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Why does the NHS so often accept “good enough” care?

July 3, 2013

Great care, not “good enough” care – unlocking the unrivalled power of transparent patient voice to transform the NHS

  1. What is the massive opportunity we have?

  2. Why is this so important?

  3. What could the Government do now to realise this opportunity?

  4. Why the Friends and Family Test is so important


1. What is the massive opportunity we have?

– Existing approaches to driving up the quality, safety and value of UK healthcare are fundamentally flawed.

– They are not trusted or understood by the public, they fail to engage clinicians, and – at best – report disasters many years after patients have been harmed or killed (Morecambe Bay, Mid-Staffordshire, Worcester etc.)

– The continued focus on out-dated methods of inspection and reporting, combined with bureaucratic approaches to sharing data in formats poorly understood by the public, means that UK healthcare remains stuck at least a decade behind other sectors with respect to harnessing the power of transparency and user experience to highlight excellence, expose sub-standard care, and drive up standards

– There is no longer any excuse for this failure to deploy the powerful, proven and transformative effect of real-time, continuous, transparent patient experience to raise the public’s expectation from an NHS that is merely safe, to one that is consistently excellent.

2. Why is this so important?

– There remains shocking, unwarranted, poorly understood variance in the quality of UK healthcare

– The number of people dying unnecessarily in the NHS as a result of this variance is the equivalent of a jumbo jet crashing and killing all on board each and every day of the year.

– In addition to this tragic, avoidable loss of life, the millions of pounds wasted on sub-standard care and dealing with its sequelae diverts funds from the rest of the NHS.

– Ratings and reviews by patients are known to be a timely, accurate and well understood metric of this variance in quality.

– Making such ratings a visible and standard part of UK healthcare will create an unstoppable force to drive out mediocrity and make expectation of excellence the new norm across the NHS.

– The need for this is greatest in primary care, where total absence of comparative information casts a huge shadow over government efforts to make transparency the norm in public services.

– The required approach can be delivered across the whole of the NHS before the end of 2014, at minimal cost and will be immediately understood by the public, patients and NHS staff.


3. What could the Government do now to realise this opportunity?

– Activate the public, not the NHS

  • Public campaign and messaging should not be “complain more”, rather it should be “feedback more – tell us what is good, and what needs to be improved”

  • Expectation should be set that all those receiving care, or their families, have a responsibility and obligation to provide feedback: “Your NHS needs you!”

  • Encourage public to be more questioning and demanding of their healthcare providers: “there is variance and you should choose carefully.”

  • This should focus on the Friends and Family Test – the public understanding and awareness of which is almost non-existent, despite it being designed as an initiative for the public to learn about the NHS, rather than vice versa

  • National switch your GP week: the public are often encouraged to switch utility providers, putting pressure on providers to provide excellent, high-value services. Suggesting the same to the public regarding their GP would, in a matter of weeks, ignite a public debate about the variance of NHS Care and the need for comparative information.


– Extend Friends and Family Test to General Practice immediately

  • Single “would you recommend” question combined with mandatory freetext: a “TripAdvisor for NHS General Practice“

  • In addition to fully sharing this feedback, uncensored or filtered, practices should be obliged to display their comparative performance on their surgery door and on their website

  • This comparative score (compared to local practices) should also be mandatory as part of information given to new patients before they register with the practice: “informed consent for GPs”

  • There are no barriers to full deployment of such a system across General Practice with immediate effect: it imposes no workload on surgeries, and has zero cost implications.


– Build on the success of the Hospital Friends and Family Test

  • FFT in NHS hospitals has been an initial success, but far more needs to be done

  • Freetext should be a mandatory part of the system (currently optional)

  • All hospitals should then be obliged to publish every comment and review on their website

  • As with GP practices, comparative scores should be displayed at the hospital main entrance and on their website

  • The response rate required of hospitals needs to be raised to 40% of all patients, from its initial “aiming low” 15% target.

  • The FFT can be a transforming catalyst in NHS acute care, but this requires clarity and focus to move beyond its initial, limited deployment.



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