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02 CHAPTER TWO
WHAT DO PATIENTS EXPECT?
01 The Wanless Report (Wanless 2002)
described a vision of the
NHS in 2022 in which patients'
expectations will be focused on five key areas:
- safe, high-quality treatment
- fast access to services
- an integrated, joined-up service
- comfortable accommodation
- a patient-centred service.
02 All of these issues are already on the
agenda for
NHS Scotland. But from the government's
perspective, it cannot be a one-way street. Alongside
promotion of involvement and partnership for patients,
there is a growing emphasis on encouraging people to take
responsibility for their own health. That has begun to take
effect in promoting changes to unhealthy lifestyles and
diet to prevent illness, but increasingly it will involve
self care of specific existing conditions.
03 The literature around health service
change is littered with references to 'putting patients
first' or 'patient-centred care'. In a sense, our report is
the same. But there are two important differences between
our and others' reports.
04 First, we have asked patients what they
want and need in public meetings and in a range of
discussions with patient groups. Second, we have tried to
anticipate how those needs might change in the future in
relation to the kinds of illness that people will have and
to their changing expectations.
Regional public meetings
05 During December 2004, the National
Framework's Advisory Group held public meetings in
Edinburgh, Glasgow, Dundee, Aberdeen and Inverness. Each
took the form of a debate, with audience participation
encouraged. They were all lively sessions with ample
opportunities for people to voice their views.
06 Though some of the issues raised were
local in nature, common themes arose which indicated that
many people share the same opinions about delivery of
health care.
07 Patients' priorities as expressed at
the meetings are to have safe, high-quality care as close
to their homes as possible, though they seem prepared to
travel for highly-specialised treatments.
08 It was stated at many meetings that
waiting times are generally considered to be too long. The
majority of members of the public backed the expansion of
role development in the
NHS, agreeing that being seen by an
appropriately-qualified health professional, not always a
doctor, would be perfectly acceptable. They would be quite
happy to be seen by a highly-trained nurse specialist or
physiotherapist, for example.
09 Concerns were expressed about
out-of-hours' services, with a good deal of discussion
around the effectiveness of
NHS 24. Other key topics included health
care for older people and support for carers, both in terms
of respite care and ongoing access to help and advice.
Remote and rural meetings
10 Following the regional meetings,
members of the Advisory Group visited rural and island
communities to get a clearer view of what issues are of
particular concern there and exactly how they differ from
those in urban areas. They went to Shetland, Orkney, the
Western Isles, Ayrshire and Arran, and the Borders. The
common themes emerging were similar to those at the
regional events.
11 Centralisation of services is a major
concern in rural and island areas. The overriding problem,
however, is staff recruitment and retention, difficulties
with which were raised at many of the meetings.
12 Transport was raised as a topic at
every event, the main concerns being journey times and lack
of co-ordination between appointment slots and travel
arrangements. The main priority of patients, it was
emphasised, is to have safe, high-quality care close to
home, though there was acceptance of the need to go to
major centres for highly-specialist attention.
13 New technology was a much-debated
subject, with particular emphasis on the importance of an
integrated information system for patient records and the
expansion of telemedicine. Another clear message coming
from the meetings was the importance of individuals taking
responsibility for their own wellbeing.
Putting the evidence together...
14 By and large, people at the public
meetings seemed happy with the service they were getting,
had worries about recent deterioration, but were hopeful
about the future. The National Framework should make a
contribution to ensuring that their confidence is not
misplaced.
15 The feedback received at public
meetings was very much in line with the findings of the
survey undertaken by
NOP Social and Political in 2004 on
behalf of the Scottish Executive. That survey of 2600
adults showed high satisfaction with
NHS services. It revealed that about 90%
of patients were 'very' or 'fairly' satisfied with the
services covered in the survey. This is an important point.
Health services in Scotland are delivered by
highly-skilled, committed people who strive to do their
best for patients. We need to build on that, to develop and
improve rather than to denigrate.
16 But within the results of the
NOP survey were one or two areas for
concern. There was evidence of a link between satisfaction
and access to
NHS services. There was also evidence
that rather more people thought the
NHS had got worse over the previous few
years than felt it had improved (27% against 20%). Around
half the sample thought there had been no change.
17 In contrast, there was a net positive
balance with regard to the future - 39% expected
improvements, while 23% thought the situation would worsen.
Interestingly, these attitudes to the future did not vary
according to whether people had been users or non-users of
health services in the previous 12 months, suggesting that
people's views and expectations are influenced by factors
other than personal experience.
What do patients expect?
18 What does all this tell us about the
service that patients will expect in the future?
19 Patients will demand safe, high-quality
treatment with minimum variation across the country, and
will want to be active partners, rather than passive
recipients, in their care. They are likely to value
'high-tech', proactive services delivered by staff who are
at their best. They will be reluctant to wait and will
expect the service to be more joined up. If they have to go
into hospital, they will expect higher-quality
accommodation and food.
20 They will want services that are
tailored to their needs and which meet the best standards
of customer care found elsewhere. In healthcare terms, that
might mean quicker access to a health professional at
convenient times. Current waiting times for diagnosis and
elective treatment are unlikely to be acceptable. The
health service will have to be quicker, sharper and smarter
at the point of delivery.
21 The analysis above is supported by work
done by the Picker Institute, a
UK-registered charity that works
extensively with European healthcare providers to obtain
feedback from patients and promote patient-centred care. In
its 2003 study, 'The European Patient of the Future', the
Institute found that 'people want better access to health
care, better communication with doctors and greater
participation in clinical decisions affecting their own
health care' (Coulter and Magee, 2003).
22 The study also showed that people felt
that as citizens, they should be able to help shape health
policy, and that their views on priorities should be
listened to by policy makers. Again, this chimes with the
feedback that the National Framework team received at their
public meetings.
Into the future
23 Recent work on how wider trends in
society and customer experiences in other sectors might
impact on the healthcare sector suggests that in 20 years
time, patients may be very different. The research
indicated that in future patients will:
- be better informed
- be more educated
- not have enough time to get things done
- be more affluent
- be less deferential to authority and
professionals
- have more source against which to compare the
health service
- want more control and more choice - they will
reject 'one size fits all' services.
24 Despite these changing expectations and
challenging demands, there is little or no evidence to
suggest that patients will change their basic support for
the
NHS and its core values. The ethos of
the
NHS - comprehensive care available to
all - commands universal support and, according to an
ICM survey in 2002, over 90% of people
believe that the
NHS should be available free of charge
when they need it.
25 It seems generally safe to assume,
therefore, that unless there is a significant reduction in
the level or quality of service, people will continue to
support this general principle and will continue to expect
that the service will be equitable and fair.
References
Coulter A, Magee H (Eds) (2003)
European Patient of the Future. Buckingham: Open
University Press.
Wanless D (2002)
Securing Our Future Health: taking a long term view The
Wanless Report. London:
MH Treasury.
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