Select Committee on Health Written Evidence

26. Evidence submitted by Dr Foster Intelligence (PPI 125)

  Our response is based on our experience in a number of key areas:

    —  Working with three quarters of NHS acute trusts, in particular providing information on referral patterns, efficiency and quality.

    —  Managing campaigns to communicate health messages, including focussing on particular at risk or vulnerable groups.

    —  Producing information about healthcare providers for the public.

    —  Primary research with members of the public, for example, in relation to the configuration of services.

    —  Thought leadership and policy research in relevant areas.

  We very much welcome the committee's initiative to examine the issue of patient and public involvement. One of our key observations from our extensive experience in working with the NHS is that it has a long way to go before it succeeds in putting patients at the heart of the system.

  The debate around patient and public involved has become sterile. It has generated an industry of its own—including its language and a bureaucracy. "Involvement" has become an end of itself, rather than an integral element of the delivery of health and healthcare. On the whole, the existing patient and public involvement machinery has failed and alienated those its success depends on: patients and frontline staff, through inadequate or misguided consultation, jargonistic language and resource intensive processes.

  NHS organisations, commissioners and providers, need to develop their understanding of their "customers", those that they are trying to keep well, or who need health services. Firstly, they need to improve their use of existing sources of data, such as that routinely used by the market intelligence teams in other service providing industries. Using consumer lifestyle information, linked to health data, provides a powerful source of insight into populations, their behaviours and preferences. Understanding populations in this way, allows health organisations to improve public consultation and engagement, because they understand who they are involving and why.

  Secondly, the NHS needs to improve the feedback they receive from their customers and act on it to improve services. Hospitals and GPs are required to collect feedback on an annual basis which provides no meaningful insight into service delivery. Providers need to collect, analyse and act on data systematically. Commissioners need to ensure that evidence of feedback from patients is built into contracts and regularly monitored.

  The future system needs to redefine the language and case for patient and public involvement. It must avoid structures which set it apart from the commissioning and delivery of health services, if it is to deliver services which meet the needs and expectations of those who use it. The current system relies all too often on one board member or an individual within an organisation rather than promoting genuine cultural change.

  There are organisations which are working in innovative ways to engage their local communities and patients. Examples we are aware of include:

    —  Brent Teaching PCT—Local teenagers were recruited to distribute sexual health messages and a voucher system for free condoms to tackle increasing rates of teenage pregnancy and sexually transmitted infections. Reactions to the campaign were overwhelmingly positive amongst the target, teenage group. As one girl told the project team: "I don't want sex education from some posh woman from Surrey. I want someone my own age".

    —  Tower Hamlets PCT—the PCT identified a significant spend on unnecessary admissions to local Accident and Emergency departments. Analysis of focus groups and consumer data found that local residents trusted the opinion of hospital doctors more than local GPs. The PCT carried out a local education campaign outlining the appropriate use of local health services including GPs and pharmacists. Numbers of local residents presenting to A&E fell.

    —  Slough PCT—increased its early detection of diabetes by 164% by creating a tailored awareness campaign for local residential areas: Action Diabetes. Local diabetes patients, acting as health advocates, visited specific residential areas where populations likely to be at high risk of diabetes live. A mobile testing bus went to workplaces, shopping and leisure centres. The campaign also included a free health magazine, health information in different languages, celebrity support and local media coverage.

  Should the committee wish to interview representatives of the campaign or the organisations we would be very happy to facilitate this.

Tim Kelsey

Chair, Executive Board, Dr Foster Intelligence

January 2007

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