Design NHS services 'around patient need', says Health Secretary

Health services should do more to design care around the needs of the local community, healthcare leaders say.

5 December 2018, by Siobhan Chan

Image of Matt Hancock, credit: Bart Lenoir / Shutterstock.com

Health Secretary Matt Hancock. Image credit: Bart Lenoir / Shutterstock.com

The NHS in England should emulate the way technology is developed by incorporating people’s needs and experiences when designing services, the Health Secretary has said.

Matt Hancock said technology is designed around ‘user needs’, and that the health system should follow suit when building services.

Speaking at the King’s Fund annual conference, he said: “Requiring [programmers] to ask ‘what is the user need?’ is vital to developing a piece of kit that can actually be used by people who don’t understand a program,” he said.

“'What is the patient need?’ is the core question that any organisation in healthcare should be asking. 

“The whole purpose of NHS organisations is to serve patients,” he said. “It’s about listening to patients - what patients need and what they want, and asking them about their experiences.”

Virtual wards

The idea that services should be designed around the needs of patients was echoed by other speakers at the event in London on 28 November 2018.

Dr Matthew Lewis, Consultant Gastroenterologist and Medical Director at Walsall Healthcare NHS Trust, said that in some cases “people work in ways that don’t meet the needs of the patients they’re looking after”.

He described patients who were fit to be discharged from hospital on a Friday evening, but the hospital not having the staff or resources to discharge them until Monday.

“People can go backwards in hospital,” he said. “We take the responsibility away from patients, and they suffer.”

Dr Lewis said he sees many patients in his outpatient clinic who don’t require a physical examination, and just need a conversation about medications or their condition in general.

“It could have been a phone call or Skype chat – those patients didn’t need to take a day off work or arrange for someone to watch their kids,” he said.

Dr Lewis discussed the approach taken by Bradford Teaching Hospitals NHS Foundation Trust, which has developed ‘virtual wards’ that allow patients to receive consultant-led care at home, rather than in hospital.

Open discussion

Involving patients in their own care can improve outcomes and patient experience and could lead to efficiency savings, according to the Nuffield Trust.

The BHF’s House of Care programme has assessed the impact of person-centred care on patients and healthcare professionals.

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Dr Lewis pointed to Choosing Wisely UK, an initiative hosted by the Academy of Medical Royal Colleges. Here, clinicians are prompted to have an open discussion with their patients and make decisions together, based on what’s important to the patient.

Roger Davidson, Director of Engagement and Communications for Health System Transformation at NHS England, also thought that a “different conversation with the public” was needed.

He highlighted the Healthier Wigan Partnership programme, led by Wigan Council, which has worked with the NHS, police, fire and rescue services, housing agencies and the community in Wigan to redesign health and social care services.

The council has trained health and care professionals to have ‘a different conversation’ with people who need health or social care support; working with community groups to tackle loneliness; providing food to people with low incomes; and investing in leisure services.

Rates of smoking, suicides and premature deaths from heart disease and cancer have dropped as a result, Wigan Council reports.

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Changing conversations

Dr Andy Knox, GP and Director of Population Health at NHS Morecambe Bay Clinical Commissioning Group (CCG), said that “an utterly different kind of leadership is needed”.

“We have a new rule in Morecambe Bay – if you are redesigning something, a third of the people in the room must be living with that thing.”

He described hearing “humbling and difficult stories” from people with diabetes that helped the CCG to redesign its diabetes service.

“We have to be willing to be changed by our conversations with those we serve,” he said.


Learn more about the benefits of person-centred care from the findings of the BHF House of Care programme.

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