it is celebrated. This is the culture of transparency that can too often be missed. And it didn't happen by accident.

At Circle, empowering our staff to take responsibility and ownership for their work is key to our success. All of our partners value transparency because it allows them to hold themselves, and each other, to account.

One of the first things we did in Hinchingbrooke was introduce an initiative called Stop the Line. We told every member of staff they had not only the right, but the duty, to stop any procedure if they thought a patient might be in danger. All senior staff then attend the scene of the incident and a decision is taken before an operation can resume.

The culture change we saw was overwhelming. Staff across our hospital aren't looking to cover up failure – they're looking to root it out. And since we introduced the initiative, we've seen a 50% drop in serious incidents.

Transparency does have a role in improving care. But it is naive at best to imagine that this alone will miraculously improve standards. Without the accompanying culture of openness and accountability, efforts to increase information about patient care will fall on deaf ears. We need a cultural revolution in the NHS – and we need the leadership to make it stick.

Steve Melton is chief executive of Circle Partnership.

Reposted from here.

Explore more data & articles