“One particular concern was that a response would only be recorded as positive when a person said they were “extremely likely” to recommend an NHS service. Those who would be “likely” to recommend a hospital are to be regarded as offering a neutral response, and all other responses – including those who say they are unsure – will be recorded as negative. wThe Ipsos Mori report, commissioned by the Department of Health, said one focus group “got very focused on why ‘likelys’ were counted as neutrals and ‘neither/nors’ as detractors – which they felt did not accurately represent what the patients had meant when responding to the survey”… …The Ipsos Mori report added: “The public did not appear convinced that this was a necessary measure – with comments about the cost of implementing, and also that they would tend to rely on GP recommendations, or other data, such as mortality rates – to decide which hospital to go to. This emphasises the point that, if the public are to engage with this measure, the scoring mechanism does need to be simple, readily explainable and seen as credible.” The chosen design of the friends and family survey has raised fears that the new scheme is being used to undermine NHS hospitals just as people are being offered the chance to choose a private provider for operations. The controversial Health and Social Care Act encourages private providers to offer treatment to NHS patients. But as NHS hospitals currently offer the vast majority of services, there are concerns that the survey could work to undermine the NHS“
The idea of Exit Surveys rather than documented care is clearly an example of putting the cart before the horse to me but it’s encouraging to read the comments to this Observer article from the weekend if you’ve ever been concerned that Patients would be bamboozled by political stunts masquerading as attempts to improve the quality of care:
“The government structures its surveys to get the answers it wants. Undoubtedly the answer it wants here is whatever undermines the NHS and boosts the private sector.
If Cameron is so keen to know what patients think about their health services he only has to look out of the window to see thousands marching and campaigning to save their local NHS services and protect them from the rapacious private sector. Odd that he doesn’t seem interested in those voices”
“But there is no value in responding to the questions if, when I am asked if I am likely to recommend something and I reply yes I am likely to recommend it then the official interpretation is that I am not likely to recommend it”
“They generally only ask for people’s opinions when they need support for some counter-evidential policy. Opinions are great because everyone is entitled to one, even if they know nothing or are convinced of things that are provably untrue.
In this case, the question being asked is essentially “how much did you enjoy your experience of your friend or relative being sick/dying in hospital?” Not in so many words, of course, but when you’re asking non-firsthand service users to judge the quality of service that someone else received, you aren’t going to get meaningful data on anything other than how grieving or anxious people feel about illness, and you don’t really need to conduct a survey to know that”
“there are number of more extensive questionnaires that go to patients, or at least some patients, which produce a more complex dataset for analysis. It seems this friends and family approach is just a ruse to undermine the NHS. I mean, I might enthusiastically recommend that people go and see a film i enjoyed at the cinema – but healthcare isn’t about enjoyment, is it? So recommending a hospital might come with an uncomfortable connotation of wishing ill-health on someone”
“…Cameron personally launched the scheme, which comes into place this month, claiming that it could act as a “flashlight” on the NHS’s failings. Not as a means to act as a flashlight on all the successes of the NHS, or on the successes and failings of the NHS, just on the failings”
“I have the task of implementing this in my organisation… …my experience has been more of a lack of any clue by the current Dept of Health lot about surveying patients. Cameron decided this is what he wanted and there has been a ham-fisted attempt to make it work. There was a study before the work started by Picker which said very clearly that it was the wrong question to ask; this was ignored. The DH guidance is complicated, confused and parts of it are hugely difficult, if not impossible, to implement. It is a real mess but, unsurprisingly, it is being performance managed to the nth degree. In addition, the scoring, as described in this article, is based on the net promoter score, but the F&FT scoring is not the same which is where things run into trouble. The real net promoter score has 11 points (0-10) and people are asked to give a score on the scale (not asked extremely likely, likely to recommend etc). 9 and 10 responses are both considered as promoters. The brains at the DH opted to use a net promoter approach but change it to a different model. The whole thing has been a major fudge and will end up telling us not very much. The first full results won’t be available until July but early results are suggesting scores of 60+ which, if the results were comparable, would put the NHS in Apple territory. So if the aim is to highlight the failings, it looks like it could backfire”
“Haha, this is relatively smart by Camo’s standards. Firsthand users of the NHS aren’t giving you the resoundingly negative picture of the NHS that you want, so what do you do? Go to their friends and relatives! My brief experience working in a hospital’s social services department leads me to believe this was the intention. Friends and family of patients have a much more negative opinion of the NHS than the patients themselves, and it mostly has to do with them being frustrated – at feeling powerless to help their loved ones, and occasionally because they’re stroppy control freaks and/or fighting over inheritance.
So it doesn’t surprise me that someone who wants the NHS to look unsalvageable would turn to them. Whereas I think most of us would agree that no one who is not a firsthand user of the service is entitled to an opinion about the NHS in terms of its quality”
“They use these where I work too. What always puzzles me is no one is asking the staff to evaluate their managers on a scale of smiley faces. What might be more beneficial to the country is if we could all evaluate the government in such a way”
“The purpose of the surveys is to run down the NHS so that can be used as a further excuse to dismantle it and hand profit making opportunities to greedy people”
“Why isn’t one surprised that the survey responses are skewed to provide an anti-NHS prospective”
“I’m only shocked that it’s so blatant. ‘Likely to recommend’ being recorded as neutral? What kind of distorted mind thought that that was OK?”
“We had two surveys in 6 weeks when we made two visits on unrelated matters to our very good local GPs practise. Big glossy surveys which came through the post and obviously cost a lot to produce, and rather oddly worded questions. Wish now I had photocopied them. I sent the second one back with “why are you wasting my time, and by the way, who is paying for this survey?” scribbled across it. Since then – nothing”
“The whole point of it is to be misleadingly negative so that the private sector can ride to the rescue”
“A health department spokesman said a more generous system would have given a majority of trusts highly favourable results,
Because most of us think favourably of the NHS and most trusts are doing a good job. But let’s not let the truth spoil the Coalition’s wrecking party, eh?”
“No on wants it, it doesn’t do the job it is intended for and it wastes money so bin it! Oh wait a minute it skewes its results in a way that undermines the NHS to the advantage of private companies; now I see why this miserable shower of a government brought it in and probably won’t get rid of it!”
“Marking “likely” as neutral and “neither/nor” as negative is simply fraud. If you offer 5 responses, most people instinctively exclude the top and the bottom. Set up. Like every other evaluative tool of the NHS these days”
“A real ‘patient experience’: “I’ve nearly died three times from this ghastly condition that I may have passed on to my child. As I finally leave this hospital grateful to be alive but desperately worried about the future you’re now asking me to speculate what it would be like for my daughter to endure such pain and fear? Can you think of any good reason why I shouldn’t hit you?” My recommended alternative: “Please rate the Friend & Family test: 1. Inept; 2. Irrelevant; 3. Misleading; 4. Ripe for cheating and gaming; 5. Typical of this stupid government; 6. Downright cruel and hurtful. You may choose more than one of the above.””
So far there’s a 115 comments on that single newspaper article. For me Patient led Healthcare system redesign can’t come too soon…