Video: 11 May 2015.

Dan Wellings, head of insight and feedback at NHS England, told a recent HARC Forum that asking patients directly about their experiences and their outcomes is providing valuable data to help improve health services.

Giving patients a voice

The relatively simple step of asking patients whether they feel better after a health intervention is among a growing range of measures being used to drive change in the health system, a recent HARC forum heard.

The forum keynote speaker, Mr Dan Wellings, head of insight and feedback at NHS England, outlined several ways in which the organisation was collecting data on both patient experiences and patient reported outcome measures ‒ known as PROMs.

“Increasingly we’re moving to make sure health is not done to people, but people become involved in their health,” he said.
Mr Wellings outlined use of the Friends and Family Test (FFT), which aimed to measure patients’ experience in the health system by asking them at the time of their treatment, whether they were likely to recommend the health service or treatment to friends and family, and why.

So far, 6.5 million patients had completed the FFT and a review showed that 78% of Trusts (or hospital groups) reported the test had increased the emphasis they placed on patient experience, he told he forum.

“The vast majority of feedback we get is positive. It shows what is going well,” he said. “The key thing is that it is real time – not six months after the event”.

He said the test was mainly used as a service improvement tool, providing feedback to frontline staff and boosting morale. But it could also act as an early warning system, helping to identify problems – big or small – which health services could address.

A recently published UK study also showed that feedback from patients about the safety of care they receive in hospital, including  data from the Friends and Family Test can be used to drive safety improvements, (See below: Patient Feedback on safety can drive improvements).

Mr Wellings also outlined the NHS England PROMS program, which was introduced in 2009 and covers four surgical conditions: hip replacement, knee replacement, groin hernia and varicose veins.

Each year, 180,000 patients undergoing those procedures complete a questionnaire about how they feel pre-surgery. Three to six months later, they repeat the survey to assess if they feel better. The data on knee surgery suggested the procedure resulted in big health improvements for patients, he said.

PROMs data was also being used to identify hospitals that were doing well and those that were not doing so well, he said.  It had led to the establishment of best practice tariffs for hip and knee replacements, under which providers with significantly poorer outcomes received a reduced payment per procedure.

Bureau of Health Information chief executive Dr Jean‒Frederic Levesque told the Forum that a range of patient reported data was now being collected in NSW hospitals.

“We are listening to patients and what they have to say about their outcomes, and going beyond satisfaction to the patient experience and asking them how they feel their care has influenced them,” he said. “The real challenge continues to be linking all this patient data and other sorts of data.”

Dr Karen Luxford, director of patient based care at the Clinical Excellence Commission (CEC), outlined a number of initiatives aimed at collecting and responding to patient feedback, including the Patient Based Care Challenge being taken up by many Local Health Districts.

“Stories we hear, along with data, and the way we use these two things in combination, are for us some of the real drivers for change,” she said.

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