Patient Centred Care in the NHS

Introduction

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.

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.

Departments

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 patients^7-10

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 Survey

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.

 Conclusion

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.

Reference List

1. Department of Health. Chief Executive’s report to the NHS: December 2005. 272002. Department of Health, 2005.

2. http://webarchive.nationalarchives.gov.uk/20080728140415/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4124276. Accessed 26th October 2017

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 26^th 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 26^th 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 5^th 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 5^th NovemberDayan M. who is accountable in the NHS?. Nuffield Trust. 2016.

9. https://www.nuffieldtrust.org.uk/news-item/who-is-accountable-in-the-nhs
Accessed 5^th 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 8^th 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 8^th 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 8^th 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 8^th 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 8^th 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 10^th 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 10^th 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 11^th November.

28. NHS. NHS statistics, facts and figures.2017.NHS. http://www.nhsconfed.org/resources/key-statistics-on-the-nhs. Accessed 11th November.

29.

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.