Barbara Harpham is chair of the Medical Technology Group and a former Conservative Parliamentary Candidate.
This Government’s campaign to improve transparency in the NHS has been one of its outstanding successes. Focusing on quality, outcomes, safety, and a better patient experience, there’s now a broad range of health service information available to help patients and clinicians reach the right decisions together.
We’re moving closer to Andrew Lansley’s vision as health secretary: “No decision about me, without me.”
So, for example, we have figures on local mortality rates and accident and emergency waiting times. There’s also MyNHS, part of the NHS Choices website, where patients and professionals can compare the performance of their local hospital, GP surgery and services.
It’s an unprecedented level of openness in our healthcare system. But we need to go further. Much further. I think we’ll only be able to say we have true patient choice when detailed clinical outcomes figures are published by patient age, by consultant and by hospital.
Outcomes data by region is available, but this falls way too short to be truly valuable. Patients need fuller information to be able to make informed decisions about their care, and they should have it.
They also need to be fully, and objectively, made aware of all treatment options, even if they’re not provided locally, as well as given information on possible complications and risks.
I’d like to see the next Government clear the path for even greater transparency, with a manifesto for healthcare that includes all, or at least some, of the following:
Patient information and choice
Ensure patients are fully informed about all treatment options. This could be done by enforcing Government and General Medical Council policies. Currently it’s devolved by the Department of Health to Clinical Commissioning Groups (CCGs), but many ignore this responsibility.
Patients should be sent information about all possible treatment options before their out-patient appointment, as recommended in some National Institute for Health and Care Excellence (NICE) clinical guidelines. They could then discuss this with their doctor, even if not all the treatments were available at that particular provider.
There should be a central information point for all patients on available treatments. This could be on the Patient Choices website and accessible at GP surgeries. Information on hospital websites about the treatments they offer, and patient information leaflets under each disease, would also be useful.
Mortality, morbidity and outcomes data
In my view the data published to date is welcome but it needs to go much further. What’s needed is what has been promised, but has not yet been delivered – data relating to individual consultants.
The information also needs to be more accessible and understandable for patients. You only need to glance at the Patient Reported Outcome Surveys data (PROMS) to see how patient questionnaire responses can be turned into incomprehensible data that looks more like binary code.
We know, for example, that patients respond to information about MRSA infection and use it to choose which hospital to attend. But we need to add to this and make sure that other data is also accessible to patients, on consultant, treatment and hospital outcomes, so they can make an informed choice.
This will be better for patients and, ultimately, will improve care.
Measuring patient experience
Patient satisfaction and experience should be continually measured and fed back to managers and clinicians to improve standards. It’s also important to ensure patient confidentiality and anonymity, so patients can respond honestly about their experience.
Providers too should be rated on an on-going basis to see if they are improving, down to department level, so the public can use the information to choose a hospital and the hospital can improve its performance. Successful managers should be rewarded and complaints acted upon.
Improving clinical standards
The focus on raising clinical standards has been good, especially compared with the last Government’s handling of the crisis at Mid Staffordshire, the abolition of the Community Health Councils (CHCs) and the dumbing down of the patient complaints system.
I think other measures are also needed though. I’d like to see a national body established to investigate medical accidents. The House of Commons Public Administration Select Committee has called for this because, it says, the current patient safety system is too complicated and takes too long.
Information on outcomes and deaths by consultant should be available and follow-up action taken, including involving the Royal Colleges. The NHS should act on evidence and clinical audits to ensure that the worst consultants are improved, or that they stop providing specific procedures.
I’d also like to see the patient complaints procedure put it back to where it was under the last Conservative Government, and we should help and support whistleblowers and investigate and act on their concerns.
Review older treatments
All new treatments are reviewed by NICE for safety and efficacy. However, some older treatments – for example hysterectomies – have not been formally reviewed, and they should be.
The Government’s approach to transparency is a bold move, but in my opinion it can and should go further. A more transparent NHS will spark innovation and change, and will lead to better care, better outcomes and a better patient experience.
It’s not, as the left may say, about spending more. It’s about using our resources more efficiently.