If we listen to patients, they will give us the route map to success. We will have better patient safety, improved staff retention and better finances.
When people take the time to tell us what is wrong, it’s vital to listen and to take action. Over two hundred people have contacted me since I started in post, covering a wide range of concerns. As well as pelvic mesh and sodium valproate, two of my priority areas for this year, I have heard about the tragic consequences following isotretinoin use, devastating impacts from PIP breast implants, rare and catastrophic side effects from fluoroquinolones and the delays that patients are facing in seeking redress from Covid 19 vaccine damage. These along with many other concerns leave patients stuck in a system which continues to be slow, siloed, disjointed and lacking compassion.
Report after report highlights the same issues, the lessons may be learned but they are not being implemented. Why do we spend so much time on quality failure but don’t fund an implementation plan for success? What would we think if a rail company continued to send trains knowingly on a damaged track? How strange it would be if they had no link between safety findings and the resources to put things right. But that is precisely what happens in the health sector today. The National Patient Safety strategy is so welcome as it brings patients and families into the conversation, helps to identify potential causes of harm and seeks to remedy these, locally and nationally. Success is when we start these conversations before harm has occurred, inviting patients and families to help develop the systems and processes with patients seen as part of the team.
Who is responsible? The answer is that we currently have distributed responsibility which gives each organisation the ability to say ‘we have done everything in our remit’ while patients are still falling between the cracks. Look at the ongoing safety concerns about Sodium Valproate and the fact that a baby exposed to the medicine in utero is born every ten days. With pelvic mesh, tens of thousands of women were harmed because patients were not given the right information to make a choice about their treatment and were not asked about their experience.
What’s going to make the difference? Headlines such as ‘NHSE turns the screws on dozens of trusts without acceptable financial plan’ demonstrates what matters to regulators. When the conversation is only about money, it increases the risk to patients.
This is a system problem which requires a system solution. It takes a leadership intent from the top to understand that listening to patients is the answer. We will know that the direction has changed when contract monitoring, assurance meetings and inspection all ask: ‘how well do the services meet the needs of the population you are serving?’ The only way to know this is to co-design services with patients and communities, to ask whether their needs are served, and then make improvements.
When Tesco plans a new store, they establish a representative customer panel drawn from the local community. They ask the panel, what would you like to buy, then set up a mock store to see if it works for their intended customers. Tesco remain intensely curious about whether the store works for the people it is due to serve by continuing to ask for feedback. Because they know that customers will give them the route map to success.
I hear from NHS CEOs that around 40% of their time is spent talking about money and about 5% of time talking about patients. Not all trusts have appointed Patient Safety Partners or patient directors, but this goes unmonitored, and I have never heard of a trust being ‘reprimanded’ for this delay. When the headline reads: ‘NHSE turns the screws on dozens of trusts without acceptable methods of listening to patients and communities’, we will know that we are on the right track.
Patients lack power in a system which isn’t listening or acting on their concerns. I want to see the conversation changing so that the NHS England framework objective of ‘strengthening the hands of those we serve’ is the NHS England talk track. And when the Care Quality Commission inspections focus on how well an organisation or system is meeting the needs of the community it serves, and how people know that this is the case. We need a system that unlocks resources to implement recommendations from a national body. These changes will make all the difference, turning the focus towards quality improvement and away from a relentless focus on quality failure. These changes will prevent harm, release time to care, improve staff morale, reduce the financial burden of harm, and create a health system that the public deserve and the workforce desire.