20 YEARS IN PAT I ENT CAR E
Reflections on care quality and safety
Rachel Power, chief executive of the Patients Association, shares her views on how patient care has evolved over the past two decades. The organisation celebrates its 60th anniversary in 2023 and has witnessed some significant changes in the culture around patient care, during this time. Here, Rachel reflects on the progress achieved and what still needs to improve.
In many ways our work hasn’t changed. The Patients Association’s was established in January 1963 by teacher Helen Hodgson, who was moved to establish the organisation by “reports on thalidomide babies, wrong patient operations and tests on patients”. These three elements – safety, rights, and ethics – continue to inform our work. But what has changed is that, with our strategy focusing on embedding patient partnership across the health and social system, we see ourselves as part of the solution, rather than just a critic. In 2013, following publication of the findings of the public inquiry into Mid Staffs, we started to work with NHS Trusts to improve their complaints handling. Our goal is to help them transform into learning organisations, valuing what patients say and acting on it, not least when things go wrong. Over the last 20 years we have had to call out safety issues time and time again, and many situations are caused by the abject
failure of healthcare professionals to listen to patients or carers.
Another change is that we are now much more vocal about how healthcare professionals are trained, recognising that when healthcare professionals’ basic training does not include how to engage and work with patients, on the job training and experience cannot make up for that lost understanding of basic principles. To us, a strategy of patient partnership is a natural evolution of those original themes of safety, rights, and ethics. To us, patients partnering with the healthcare professionals tasked with the duty of caring for them leads to safe care that delivers outcomes that are good for the patient and good for the system, delivered in a manner that is respectful.
What has changed for the better? The idea that patients have rights and should be at the centre of care has been firmly established during the last 20 years. As
derided as the Lansley reforms of the NHS are nowadays, the 2010 white paper, Equity and excellence: Liberating the NHS, did place the onus on the NHS to practice shared decision making, thanks to its core concept: ‘no decision about me, without me’. Clearly, shared decision making is not fully achieved across the NHS. But the idea is firmly established and accepted as evidenced by the promotion of personalised care – an important part of shared decision making. However, as we have seen throughout the pandemic, the attitude among some health professionals has been that patients have to accept what is offered to them with no discussion of choice. There is still a way to go to see it practised as a matter of routine.
Another positive has been the formalisation of the assessment of the performance of healthcare providers. The star rating of hospitals was ditched after just a few years, and the Care Quality Commission is changing how it assesses the providers of care. Nevertheless, assessing care providers, making those assessments public, tasking the providers to make improvements – all this is a huge step forward for patients.
The introduction of digital technologies has been positive in lots of ways, but its introduction has been haphazard. Digital technologies have yet to show that they reduce pressure on an overstretched workforce, giving them more time for patients, and helping target disparities in access and outcomes. The highlights of digitisation are things like the NHS website, which enables those with access to the internet to get information on local NHS services and their health conditions. But the goal of consulting with professionals online is hampered by digital inequality and a
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