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Joan Saddler: Implications for putting patients and the public first

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  • 1. ‘Liberating the NHS: Legislative Framework and Next Steps’ Implications for ‘Putting Patients and the Public First’ Joan Saddler National Director of Patient & Public Affairs
  • 2. NHS reforms still dependon effective Engagement  3 Coalition reforms restated in Command Paper: (prioritises Patient and Public Engagement (PPE) A ‘patient-led NHS’ - highlights PPE Focus on outcomes - must involve patient experience as part of ‘quality’ Empowering professionals - GP commissioning requires PPE  ( Reforms to public health and social care not included here - but part of ‘wider strategy’ )
  • 3. Command Paper: Contents Introduction Putting patients and public first Improving healthcare outcomes Commissioning for patients Local democratic legitimacy Regulating healthcare providers Implementation and transition
  • 4. 1)Transition for cultural ChangeKey changes following consultation- 1 Longer transition period for reforms Stronger Health and Wellbeing Boards and joint working in health & soc. care GPC Pathfinder programme HWB Early Implementer programme HealthWatch England to have more distinct identity More transparency for GPCs
  • 5. Key changes following consultation - 2 Maternity services commissioned by GPCs, not NHS Cmsg Board Scrutiny role stays with LG - not HWBs Flexibility in commissioning NHS complaints advocacy GPCs to have stronger role in primary care quality improvement Arms Length Bodies to have explicit duty to cooperate with each other
  • 6. 2. Confronting the tension between mandatory and discretionary PPE leversWhy you should engage patients and public and take account of their individual and collective experiences:• Understanding patient and carer experiences of services can help you identify how to improve services from a patient perspective• Understanding patient experience of services allows you to define the outcomes of service reconfigurations from the patient and public perspective as a ‘measurable’ patient experience where redesigned care pathways are more patient friendly, efficient and understood by diverse populations.• Involving patients in their own health and care has the potential to boost outcomes, reduce unnecessary consultations, reduce health inequalities and unwarranted variations, improve patient experience, improve concordance with treatment and save money.
  • 7. 2. Confronting the tension between mandatory and discretionary PPE levers Why you have to engage patients and public and take account of patient experienceConsortia will be required by law (subject to parliament):– to involve and consult– to report on involvement in Annual Report– to consult LAs about substantial service change– to have processes to handle complaints, both about their own activities and for complaints escalated to them in their role of commissioner– to have regard to the NHS Constitution in carrying out their functions– to promote the involvement of patients in decisions about their care and promote choice– to reduce inequalities between patients with respect to outcomes achieved– to consult about service designationYou could be at risk of judicial review and /or referral to NHSCB and SoS. This could likely result in additional costs and delay and damage to local relationships and reputation– Operating Framework
  • 8. 3. Understand and using existingdata/evidence on what patients and thepublic want, need and get from the NHSWhy – Most patients say they want more involvement in decisions about their care, not less – UK performs quite well in most international health comparisons, but it is worst out of seven comparator countries when it comes to delivering patient-centred care – Patient experience is closely related to and influences clinical effectiveness and safety – Organisations that are more patient-centred have better clinical outcomes – Individuals’ anxiety and fear can delay healing (National Patient Survey, Picker, Kings Fund, NHS Alliance) We also need to ensure that engagement processes are efficient
  • 9. Developing lean, evidence based approaches to patient and public engagement and in GP commissioningA practical development framework for emerging consortia over the next 12 months• This is a practical framework to help emerging consortia and their clinical leaders to think through and begin to tackle how they build engagement and experience into their consortia from the outset• What emerging consortia need to be thinking about and doing• Developed with clinical stakeholders, it also identifies sources of support and advice. More information about the examples can be found at the Commissioning Zone
  • 10. Improving Public & PatientEngagement and experience is a long haul, not a quick fix As much about cultural change as is it is about availability of data:“Small measurable improvements in patientexperience may be achieved over short projects.”“Sustaining more substantial change is likely to requireorganisational strategies, engaged leadership, culturalchange, regular measurement and performance feedback,and experience of interpreting and using survey data.”(Davies et al 2008) 10
  • 11. Where to go for help and support• Commissioning Zone and Pathfinder Learning websites• Invest in Engagement website (Picker), PWC and Frontline products• SHA / PCT engagement leads ( LA engagement leads)• NHS Institute for Innovation and Improvement• DH policy teams and website• RCGP, BMA, NHS Alliance and NAPC• The Independent Reconfiguration Panel (http//www.irpanel.org.uk)