Dr Phil Hammond, broadcaster and sessional GP in Bristol

Last night, I sat next to the Chief Executive of the GMC. I wasn’t on trial, although it won’t be long now (my revalidation date is September the something). Rather, we were chewing the ‘post Mid Staffs’ fat in a round table, constructive sort of a way with chief executives, nurse leaders, whistleblowers, and assorted doctors. No patients were present, but then we always promise to put patients at the heart of everything we do, and then forget to ask their opinion.

GMC chief Niall (pronounced Neil) Dixon made me smile. He said: ‘The NHS is so vast, that just about any statement you make about it is probably true somewhere.’ The NHS is neither the childish love-bomb fantasy of the Olympic opening ceremony, nor the Killing Fields of Mid Staffordshire. It is a vast organisation that has islands of excellence in a sea of so-so with a few shocking black holes. And as long as the Department of Health accentuates the positive but denies the negative for political expediency, we will never get a true focus on precisely how much more good than harm we do.

So when are we going to start growing up, measure outcomes that matter, and acknowledge the harm we do as well as the good? The fact that no one at the top of the NHS has seen the need to take responsibility and step aside over Mid Staffs troubles me. It was a prolonged system failure at every level, with clear warnings, that weren’t acted on, resulting in horrific experiences and needless death. People at the NHS summit should have known about the high death rates (published in national newspapers!) and acted sooner to prevent avoidable harm. But the same top team is still in place to lead the biggest ‘transformational change’ the NHS has ever seen. Don’t hold your breath.

The NHS needs bottom-up change as much as top-down strategy. It employs more than 1.7 million people, including 39,780 GPs, 370,327 nurses, 18,687 ambulance staff, and 105,711 hospital and community medical and dental staff. Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain, and the Indian Railways directly employ more people.1 The NHS also treats a million people every 36 hours.1 If we captured just a fraction of feedback from staff and patients, we might be able to nip harm in the bud and avoid hugely damaging scandals.

Among the Francis Inquiry’s 290 recommendations, there is a clear steer that we need to start gathering feedback about patient and staff experience; for example:
  • qualitative patient feedback needs to be available to all stakeholders in real time
  • following up patients after discharge would provide broader feedback
  • nurses should have mandatory annual appraisal, including feedback from patients on care provided
  • comments describing events that amount to an adverse/serious untoward incident should trigger an investigation
  • patient feedback that is cause for concern should be treated as a complaint
  • patients should be constantly encouraged to share their comments/criticisms, and providers must constantly promote the desire to receive and learn from them; methods of commenting must be accessible and easily understood
  • greater attention should be paid to the narrative contained in, for example, complaints data, than to the numbers
  • information shared between regulators needs to include all intelligence that may raise the level of concern.

Dr Neil Bacon, who started I Want Great Care,2 talks of using frontline feedback as a smoke alarm for the NHS. I agree. We have the technology to gather information quickly, and the methodology to turn it into a fair and discriminating quality measurement. The best way never to lose sight of patients and frontline staff is to keep in touch with them. Not all feedback will be useful, but some will be gold dust for quality improvement and safety. The bigger the house, the more smoke alarms. And Mansion NHS is huge!

  1. NHS Choices website. About the NHS in England. www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx (accessed 8 March 2013).
  2. iWantGreatCare website. iwantgreatcare.orgG