Public involvement in NHS inspections needs to go further

Sir Mike Richards is the new CQC Chief Inspector of Hospitals and he has announced his new plan to include patients in hospital inspection teams. This is a good idea, and means that although a hospital will know an inspection is on it’s way, it won’t know the exact timing. This gives people locally the chance to attend ‘Town Hall’ style meetings to share their experiences, praise and concerns ahead of the visit.

The idea’s strength rests on involving patients, thus increasing their confidence in local services and offering accountability. However it has it’s weaknesses too: Most people feel attached to their local services, and Sir Mike’s idea is to include a “50 mile rule” that will not allow local people to inspect local services. Call me parochial, but the public care most about what happens on their patch, not on the other side of the county. Added to this the traveling time will be a deterrent to those on low incomes (even though expenses are reimbursed) and older people. Bias is unavoidable; what matters is the evidence and experience for the bias and whether it stands up to scrutiny. You are as likely to get people unduly positive about a local service as negative.

There is a significant flaw as well (which was touched on as a need in Sir Bruce Keogh’s report) in that the inspection will not lead to real time feedback and improvements. We have some excellent live feed-back mechanisms already in hospitals (the DLS patient feedback app, electronic bedside experience reporting) and these should be mandated. Many issues can and should be resolved quickly. If you are an in-patient, it will be no consolation to you that is two years time, the service might be better. No other business would settle for this – and we must see the NHS as a business, invested in by you and me, and accountable for the way it’s spends our money and the service it delivers. Sir Bruce listed real-time feedback in his third ambition as one way hospitals can enable patients to be treated as equal and vital, confident that their feedback is being heard.

Last week I was in Washington DC looking at the Veteran Affair’s use of technology in their Health Administration. This included:

  • Truth point – bed side ipad-enabled feed-back run by volunteers
  • Hawkeye phones around the hospital – orange phones on which anyone can leave a message about their experiences
  • Ambassadors – staff from all levels spending 2 hours of their working day (for 60 days!) observing behaviour in their hospital and picking up immediately with everyone from porters to consultants on good and bad service.

All information is reviewed at 3pm by the officer in charge and by the Senior Management Team the next morning. Every day.  This, to be honest, is exactly what every NHS organisation should be doing daily.

We also need to recognise that the NHS desperately needs a fresh start. I am hugely concerned by some reckless MPs who are saying the NHS needs to be scrapped. Of course it’s not perfect, no system is, and all orgnisations need constant review for improvement. But have these MPs lived in another country and found a system, in totality, that is fairer, safer, better quality, better at training and with all-round better outcomes? I haven’t found one, and I write this as a daughter who saw her mother experience some fantastic care and some appalling neglect within the NHS.

Failure needs to be acknowledged but the current debate is dangerously politicised: the honest truth is that all governments have pressurised and manipulated the NHS for political gain. The fresh start should include dropping all process targets (e.g. 4 hour wait in A&E); truth and reconciliation events run in all Trusts; instigation of real-time feedback and accountability with results posted daily on each Trust’s website; patient involvement through inspection, patient held electronic records and personal health budgets; public clarity on who is responsible for what and how to get redress.

This all needs to be applied appropriately to primary and community care as well; the ambition for the NHS is for more people to be treated at home and they too need to have the reassurance that they too will receive high quality care that is inspected and kept accountable. Politicians may have handed over many levers for change to quasi-independent organisations, but Ministers still hold the purse-strings. Without demanding real time data, they cannot know what they are paying for.

About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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