House of Commons - Public Accounts - Forty-Seventh Report

Select Committee on Public Accounts Forty-Seventh Report

3 Engaging patients and the public in improving quality and safety

18. A key objective of the NHS reform agenda is to improve the patient experience by strengthening the involvement of patients and the general public in shaping the future provision of services. Patient and public involvement and the quality of the patient experience are two important components of clinical governance.[65] The National Audit Office found, however, that patient and public involvement is relatively less well developed than other aspects of clinical governance. It also found that the level of engagement with voluntary organisations supporting patients is low.[66]

19. The Department believes that public and patient representatives and speciality groups should have a say in the criteria against which doctors' capability will be assessed. The development of criteria by the Royal Colleges, speciality groups, and local participation groups showed how patients were increasingly having a say in how doctors' capability would be judged. The consultation on the role of PECs also identified the importance of PECs engaging with the voluntary sector in a way that they might not have been done previously.[67]

20. Unless patients are more involved in the process it will not be possible to develop an adequate machinery of monitoring and control to assess GPs' performance and how well they are listening to patients. At present only 30% of general practices have patient participation groups within them, but the Department is working with the National Association for Patient Participation to increase this to 100% over the next few years.[68] Its Expert Patients Programme also aims to train 30,000 patients with the intention that patients will be able to engage in real dialogue with their doctors over the future of their care.[69]

21. The quality of patients' experience depends in part upon smooth transitions between healthcare providers and 'seamless' delivery of service from the different organisations they come into contact with as they receive care.[70] Patients often have an unsatisfactory experience as they move between different parts of the NHS. Nine out of ten decisions that affect patients' lives and incur costs are made in primary care but 60 to 70% of the costs are in hospitals. The Department therefore aims to get primary care more involved in discussions which make a difference to pathways of care by providing incentives through practice-based commissioning.[71] Any savings made as a result of commissioning decisions made under practice-based commissioning can be used by practices for the benefit of patient care.[72]

22. One of the Department's key initiatives in the area of patient and public involvement is the development of Local Involvement Networks (LINks) to replace patient forums.[73] The Department told us that LINks will be larger, more networked organisations that will provide a better patient and public voice than patient forums centred around small executive teams. In the present system patient forums are also closely linked to individual organisations, whereas LINks will cover geographical localities and will therefore be able to address issues that cut across organisations.[74]

23. Part of improving PCT engagement with patients and carers involves effective complaints procedures so that information can be fed back and incorporated into future service design.[75] Although the NHS complaints procedure is an important mechanism through which patients can give feedback on the quality of care they receive, and 35,431 written complaints were received by GP practices in 2004-05,[76] the channels available for patients to complain about ill-treatment by a GP are inadequate.[77] The National Audit Office's survey of GPs also found that where GPs were involved in complaints, just half of GP respondents were routinely informed of the outcome of these complaints by the PCT. The Department agreed that this situation was unsatisfactory and that PCTs needed to learn how better to use complaints as a fundamental part of quality improvement.[78]

24. Patients have also experienced particular difficulties in registering complaints that cut across services provided by a GP, PCT and a hospital.[79] The majority of complaints to GPs are dealt with relatively quickly to the satisfaction of both the patient and the GP involved. Some complaints are not dealt with effectively, however, especially those which cross the dividing lines between primary and secondary care, or health and social care.[80]

25. The need for a complaints system which crosses organisational boundaries was highlighted in the White Paper Our health, our care, our say.[81] The Department would be consulting on proposals for a new complaints system shortly after our hearing.[82] A complaints procedure that links health and social care is expected to be in place by 2009.[83] Legislation aimed at improving the NHS complaints procedure came into force on 1 September 2006.[84]