Notes from the field of public involvement

Monday, 06 November 2006

State of Healthcare 2006

The Healthcare Commission's 2006 report for England and Wales published last week is the third so far. This one includes an assessment of the private healthcare sector (much bigger than most people think) which, perhaps surprisingly, doesn't score particularly better or worse than the NHS. So what is the attraction of "going private" many may well ask? It's probably all about perception (see more below).

More to the point, the HC's report asks some pertinent questions about all health care: is it safe? is it effective? is it provided in a way that meets people's needs? are people involved in decisions about their own healthcare? are services helping to improve the public's health? are services in the NHS delivered efficiently and effectively? In the following 160 pages, the detail of how NHS bodies measure up to the health care standards reveals that 81% of Trusts met 90% of the standards. The HC concludes that things overall seem to be getting better. But surprisingly that's not how many see it.

Positive experience vs negative perception - a recipe for danger
What comes out of the report's narrative that particularly intrigues us is the contrast - yet again - between the good experiences which individuals generally report about the standard of care they received from their local NHS, contrasted with the general public's pessimism and negativity about the overall state of the NHS and the direction in which they believe it is headed. This pall of gloom can't all be put down to media doom mongering, though there's enough of that around. Good stories don't sell newspapers.

We wrote back in September about the political dangers of the gap opening up between experience and perception. The same findings came out of YouGov poll for the TUC last week: over 60% of 2000+ people interviewed said their most recent NHS experience was good or very good, but almost in the same breath more than half worried that the NHS had got a little or much worse over the past ten years. Can both be true?

Irony No. 1
Here's the first irony: according to Ipsos MORI poll results included in the Healthcare Commission 2006 report, the public's biggest concern is about lack of resources and investment in the NHS. Are people not aware that the NHS has had record amounts of year on year investment recently? Waiting lists are down and virtually non-existant in some places. The focus groups should be delighted. So how, we wonder, will people react when the resources tap at the Treasury starts to be turned down significantly from 2007 as other public services take their turn at the investment trough? We should be thinking about how to do better with less in the next funding cycle, not lamenting that we haven't had enough. Will any politician be brave enough to recommend that? Unlikely before a general election.

User involvement in decision making - a lifeline for the NHS
There is one thing the NHS could - indeed must - do if it is to survive and even flourish in the coming lean times. It must get better - much better and quickly - at involving its customers (aka patients) in decision making. That's a key part of what Derek Wanless meant when he talked about the "fully engaged scenario", without which a centrally funded service would be not be sustainable. It is still beyond our grasp. Having more "choice" isn't the same as being fully engaged. As the Healthcare Commission concluded , "many still feel left out of decisions about their care. Staff need to adopt a more open approach to decision making, the care of individuals, the future of services and how patients look after themselves."

Irony No 2
Here's the second irony: this verdict appeared only three months after the splendidly comprehensive and readable evidence review by Angela Coulter and Jo Ellins on Patient-focused Interventions, courtesy of The Health Foundation. HSJ was unstinting in its praise, saying the review "collates and analyses published evidence from the last eight years on patient involvement initiatives from around the world. It is a definitive guide to what does and does not work, ranging from patient choice through to self-care and shared decision-making." We have to concur and this resource will definitely find a place in the next edition of M-A-C's recommended reading for patient and public involvement. It is a hefty read at over 270 pages, but worth it. Coulter and Ellins include a section on patient and public involvement and it was very pleasing to see references to the work of Christine Hogg, a friend and an Associate Consultant with the Partnership.

A way to raise quality and effectiveness together
Patient focused interventions are "those that recognise the role of patients as active participants in the process of securing appropriate, effective, safe and responsive healthcare. There is a growing belief among policy-makers that patients/citizens can contribute to quality improvement at both an individual and a collective level." In other words - patient focused interventions directly address the key questions which the Healthcare Commission asks and should be a main way for NHS organisations to make improvements in their performance against the healthcare standars.

The message for commissioners as well as providers - public or private - must be: get the service users involved in all aspects of decision making in order to raise quality and effectiveness at the same time. That is a survival lifeline which healthcare is going to need in the coming lean years.

State of Healthcare 2006: Health Care Commission (Adobe PDF)

Patient-focused interventions: www.health.org.uk/aboutus/publications/research/QEI-Review-final.pdf

Read more about M-A-C's thoughts and approaches on collecting and understanding consumer and user data, and our article Emotions in Decision Making where we put our principles and experience to work and add value to research by understanding how to use data and also how to get data that is useable and prompts action. We like to field our surveys in partnership with Surveylab.

Andrew Craig | (Problem occured connecting to database: The server requested authentication method unknown to the client