Are patients’ voices listened to?

As the month-long celebrations of the 70^th anniversary of the NHS draws to a close, Victoria Winckler asks if patients’ voices are being heard and explains why it’s important that they are.

The last month has been an extraordinary one for the NHS publicity machine. On the one hand there have been TV and radio shows, multi-faith services attended by Royals, bed-pushes and tree planting. On the other, there have been stories about women enduring severe pain from vaginal mesh implants, damning reports about the quality of mental health services, and worries about recruiting NHS staff. Are those organising the celebrations in denial? Or are the stories of harm done in exaggeration?

A bit of both

One of the things I have always found quite extraordinary about the NHS is that once you get away from the ward or the consulting room, patients all but vanish. I was briefly a non-executive director of a health board quite a few years ago. It was often hard to remember that behind in the targets for ‘referral to treatment’ or A&E waiting times were patients, either getting treatment on time or, for a minority, having to wait. Sadly it was often only when things went badly wrong that we heard the voice of experience in the form of media coverage, Ombudsman’s reports or safety alerts. The then health board did have an excellent patient experience and patient story programme, from which a great deal could be learned, but if there was pressure on the agenda you can guess which items got curtailed or dropped.

Patients are equally invisible if I crunch the Welsh Government’s health statistics. Stats Wales has every permutation of information you can imagine – waiting times for cancer, cardiac and cataract treatment, rates of delayed transfer of care, and ambulance response times to name but a few. But this is all management data – there is very little about what patients’ experience when accessing or using the NHS.

The exception is the National Survey for Wales, which gives some tantalising glimpses into what the public thinks – and then stops. For example, the survey of people’s views about GPs tells us that 37 per cent of respondents were dissatisfied with the ease of getting an appointment. Not only is that data nearly four years old but it does not tell us why people were dissatisfied. Was the phone permanently engaged? Did they want to see Dr Williams only to find she is on holiday? Was it an appointment for a routine check-up or an urgent same-day appointment? We just don’t know.

And so there’s a problem

The public overwhelmingly support the NHS. A survey in England found that around 90 per cent of people support its founding principles, and 77 per cent want to maintain it in its current form. And the real acid test is that two-thirds (66 per cent) would pay higher taxes themselves to fund it.

But public trust and confidence will quickly erode if the NHS does not match their expectations or if they come to fear it will do more harm than good. It does not matter whether that is based on their own experience, reports of abuse in mental health settings or rogue surgeons. The little things matter to patients too, like a nurse being kind or a welcoming GP receptionist, as well as the big things like mis-diagnoses.

The NHS is an extraordinary institution providing a mostly great service. But decision-makers and managers need to put patients at the centre of everything they do, listening to and learning from their experiences. This is not just because listening to the people who use your service is a basic principle that any organisation should adhere to, but because the future of the NHS depends on the public continuing to support it. If that support begins to fall below a critical level, the founding principles of the NHS will not survive.

We want to makes sure that everyone, no matter who they are, has free access to comprehensive, good quality services. We’re asking for your support to make this a reality. Please give to our Bevan NHS Birthday Gift Appeal at https://www.bevanfoundation.org/bevannhsbirthday/.

Victoria Winckler is Director of the Bevan Foundation.