Director of Strategy
This year’s World Patient Safety Day focuses on "Engaging patients for patient safety". It recognises the crucial role patients, families and caregivers play in safe healthcare.
At PHSO we see complaints as vital for capturing patient feedback. Listening and acting on what they say brings positive change for people who use and provide healthcare services.
The idea of patient feedback as an essential tool for improving the safety of services is a familiar one. In recent years we’ve seen a more fundamental shift towards recognising patients not just as commentators on the safety of the healthcare they experience, but as contributors to improving the safety of care.
Patients as partners in creating a safe healthcare system
High-quality care recognises patients, families and carers as equal partners. Intuitively, this makes sense. Patients (and their families and carers) contribute to safety in a whole host of ways, such as:
- raising the alarm when their symptoms change
- detecting errors such as medication that’s different to what they’ve had before
- adapting their own behaviour to minimise risks of a fall.
in these ways patients are already providing ‘scaffolding’ to the quality and safety of their care.
Patients do not just speak up about patient safety. They are themselves co-creators of a safe healthcare system.
Patient voices are still being ignored
PHSO’s report on avoidable harm in the NHS shows there is still some way to go for the value placed on patient voices to play out in practice, however.
We heard from families who came to the Ombudsman following the death of a loved one. Their shocking stories included examples where patients, families and carers felt their voices were ignored at critical points during treatment.
In one case, a man who was admitted to hospital with abdominal pain raised his concerns with clinical staff multiple times. He told clinicians he did not feel well enough to go home but he was discharged. Two days later he returned to hospital and died shortly after being admitted due to gastric aspiration
In another example, a son described how he’d had to persuade staff to admit his mother after she had attended the Trust’s emergency department multiple times. We found evidence staff had doubted his mother’s symptoms and failed to appreciate the serious nature of her condition. His mother died after having a stroke in hospital. This could have been avoided if staff had listened to her son’s concerns and provided the correct diagnosis and treatment earlier on.
Martha’s Rule: bolstering patients’ voices
In recent weeks, the family of Martha Mills have spoken powerfully about how difficult it was to make their voices heard when they could see that she was deteriorating rapidly. They have proposed ‘Martha’s Rule’. This would give parents, carers and patients concerned about their care the right to call for an urgent second clinical opinion from other experts at the same hospital. This bolstering of patient voice is something PHSO fully supports.
Families who speak up after an incident can similarly struggle to be heard or valued. Those who spoke to us for our Broken trust report described feeling that Trusts were ‘just not interested’ and ‘didn’t want to know’. It took enormous resilience to battle through complex systems of different investigation and complaint processes before they could be heard. Several described the ‘long’ ‘tortuous’ process of seeking answers as one that only compounded their distress and grief.
These findings are sadly all too familiar. A failure to listen to patients is a recurrent theme of numerous independent inquiries into serious harm.
An NHS that listens and responds to patient voices
When NHS staff are exhausted from working under unsustainable pressure, patients and their families and carers can find it even harder to make themselves heard. Understaffed hospitals wards and overwhelmed GP telephone lines do not provide the best environment for listening to people, nor for safe, compassionate care.
It is not enough to respond with warm rhetoric about welcoming patient voice. Healthcare staff at all levels must clearly demonstrate that they value the role of patients as equal partners at every stage. And leaders must show that they support their staff to listen to and act on feedback.
Listening and responding to complaints is an essential first step in creating an open, learning organisation that prioritises patient safety. The NHS Complaints Standards support healthcare staff to provide the best and safest service they can by providing a single, consistent and clear set of standards to handle complaints and concerns.
The future: patients as co-creators of safety
Listening when things go wrong is the very least patients should expect. To truly realise the potential of patients as partners in safety will require bringing them into every stage of designing, delivering and reflecting on care.
It will mean acknowledging the unique insight, knowledge and practices that patients bring to the delivery of safe systems.
Until we are able to describe the whole of the NHS as a listening organisation, the potential of patients as co-creators of safe healthcare will remain untapped.
