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How to get great care for those you love

December 28, 2010

This could (and maybe should) be a book, not a short posting. Indeed, many others have written such books so I will keep this to a few key points that I hope will be useful to those needing to choose who treats them, or where in the UK they are cared for.

First key-point: yes, it really does matter who you choose and where you (or your friend, relative) are looked after. There is real variation across the NHS in outcomes and the experience of patients. Most patients get average care, some get excellent care, and a significant number get poor care. Don’t let yourself or a relative get poor care.

Second key-point: you can choose where you are treated on the NHS, you don’t have to go to your local hospital or the one your GP recommends. Similarly, everyone will soon be able to register with any GP they choose, not just the local/nearest practice.

More people than ever are using this right and ensuring that they get great care – make sure you are one of them.

But how to choose where to go and who to see is not made easy by the NHS. Indeed it is easier to find out about car-parks across Londonthan it is to get the detailed information about hospitals you need to make a sensible choice. NHS Choices uses CQC ratings – but these have been shown to be unhelpful in identifying some of the worst care in the whole NHS, and I (and the majority of doctors in the UK) do not use such data when choosing where to be looked after.

Third point. Ask the doctor/hospital for their outcome data for that specific procedure. So if you need an operation ask your GP to tell you the success rate and infection rates of any hospital or specialist she/he is sending you to. If your GP doesn’t know (and they should as they are responsible for choosing the best care), then call the consultant or hospital directly and ask for the information. Also ask them how they compare with other local hospitals and specialists. If not even they can tell you if they are any good, then you probably want to look elsewhere. After all, you wouldn’t fly with an airline that does not know its own safety-record!

Fourth point. Find out other information about the hospital that might give an indication of its quality. Write to the Chief Executive and ask her how her hospital compares with the other hospitals you are considering, ask her how they monitor safety and patient experience and if you could see the latest results. Easy enough to send the same letter to a few hospitals. Just seeing how quickly you get a reply will tell you something about how patient-focused they are.

(The same applies if you are moving to an new GP. Write and ask the practice why you should register with them, as opposed to other local practices. Ask for details of their patient surveys and clinical outcomes, and how these compare with other practices in the area.)

If you get the feeling that people mind being asked for this, or they resent your questions then get your treatment elsewhere. The best doctors and organisations monitor outcomes closely and will be proud to share this with you, telling you openly if the data is not available.

Fifth, and finally, be an active patient or relative. What does this mean? It means that you ask as many questions as you want whenever you are unhappy or do not understand something. If you are not satisfied with the first answer, then ask again. Again the best organisations and professionals will welcome this, they know that care that is truly patient-centric, open and honest delivers better outcomes for the patient and more satisfied staff. Many, many patients have avoided complications or worse due to the observations and concerns of a relative who felt able to speak out or ask questions. Indeed, a Chief Executive at a prestigious teaching hospital recently told me how a patient who tragically died in their hospital would probably have survived if the staff had listened to the repeated concerns of his relatives. At that hospital they have now made it a policy to encourage and support relatives to raise issues and questions and for staff to always respond and take seriously such concerns.

Of course, the above is most useful if you or your relative requires non-emergency care – but this applies to the majority of care provided by the NHS.

And finally, to help get great care next-time for those you love (and indeed for those you don’t even know) you should provide feedback to the doctor and hospital on what was good and what could be made better. Again, great doctors welcome and encourage such feedback, knowing that it helps them and their organisations continuously improve. Your responsibility as a patient or carer is to provide that feedback and help them improve.

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