The British Social Attitudes Survey published by The King's Fund revealed that public satisfaction with the way the NHS runs has dropped from 70% in 2010 to 58% in 2011.
This is the largest drop since the start of the British Social Attitudes Survey in 1983, after a decade of almost yearly increased dissatisfaction with the NHS. Regardless of the drop, the satisfaction level with regard to the NHS has reached the third highest levels since the start of the survey.
This year's British Social Attitudes Survey tracked the public attitudes of over 1,000 people who were surveyed from July to November 2011 with regard to key areas of public policy since 1983. The survey period coincided with the first year of a four-year long real term freeze in NHS spending and supported media coverage about the government's health reforms.
The survey results are available in a report together with various potential explanations for the drop in satisfaction, and also lists the drop in satisfaction amongst supporters of all main political parties:
Conservatives: A drop of 4% from 70% in 2010 to 66% in 2011
Labour: A drop of 13% from 74% in 2010 to 61% in 2011
Liberal Democrats: A drop of 7% from 74% in 2010 to 67% in 2011
Even though Labour supporters experienced a sharp fall in satisfaction, the figures nevertheless suggest the involvement of an element of political partiality. The report concludes that the decrease in satisfaction amongst all main political party supporters indicates that the results have been influenced by other factors.
Various key indicators and patient experience surveys have established that the NHS performs well, which leads to the conclusion that the drop in satisfaction does not likely reflect that the quality of services in the NHS has deteriorated. To the contrary, the report indicates that the most obvious explanations for the fall could be concerns over the government's health reforms, reactions to funding pressures and ministerial persuasions to justify the reforms, which when combined, may have led to a lack of confidence amongst the public as to how the NHS runs.
According to the results, satisfaction with individual NHS services has also dropped. Satisfaction with regard to GP services also dropped for the second year running by 4% from 77% in 2010 to 73% in 2011 whilst the satisfaction also dropped for hospital services:
Inpatient services: a drop of 4% from 59% in 2010 to 55% in 2011
Outpatient services: a fall of 7% from 68% in 2010 to 61% in 2011
A&E services: a drop of 7% from 61% in 2010 to 54% in 2011
The downward trend in satisfaction was countered by dental services with satisfaction increasing for the third consecutive year running with a 5% increase of satisfaction from 51% in 2010 to 56% in 2011. The rise in satisfaction seems to reflect improved access, as more dentists undertake NHS work in recent years.
John Appleby, Chief Economist at The King's Fund commented:
"The value of this survey is that it has tracked public satisfaction over a long period, providing an important barometer of how the public view the NHS. The run of year-on-year increases in NHS satisfaction had to come to an end at some stage, and it is not surprising this has happened when the NHS is facing a well-publicized spending squeeze. Nevertheless, it is something of a shock that it has fallen so significantly. This will be a concern to the government given it appears to be closely linked with the debate on its NHS reforms."
Written By Petra Rattue
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Coach trip: a new journey to manage long-term conditions
posted by Clare Wexler, CEO at Totally Health on 13 Feb 2013 at 6:59 am
The current model of long-term conditions management in the NHS is not sustainable. Clare Wexler, CEO, Totally Health http://www.totallyhealth.com , examines why commissioners and patients must behave differently if care pathways for the treatment of chronic disease are to improve – and why integrated, innovative technologies must form part of the solution.
There can be little doubt that improving the management of long-term conditions (LTCs) is one of the NHS’s biggest priorities. Around one in three people in the UK are currently living with a chronic condition, and a staggering £7 of every £10 spent on the health budget goes towards supporting them. It is estimated that by 2018, nearly three million people will have three or more conditions at once. The impact on the health service, both in terms of cost and the ability to deliver quality care, is significant; demand is dramatically outstripping resource. The impact on the patient, however, is even more critical. Health outcomes are suffering as, all too often, patients become disengaged from their care and are forced to endure unnecessary hospital treatment, or sustained unemployment, because their condition has not been managed optimally. The Health Secretary has vowed to free patients with chronic diseases from the “merry-go-round of doctors’ surgeries and hospitals” – but, without meaningful change, the situation will only get worse. To progress, we not only need to change the way the NHS works, but we must also transform how patients interact with their healthcare, and redesign care pathways to put patients at the centre. The current model of managing LTCs is unsustainable. The tipping point is fast approaching. It is time for the NHS and patients to think – and behave – differently. And technology will undoubtedly sit at the centre of the solution.
Technology: the great enabler The discussion has now moved beyond debating whether technology can play a part in transforming patient care. To succeed, it must. Tomorrow’s healthcare model must optimise technology, harness the power of information and share it across the health and social care system in ways that join up care, connect organisations and empower patients. Moreover, if the NHS is to deliver patient-centric services built upon the principle of ‘no decisions about me, without me’ – and in the process, facilitate more effective management of chronic disease – the integrated use of innovations such as telehealth and health coaching must become the rule rather than exception.
The recently-published NHS Mandate outlines an NHS Commissioning Board objective to drive a substantial increase in the use of technology to help people manage their health and care. It encourages CCGs, providers and local councils to collaborate to overcome the practical barriers that prevent services working together effectively – and in particular, challenges local commissioners to stimulate the development of innovative, integrated service provision across primary, secondary and social care. The Mandate promises to make ‘significant progress’ in helping patients with LTCs to benefit from telehealth and telecare, enabling them to manage and monitor their conditions at home – reducing avoidable hospital admissions and improving health outcomes.
With the emergence of a new NHS commissioning landscape just around the corner, CCGs and Local Authorities must indeed work in partnership to ensure that local health and social care budgets are not eroded by the inefficient management of long-term conditions. The most proactive will take advantage of innovative technologies that already exist.
At a national level, tools to assist shared decision-making between patients and clinicians are being implemented as part of the QIPP Right Care programme – and are, at present, providing patients with vital information across key diseases areas. Although this provides a powerful platform to nurture informed patients, it is widely recognised that, in isolation, educating patients is not enough to bring about true behavioral change. Individuals diagnosed with long-term conditions commonly require ongoing support as they seek to adapt their lifestyles. Health coaching, therefore, is emerging as a valuable integrated adjunct to shared decision-making that can help patients manage long-term conditions.
Integrated health coaching Health coaching programmes are proven to be highly effective in driving behavioural change among patients, to support specific disease management programmes. Their implementation is a simple and natural extension of existing processes. With early intervention widely accepted as the most practical and effective way of managing long-term conditions, high-risk patients that could benefit most from health coaching will commonly have been identified through standard risk stratification exercises within local health organisations. In the health coaching model, specially trained health practitioners act as individual case managers, and regularly engage in bi-directional telephone dialogue with target patients, combining treatment and lifestyle advice with education and disease management principles. This can help ensure patients adhere to recommendations in line with care pathways set out by local clinicians and commissioners. Crucially, health coaching programmes are conducted in partnership with local health organisations, ensuring that clinicians maintain total control of the patient relationship.
The approach has been shown to motivate patients towards a readiness to change unhelpful thinking patterns. It can facilitate patients’ confidence and skills in self-management, and help them prepare for consultations, proactively consider treatment options and encourage behavioural change. Moreover, with patients conscious that consultation time with their GP is limited, health coaching provides a valuable opportunity for individuals to discuss the longer-term management and implications of their condition – and proactively manage their disease.
Evidence increasingly underlines that where health coaching programmes have been deployed, patient satisfaction levels have soared and outcomes have improved. What’s more, as a consequence of individual behavioral change, unplanned emergency care across all sectors of the NHS and social care naturally reduces – with positive implications for the local health economy. The approach has clear benefits for all key stakeholders:
· Patients: quality of life improves, with fewer chronic episodes putting individuals in greater control of their condition · GPs: managing patients with long-term conditions becomes more effective and cost-effective, whilst total control of patient care is maintained · NHS: costs reduce and system capacity increases due to the avoidance of unplanned emergency care
Integrating care Integrated health coaching programmes are underpinned by robust technologies. Health coaches routinely – and transparently – capture vital health data and share it securely with key stakeholders across the health and social care system. This can alert clinicians when intervention may be necessary, inform future consultations and join up care. And as technology advances, the potential to integrate health coaching with mobile telehealth applications provides a powerful opportunity to tailor personalised care – ensuring that the right message gets to the right person at the right time, via the most appropriate route; telephone, text message, online or mobile app.
In an integrated care system, the key components of patient-centric services cannot operate in isolation. Electronic healthcare and telehealth offer tremendous potential to transform services. But on their own they will achieve little – they must be joined together. Health coaching provides a human mechanism to sit at the centre and evaluate all available, linked data, and identify areas where technology can help reduce costs and improve care pathways. Holistic systems that combine shared decision-making, telehealth and health coaching are therefore critical to the effective management of long-term conditions.
To optimise the opportunity, tomorrow’s commissioners must capitalise on today’s innovations. Fully integrated, scalable systems that can transform patient services can be implemented quickly and easily at low cost. Building a new model for the management of long-term conditions is not impossible – it’s already happening. And it works. It just requires some innovative thinking.
posted by Paul Fitzsimmons on 13 Feb 2013 at 5:00 am
As the NHS continues its current dramatic evolution, it is worth a pause for thought to consider exactly how the healthcare market will look in, say, five years’ time. Potentially it could be a radically different beast with the key to the change being data and how it will play a crucial role in the evolution. Data is already being used in a very different way, with it empowering patients like they have never been empowered before.
There is also a drive towards outcomes and quality that we haven’t seen before. What does this mean for the providers? Are they being asked to do too much with too little? And will this highlight a competitive advantage for those who can supply what’s needed?
With GP-led CCGs, it will be the patient who will be leading the charge in the dialogue about their care, how it is delivered and by whom. So how can the role of data develop with this ever-changing landscape to effectively aid suppliers, GPs and the patient?
Recent comment from Robert Harris, Director of Strategy, NHS Commission Board, indicated his thoughts on how “…we could be facing a potentially radically different market in five years, using information in different ways and empowering patients like they’ve never been empowered before and listening to them.”
He went on to say, “If we can identify data and information and it is a single source of truth and people can accept that it has its veracity, accept that it has application and purpose and accept that it’s the underpinning around any constructive conversation around service change and service improvement and if we look at information, whether clinical, financial, governance, outcomes-led or on social connectivity, we can do a lot more.”
He concluded that “…for every other industry that has undergone a radical transformation it has had information and data playing a radical part in informing and reinforcing the change and without it, we can’t have the debate or enable the we can’t make that big leap forward.”
The Information Strategy finally puts data at centre-stage and it is key for Trusts to be armed with the right information. The trusts which are using their information effectively will find they can empower clinicians and managers to take ownership of their performance, yielding improvements in their financial position as well as fostering a culture of collective participation in determining the future targets and actions needed to achieve them.
Decisions on how to fulfil these requirements successfully need to be based on the evidence. This will allow Trusts to address any problems and leave well-run departments to continue running efficiently, without jeopardising the level of patient care that healthcare professionals are providing. Not only should this be of paramount consideration now but it will be of key importance as we continue into the unknown realm of what tomorrow’s NHS will look like.
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