The NHS is a large multi-functioning health care service that deals with over 1 million patients every 36 hours1. The NHS sets out to provide quality health care which include three important parts; Clinical efficiency, patient safety and patient experience2 . The need for even greater quality health care in the NHS saw a shift in focus towards a more patient centric NHS3. This is because they believe a patient centric care, care that encompasses the patients’ needs and values and allowing this to shape and guide all clinical decisions4, will allow for a better quality of health care.
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This essay will explore how patient centric the NHS really is in terms of the different departments it encompasses, policies, laws and overall patient satisfaction. It will also investigate whether there are certain areas that the NHS needs to improve in terms of patient centric care and exploring if this is the case how to do so.
The NHS is made up of many departments and collaborates with a wide range of organisations such as the National Institute for Health &. Clinical Excellence (NICE)5. The structure can be described as complex and can cause confusion for patients trying to access these services6. In addition the complex structure makes the health care provided by these, less efficient and effective in the health services they are providing; and brings about questions of who is really responsible for the care of the patients7-10
In 2014 the NHS released the Five Year Forward View2, which outlines planned improvements for various areas of the NHS. Since the five year forward view plan was released, there has been a focus of new models and an increased focus on integrated care7. This emphases a more holistic approach to health care and looks to encompass all services11. Integrated care sets out to bring together a range of services so that all aspects of the patients’ needs are more closely met11. One of the new care models, called Vanguards has been set up around the country12. Vanguards aims to trial new integrated care methods which were presented in the five year forward view. Some of these new integrated care methods include Sustainability and Transformation Partnerships (STPS)13 and Accountability Care Systems (ACS)14. STPs are there to help organizations including GPs, hospitals, local authorities to work together and have unified services for the most vulnerable13. ACS’ have been developed to co-ordinate services under a set budget for organisations outside the NHS that impact health, this includes working with housing and social care organisations to create accountable care to assure that patients needs are being met7.
Quality Surveillance groups (QSGs) identifies risks to patients in terms of quality and safety of the health care being received from the NHS and associated organisations acts as safeguarders15. This creates accountability for those providing health care services to the public. One individual organization within QSG is Care Quality Commission (CQCs). CQCs regulates the health and social care act, directly relating to patient centric care within the NHS as regulation act 9 with this act says that providers must take action to make sure every individual has access to personal care treatment16. If this not being provided the CQC can take regulatory action, this provides further evidence that the NHS is patient centric as they are constantly monitoring the quality of patient care.
Another QSG group is the clinical commission group (CCGs) this group, led by GPs commissions services on the behalf of the NHS, works to improve the health of the population in their area. CCGs are important because they allow the clinicians (GPs) that have knowledge on the needs of that particular area to provide the required healthcare services17. An example of this is the provision of integrated care within Oldham to provide a budget for vulnerable people to have fuel in the winter18. Although CCGs have been widely successful in terms of some of the services its commissioned, 19 one year after the creation of CCGs, a report commissioned by King’s Fund and Nuffield trust saw that less than half of GPs felt that CCGs reflects their views20. This report questions the patient centrism of CCGs as one of the reasons that CCGs are led by GPs is that they’ll have a better understanding of the patients’ needs in that area21, if GPs are not being consulted then this could also lead to less patient centered services. Furthermore, CCGs recently have had to make difficult decisions which have led protests from the public. One such decision is the closure of Accidents and Emergency’s across the country22. CCG have decided these A &E’s are unsustainable and are creating a larger deficit than necessary23. This has led to dissatisfaction from the public and feeling like their voices in regard to this matter is not being heard 24 .This goes against patient centered care, which is there to involve the patient in every step of care1. However, this is only one issue, overall the CCGs are a step in the right direction toward a more patient focused health care services for the NHS. With further consideration of GPs and the public views the CCGs can become an effective tool for building a patient centric health system.
Policies and Legislation
There are several laws in place that are there to protect the patient but also to put the patient at the forefront of every clinical decision that is made in the NHS. The health and Social Care Act 201225 allowed for the patients to be more involved in their care on every level. It does this by allowing patients support to manage their health in their everyday lives, it also gives them control over the care that they are receiving and also treating each patient as an individual with an individual circumstance25. In addition, this Act allowed for the establishment of Healthwatch England which will provide crucial information to the CQC on the opinions of the patients using their service26. To a certain degree this has been successful as Healthwatch England has published 1450 reports as of 201627 and has worked with local health ministers and the public to implement the care that is wanted by the patient. They have also worked closely together with CQC to provide information on which health services in which area need to improve28. However, they have only engaged 385,000 people28 to find out their view. Although this seems like a large sample the total amount of outpatients the NHS had in 2015/2016 was 89.436 million people29 and so this is a relatively small sample of the people treated by the NHS views which are being heard and so those which have the most need for improvement in the health care services may not be heard.
Other legislation which provides the case of a patient centric NHS includes the Social Value Act30, This encourages commissioners of public services to think about how the services will benefit the public. The use of the Social Value Act in policy and practice can only be clearly shown by 13% of the CCGsand 43% of CCGshad no policy or were in the process of making a policy on the Social Value Act31.To improve to become more patient centric, the Social Value Act could be implemented on a wide scale basis into main policy of NHS England but also within the framework of QGS`.
In addition to the previous laws, The Equality Act32, which protects patients from discrimination and permits them to get quality health care, also helps a patient centered NHS. It Allows for every Citizen of England no matter their culture and values to have health care which is free and of quality. These legislations are designed to make the NHS patient centric through creating a patient- NHS relationship free of discrimination and allows for the patient’s values and opinions to be respected. Although there could be some improvement on the implementation such as making sure these laws are practiced this can be done by setting up accountability groups and incentives for healthcare professionals to provide better patient centered care, these laws go a long way in making the patient the focus of the NHS healthcare33
Patient experience has been seen as vital to the care provided by the NHS34. Listening and taking action on a patients’ feedback about their experiences of health care is seen as critical to making sure that care within the NHS is centered around the person35. patient reported information can be described as Information which comes from the patient or family and Carers as an account or through surveys36. There has been increase in the number of surveys carried out by the NHS but have found that GPs were resistant to feedback which was to do with the patient or was dismissive questioning the validity of the report37. However there have been positive reports on services attempting to improve due to feedback from Patients38. This Creates a more patient centered NHS as they are listening to the feedback and taking action to it, meaning the views and experiences of the patient are valued.
To conclude, The NHS has had a shift in view towards a more patient centric NHS, this can be seen as widely successful due to the policies and legislation its placed but also different quality surveillance groups and the listening of patients’ feedback. Although some improvement could be made in terms of CCGs and a straight forward pathway for the patient, the NHS can be seen as patient centric.
1. Department of Health. Chief Executive’s report to the NHS: December 2005. 272002. Department of Health, 2005.
3. NHS. Next Steps On The NHS Five Year Forward View. 06669. NHS. 2017. https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/ Accessed 26th October 2017.
3. The Rt Hon J. Hunt. Making healthcare more human-centred and not system-centred. GOV.co.uk. 2015. https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred Accessed 26th October 2017
4. Institute of Medicine. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. https://www.ncbi.nlm.nih.gov/books/NBK222262/ Accessed 26th October
5. National Health Service (NHS). Putting Patients First: The NHS England Business Plan for 2013/14 – 2015/16. England. 2013. http://www.thehealthwell.info/node/454557 Accessed 5th November,2017
6. Bamford, David and Daniel, Stephen A case study of change management effectiveness within the NHS. Journal of Change Management, (2005). 5 (4). pp. 391-406. ISSN 1469-7017.
7) Kings fund, Creative connection. How does the NHS in England work? An alternative guide Kings Fund, 2017
https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-workAccessed 5th November 2017
8. HJarmon. The new NHS structure is unstable.HSJ. 2014https://www.hsj.co.uk/comment/the-new-nhs-structure-is-unstable/5067897.article Accessed 5th NovemberDayan M. who is accountable in the NHS?. Nuffield Trust. 2016.
Accessed 5th November
10. NHS. Challenging bureaucracy. England. 2013. NHS. http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/challenging-bureaucracy.pdf Accessed 5th November
11. Department of Health. Integrated Care: Our Shared Commitment. England. NHS. 2013. https://www.gov.uk/government/publications/integrated-care
Accessed 8th November
12. Williams. NHS England reveals new care model ‘vanguard’. HSJ. 2015. https://www.hsj.co.uk/topics/service-design/nhs-england-reveals-new-care-model-vanguard/5083135.article Accessed 8th November
13. N. Laccobucci. Community hospitals: still a viable option? BMJ.2017. 358 :j3581 https://doi.org/10.1136/bmj.j3581. Accessed 8th November
14. T. Moberly. Accountable care systems and accountable care organisations in the NHS: progress or route to privatisation?, BMJ.2017. 358 :j4105 https://doi.org/10.1136/bmj.j4105 Accessed 8th November
15. NHS England. Quality Surveilance groups. England. 2017. https://www.england.nhs.uk/wp-content/uploads/2017/07/quality-surveillance-groups-guidance-july-2017.pdf Accessed 8th November
16. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 https://www.brad.ac.uk/library/media/library/documents/numeric-referencing-guide-October-2017.pdf Accessed 8th November
17. Kings Fund. An alternative guide to the new NHS in England.. Kings Fund, 2013. https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england-2013 Accessed 8th November
18. Oldham CCG. Oldham Affordable Warmth Strategy. 2014 http://committees.oldham.gov.uk/documents/s66368/Affordable%20Warmth%20Progress%20Update.pdf Accessed 8th November
19. NHS Clinical Commissioners. Delivering a healthier future: How CCGs are leading the way on prevention and early diagnosis. 2016. https://www.nhscc.org/policy-briefing/5061/ Accessed 10th November
20. Kings Fund. One year on, new commissioning groups are an improvement on their predecessors but do not reflect the views of members, say GPs. 2014 https://www.kingsfund.org.uk/press/press-releases/one-year-new-commissioning-groups-are-improvement-their-predecessors-do-not Accessed 10th November.
21. Kings Fund. Clinical Commissioning, GPs in Charge?. Kings Fund and Nuffield Trust. 2016 https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Clinical_commissioning_web_pdf.pdf
Accessed 10th November
22. G. Newton. Slideshow: Thousands march through Grantham in protest against overnight closure of A&E. Grantham Journal.2017. http://www.granthamjournal.co.uk/news/slideshow-thousands-march-through-grantham-in-protest-against-overnight-closure-of-a-e-1-7839498 Accessed 10th November
23. CCGS. Preconsultation business case.NHS.2016 https://www.calderdaleccg.nhs.uk/wp-content/uploads/2016/01/Right-Care-Right-Time-Right-Place-pre-consultation-business-case-15-January-2016.pdf Accessed 10th November
24.Robertson. Public Satisfaction with the NHS- 2015. Kings Fund. 2015 https://www.kingsfund.org.uk/publications/public-satisfaction-nhs-2016 Accessed 10th November
25. Health and Social Care Act 2012 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted Accessed 11th November
26. Tingle, Kribb. Nursing law and Ethics. Forth Edition. Blackwell Publishing. 2014
27. Health Watch England. Every Voice Matters. 2015-2016. Healthwatch http://www.healthwatch.co.uk/news/every-voice-matters-our-annual-report-parliament-20152016?mc_cid=1f74368018&mc_eid=da5769ac78. Accessed 11th November.
28. NHS. NHS statistics, facts and figures.2017.NHS. http://www.nhsconfed.org/resources/key-statistics-on-the-nhs. Accessed 11th November.
30. Social Value Act.2016. https://www.gov.uk/government/publications/social-value-act-information-and-resources/social-value-act-information-and-resources Accessed 11th November.
31. National Voices. Healthy commissioning: How the Social Value Act is being used by Clinical Commissioning Groups.2017. https://www.nationalvoices.org.uk/publications/our-publications/healthy-commissioning-how-social-value-act-being-used-clinical Accessed 12th November
32. Equality Act 2010. https://www.legislation.gov.uk/ukpga/2010/15/contents Accessed 12th November
33. Department Of Health. The NHS Constitution For England. Government.2015. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england.
34. Department of Health. High quality care for all: NHS Next Stage Review final report.Stationery Office, 2008.
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