Q members reflect on the NHS 10-Year Health Plan for England: Miles Sibley

The NHS 10-Year Health Plan for England has laid out ambitions for three shifts: from care delivered in hospitals to in communities, from a focus on treatment to prevention and from analogue to digital.

In the spirit of collaboration and learning, we asked members to share what they found exciting about the plan, what is missing and where they think improvement approaches can play a role. 

For the next week, we will be sharing reflections from members across England on the plan and the culture and conditions needed for its implementation. Our diverse community of people working to improve health and care is uniquely placed to make a real difference to the success of its implementation. These reflections can help us all take stock of where we are and think together about how to get where we need to go.

When it comes to patient experience, the 10-year plan is refreshingly honest: ​‘The NHS does not take patient feedback seriously enough.’ As far as complaints are concerned, it acknowledges that ‘[t]he problem is that the NHS doesn’t listen well enough’. And on safety failures, ​‘patient, staff and public attempts to sound the alarm go unheard’. The conclusion is that ‘[i]t is time for the NHS to learn’. 

This is a good start – but as always, the devil is in the detail. So what learning mechanisms does the plan propose? How will staff be helped to take feedback more seriously, listen better and detect warning signals?

The answers, it seems, are data driven. The NHS App will collect patient feedback and then ​‘deploy AI to help translate it into actions for managers and clinicians’. Complaints work will ​‘increase the use of AI tools to ensure complaints data is collected – and responded to – far more quickly’. In quality assurance, existing metrics will be supplemented with patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) – described as ​‘powerful tools to measure the impact of care’.

Of course, we must hope that better data does indeed lead to better patient experience. But data are just one part of the picture, and there are other, bigger challenges on which the plan is noticeably silent.

First, it acknowledges that health care disasters at Mid Staffs, Morecambe Bay, East Kent and elsewhere arose from ​‘toxic culture’. Every one of those providers had ample data indicating poor patient experience, widespread safety risks and severe harms. But they chose to ignore it. If we want a better experience for patients, better data – on its own – will not do it. We have to tackle continuing problems with bad culture in health care. 

Second, the plan recognises that the future of health care is not in hospitals but in the community. It lies with an ageing population and a growth in long-term conditions, where ​‘patient experience’ is about people’s daily struggles to cope with illness. So we need a new understanding of people’s experiences of things like loneliness, unheated homes and poor access to essential services. PROMs and PREMs won’t help with that.

Finally, the plan says that ‘[i]t is time for the NHS to learn’. But that must mean more than simply spoon-feeding staff with whatever the AI comes up with. Patient experience staff and complaints handlers are almost unique in the NHS workforce in having no formal qualifications for their work, nor any continuing professional development. If it is time for the NHS to learn, it is time for patient experience staff to be properly supported in their learning.

In summary, the plan’s analysis of the problems facing patient experience work is refreshingly honest. But its solutions, heavily reliant on data and AI, are inadequate. There are big gaps around organisational cultures, people’s daily lives and staff training and support. And they all need to be plugged.