Starting yesterday every patient in England who visits an A&E or stays in a NHS England Hospital overnight will be asked to complete the “friends-and-family test” which will then be published on the NHS Choices website (a website that has been run for the last 3 years for £60 million by Capita Group – a private sector business process outsourcing company).
I’m not a fan of this because I can see several problems emerging from this superficial method of introducing documentation:
1) Patient Privacy
This is not a new problem but where’s it made clear who and how this information will be handled? What’s being done with it? Are Patients allowed to use their real names/if not why not? How is this all going to be communicated by the NHS (an organisation that still outsources important Patient information distribution despite bans being in place?
2) What difference will negative feedback have?
Will Healthcare Workers who get negative feedback face disciplinary measures? If not why not? If it’s being considered why aren’t the regulators (like the GMC) involved in this survey? Will Patients be told about the potential for repercussions on their carers and their care? Is it possible that a Patient who expresses their opinion as they leave a clinic which is later posted on the NHS Choices website could be struck off by their carers (like we’ve seen happen already as a result of a Patient making a comment on social media)?
3) Extra administrative burden
When Patients are leaving hospital without detailed discharge notes where will the resources be found for this extra administrative task? Will Hospitals who are desperate to maintain their brand put their best staff on exit survey duties instead of in caring roles? Why would you be creating content (especially sensitive Patient generated content) for a website that we’ve been told is being wound down?
The NHS sadly seems to have learnt nothing from major Patient safety failures. Attempts to generate a quality estimate of care need to be appreciated in terms of the burden it will place on frontline workers and can’t be done without an increase in dedicated resources.
The Airline industry didn’t improve safety by asking customers did they enjoy the flight but by accurate documentation of what was happening and an acceptance of mistakes with the objective that we can learn from them so that they don’t happen again.
The success of consumer websites like Tripadvisor make it obvious how much power can be created by running a website that posts public opinions but not all NHS Patients have a choice over the hospital they go to and in many cases ratings themselves are impacting the care that hospitals provide (eg. good Hospitals get overcrowded, ‘bad’ hospitals get less Patients and encounter recruitment and financial pressures, etc, etc).
In my opinion creating more duplication of the processes for reporting bad care experiences will only ultimately do a disservice to Patients because this will increase the capacity for valuable feedback, Patient safety issues and clinical best practice to be missed and fall through the cracks.
When a Patient is leaving Hospital and the care has effectively finished is not the time to start documenting Patient needs. As Dr John Bachman MD, Professor of Primary Care at the Mayo Clinic, explains in the following video it should actually start before they even meet with their Family Doctor because it’s then that we have the opportunity to influence what care is provided and by whom. In an organisation like the NHS that might even mean Patients aren’t admitted to the Hospital in the first place…