Readers' letters – 19 July 2012

Empowered by information

The recent survey from the NHS Confederation, which shows that NHS bosses expect quality of care to fall, raises important questions about how trusts make decisions on where to make cost savings.

To achieve significant efficiency gains, trusts need to be armed with the right information. Some hospitals will already know where their inefficiencies lie. They will have reviewed their inpatient and outpatient activity, assessed theatre utilisation, prescribing, staffing levels and many other factors. They will have collated and analysed the information and be monitoring how their cost improvement programmes are affecting quality of patient care. More trusts need to adopt this evidence-based approach. 

Many services will be running efficiently already and providing good quality care. To find the real opportunities to make savings - rather than arbitrarily topslicing budgets across all departments - trusts must use their data. The long-awaited information strategy finally puts data at centre stage. The trusts that are using their information effectively have found that it has empowered clinicians and managers to take ownership of their performance. This has yielded improvements in their financial position as well as fostered a culture of collective participation in determining the future targets and actions needed to achieve them.

Although it is mandatory for healthcare organisations to make significant efficiency savings, the decisions on how to fulfil these requirements successfully needs to be based on the evidence - evidence that is available in every trust if only they can get to it quickly and easily. This will allow them to start fixing the problems and leave well-run departments to continue running efficiently, without jeopardising the level of patient care that healthcare professionals are providing.

Paul Fitzsimmons, managing director, MedeAnalytics

Short on details

It had been hoped that the Department of Health’s recently published information strategy, The Power of Information, would provide clear and concise guidance on how the NHS could embrace IT as a means of increasing safety and improving the quality of healthcare delivery. Unfortunately, the strategy proved long on the reasons why, but short on the how - with the notable absence of detail on interoperability, coding standards and data structures.

The need for a standards-based, rather than a product-based, approach to interoperability is unequivocal. Companies wishing to supply IT solutions to the NHS must unite around a common data model and a common coding system, and comply with the information standards board outputs that already exist. Indeed suppliers, through the adoption of these interoperability standards, will ensure that all future systems become patient-centric throughout the care pathway - the key to successful systems delivery within the NHS. In fairness, most of what is required to develop national standards has already been written. It simply needs to be put in place and be directive enough to make a difference. In the interim, under the current circumstances, the situation would be vastly improved if there was guidance on the technical standards that will be mandated by the NHS Commissioning Board.

If the goal to build a high quality, patient-centric integrated care system, with increased safety, is to be achieved, IT must play a vital role at the centre of it. Particularly IT that allows patients easy access to their own data. In an NHS battling financial constraints and widespread reorganisation, technology can help to save money and save lives. And that will be better for local health economies, better for the NHS and, most importantly of all, better for the patient.

Professor Michael Thick, vice-president, clinical strategy and governance, McKesson

The invisible health service

I was interested to read your recent article on the importance of the voluntary sector in healthcare and their need to show its value.

I agree that these groups most probably play a substantial role in healthcare which is largely taken for granted in the same way that carers save the NHS tens of millions of pounds every year.

It is, to a degree, a “hidden role” but one that would become very noticeable if these services were further eroded. The government puts great store in its Big Society of a more caring sharing society, although cynics might say the call for more volunteers is simply a band aid to cover huge cuts being made elsewhere.

I don’t think many hard-pressed GPs are truly aware of the scope and involvement of local community and voluntary groups and clinical commissioning groups’ closer involvement with local authorities may be a good opportunity to forge a more direct relationship with them.

We can ill afford to not work with groups that have such strong community ties.

Dr Howard Stoate, chair, Bexley Clinical Commissioning Group

Cambridgeshire: on target

I would have welcomed the usual ‘right to reply’ to the article “Revealed: DH warnings to pipeline laggards”, to clarify that having agreed with the Department of Health a realistic timescale for our foundation trust application, Cambridgeshire Community Services Trust has met every target to date within our tripartite formal agreement. We have every intention of submitting our foundation trust application on 1 November.

I am proud to lead a trust with such dedicated and high quality staff, without whom (and contrary to your “laggard” description) we would not now be well on the way to becoming one of the first foundation trusts in the country solely focused on specialist community health and social care.

Matthew Winn, chief executive, Cambridgeshire Community Services Trust

Back of the net

Dave West’s article “Research casts doubt on value of friends and family test” highlights the Picker Institute’s warning about the simplistic application of the net promoter approach being used by the NHS.

Such research is to be welcomed. But Picker spoke to fewer than 100 patients in a non-healthcare setting and overlooked the significant experience of using the question in the NHS and beyond.

The net promoter approach was developed by Fred Reichheld in his 2003 Harvard Business Review article. He suggested boards and organisations could cut through the mass of feedback data and focus on whether they were meeting the needs of those they served.

Since then the net promoter approach has evolved to be the industry gold standard. Many big firms such as Apple, Hilton, E.On, GE, Phillips, B&Q, the AA, among others, have successfully used the methodology. From 2008-11, hospitals in the east of England asked thousands of patients the question and NHS Direct has asked more than 18,000 customers whether they would recommend the service to their friends and family.

Based on this experience, and research by the King’s Fund and Kings College Hospital Foundation Trust for the Department of Health and the NHS Institute, NHS Midlands and East took the decision to roll out the friends and family test across its acute hospitals. Asking a single, simple question in a uniform and standardised way will facilitate benchmarking and comparison and allow boards and wards to focus on improving the patient experience.

Over the last two months more than 40,000 patients have been asked the question across the Midlands and East and it is already acting as a catalyst for action and debate. While we must continually check we are asking the right question in the right way, we must resist the NHS temptation to be insular and put provider interests above patient interests.

Dr Stephen Dunn, Director of Policy and Strategy, NHS East of England