NHS still has a long way to go to achieve a ‘patient-led’ service, says the Healthcare Commission
Despite improvements the NHS still falls short on putting patients first, says a watchdog. The NHS still has a long way to go to achieve a ‘patient-led’ service, says the Healthcare Commission.
The independent Commission is publishing its flagship annual report to Parliament on the state of healthcare in England and Wales, focusing for the first time on the experience of patients.
The Commission strongly praises the improvements that have taken place in some services, such as cancer and heart services. But other services have been left behind, such as sexual health, mental health, maternity and dental services.
The Chairman of the Healthcare Commission, Sir Ian Kennedy, said:
“There are many achievements to celebrate in the provision of healthcare. Services subject to targets and the requirements of national frameworks have produced significantly better outcomes, particularly for people with cancer and heart disease. People are not waiting as long for care in hospital. New ways of providing services, such as NHS Direct and walk-in centres, are helping to make services easier to obtain.
“The Government has set itself the aim of a ‘patient-led NHS’. But our health services still have a long way to go before we can say that they are really putting patients first. Being an NHS patient is too often a frustrating experience. Services can seem fragmented and seem to be designed more to suit the needs of those providing them than those using them. People want better access to services, and they also want to understand what doctors tell them and to be treated and spoken to in a caring manner. They need more comprehensive information about their health and appropriate involvement in the decisions about their care and advice on how to look after themselves when they leave hospital.”
The picture in Wales is harder to judge because the information is more limited. However it is clear that access to care in Wales is improving. The number of people waiting longer than 18 months for an outpatient appointment is down from 6,270 in December 2004 to 28 in March 2005.
The report asks three questions: do people receive effective healthcare services, do they have enough control over the care that they receive, and do some get a better deal from healthcare services than others.
The report pulls together the most available existing evidence on the experience of patients, including the Healthcare Commission’s own surveys of patients. The emerging findings were also checked with a series of patients groups.
In relation to the effectiveness of care, while overall patients’ satisfaction is high for most NHS services, there are a number of areas highlighted as concerns:
* Many people across the country have difficulty making an appointment with an NHS dentist. Nearly 60% of NHS dental practices are not taking on new patients, an increase from 40% in 2001. In some areas, no dentists are taking on new NHS patients.
* There are long waiting times for sexual health services, with 28% of people who need to be seen urgently having to wait more than 48 hours and 29% of people who have symptoms waiting more than two weeks. Only half of sexual health clinics in the UK are open more than 21 hours a week.
* Many maternity services do not meet the needs of women. Three independent investigations into maternity services over the past two years have highlighted a range of problems including: inadequate support and information for women who do not speak English; over-crowding; poor standards of cleanliness, and a lack of support and advice on issues such as feeding and bathing.
* Although services have improved for some people who need for mental health care, many mental health services still fall short of what people need. For example: fewer than half the people needing crisis care report being able gain access to it; half of people with depression are not receiving treatment; 23% of those on mental health wards and learning disability wards report having to share rooms with the opposite sex; and many people detained under the Mental Health Act say that their rights have not been explained to them.
On whether people have enough control over the care they receive, the Commission found:
* Many people are not getting enough information about healthcare, particularly about diagnostic tests and medication. Some say they do not have enough time to discuss their health with doctors and other professionals, and 70% of general practices did not have information available in a form suitable for people with learning disabilities. It is particularly worrying that more than a third of patients were not given information on the side effects of medicines, and 22% of patients with heart disease were not being told of alternatives to coronary artery bypass surgery and 49% were not given advice about necessary changes to make in their diet before being discharged.
* Many people have been given more control and choice over where they go for treatment. In areas where people were able to choose quicker treatment when they had waited six months, between 50% and 70% took up the offer. In England, 24,300 people have taken the option of faster treatment. In Wales almost 11,500 people took up the option for faster treatment in an alternative hospital.
* The Expert Patient Programme is an initiative that shows real potential and benefits, in terms of patients taking more control over the services they receive and the provision of help and support. In England, 17,000 people with long term conditions have attended courses to help them manage their own condition and become more involved in influencing how care is provided in their community. It has led to less use of A&E and greater confidence in patients in managing their pain, tiredness and depression.
On whether some people get a better deal than others, the Commission found:
* There are wide variations in service and treatment, depending on which hospital patients go to and where they live. These are again highlighted as a national problem. For example, rates of immunisation and the take-up of screening programmes, as well as stop smoking services, showed lower levels of take up in poorer areas. The experience of ‘seldom heard’ groups, such as people with learning disabilities, homeless people and travelers, can be significantly worse than that of others using the health service.
* Last year, the Commission revealed that primary care trusts (PCTs) serving more deprived populations tended to fare worse than others. This year, the Commission has found that extra funding is now going to PCTs in deprived areas in England, and distribution is now more in line with levels of deprivation. Progress has also been made in Wales, where £41 million has been redistributed and the five areas that were most below their target allocations in 2003/2004 are now getting closer to these allocations.
The report also highlights a number of lessons for healthcare organisations and regulatory bodies, such as the Healthcare Commission. In particular, it emphasises the need to:
* ensure services are assessed on a broad enough basis
* improve information for patients at all stages of their care
* involve patients and the public in the design of services
* spread good practice and take action on wider inequalities in health
The independent Commission is publishing its flagship annual report to Parliament on the state of healthcare in England and Wales, focusing for the first time on the experience of patients.
The Commission strongly praises the improvements that have taken place in some services, such as cancer and heart services. But other services have been left behind, such as sexual health, mental health, maternity and dental services.
The Chairman of the Healthcare Commission, Sir Ian Kennedy, said:
“There are many achievements to celebrate in the provision of healthcare. Services subject to targets and the requirements of national frameworks have produced significantly better outcomes, particularly for people with cancer and heart disease. People are not waiting as long for care in hospital. New ways of providing services, such as NHS Direct and walk-in centres, are helping to make services easier to obtain.
“The Government has set itself the aim of a ‘patient-led NHS’. But our health services still have a long way to go before we can say that they are really putting patients first. Being an NHS patient is too often a frustrating experience. Services can seem fragmented and seem to be designed more to suit the needs of those providing them than those using them. People want better access to services, and they also want to understand what doctors tell them and to be treated and spoken to in a caring manner. They need more comprehensive information about their health and appropriate involvement in the decisions about their care and advice on how to look after themselves when they leave hospital.”
The picture in Wales is harder to judge because the information is more limited. However it is clear that access to care in Wales is improving. The number of people waiting longer than 18 months for an outpatient appointment is down from 6,270 in December 2004 to 28 in March 2005.
The report asks three questions: do people receive effective healthcare services, do they have enough control over the care that they receive, and do some get a better deal from healthcare services than others.
The report pulls together the most available existing evidence on the experience of patients, including the Healthcare Commission’s own surveys of patients. The emerging findings were also checked with a series of patients groups.
In relation to the effectiveness of care, while overall patients’ satisfaction is high for most NHS services, there are a number of areas highlighted as concerns:
* Many people across the country have difficulty making an appointment with an NHS dentist. Nearly 60% of NHS dental practices are not taking on new patients, an increase from 40% in 2001. In some areas, no dentists are taking on new NHS patients.
* There are long waiting times for sexual health services, with 28% of people who need to be seen urgently having to wait more than 48 hours and 29% of people who have symptoms waiting more than two weeks. Only half of sexual health clinics in the UK are open more than 21 hours a week.
* Many maternity services do not meet the needs of women. Three independent investigations into maternity services over the past two years have highlighted a range of problems including: inadequate support and information for women who do not speak English; over-crowding; poor standards of cleanliness, and a lack of support and advice on issues such as feeding and bathing.
* Although services have improved for some people who need for mental health care, many mental health services still fall short of what people need. For example: fewer than half the people needing crisis care report being able gain access to it; half of people with depression are not receiving treatment; 23% of those on mental health wards and learning disability wards report having to share rooms with the opposite sex; and many people detained under the Mental Health Act say that their rights have not been explained to them.
On whether people have enough control over the care they receive, the Commission found:
* Many people are not getting enough information about healthcare, particularly about diagnostic tests and medication. Some say they do not have enough time to discuss their health with doctors and other professionals, and 70% of general practices did not have information available in a form suitable for people with learning disabilities. It is particularly worrying that more than a third of patients were not given information on the side effects of medicines, and 22% of patients with heart disease were not being told of alternatives to coronary artery bypass surgery and 49% were not given advice about necessary changes to make in their diet before being discharged.
* Many people have been given more control and choice over where they go for treatment. In areas where people were able to choose quicker treatment when they had waited six months, between 50% and 70% took up the offer. In England, 24,300 people have taken the option of faster treatment. In Wales almost 11,500 people took up the option for faster treatment in an alternative hospital.
* The Expert Patient Programme is an initiative that shows real potential and benefits, in terms of patients taking more control over the services they receive and the provision of help and support. In England, 17,000 people with long term conditions have attended courses to help them manage their own condition and become more involved in influencing how care is provided in their community. It has led to less use of A&E and greater confidence in patients in managing their pain, tiredness and depression.
On whether some people get a better deal than others, the Commission found:
* There are wide variations in service and treatment, depending on which hospital patients go to and where they live. These are again highlighted as a national problem. For example, rates of immunisation and the take-up of screening programmes, as well as stop smoking services, showed lower levels of take up in poorer areas. The experience of ‘seldom heard’ groups, such as people with learning disabilities, homeless people and travelers, can be significantly worse than that of others using the health service.
* Last year, the Commission revealed that primary care trusts (PCTs) serving more deprived populations tended to fare worse than others. This year, the Commission has found that extra funding is now going to PCTs in deprived areas in England, and distribution is now more in line with levels of deprivation. Progress has also been made in Wales, where £41 million has been redistributed and the five areas that were most below their target allocations in 2003/2004 are now getting closer to these allocations.
The report also highlights a number of lessons for healthcare organisations and regulatory bodies, such as the Healthcare Commission. In particular, it emphasises the need to:
* ensure services are assessed on a broad enough basis
* improve information for patients at all stages of their care
* involve patients and the public in the design of services
* spread good practice and take action on wider inequalities in health
http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4018541&chk=KvG1sX
posted by Dr Search- Principal Consultant at the Search Clinic at
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