Final Report > Chapter 23: Respect and Honesty > The need for openness and honesty within the hospital

The need for openness and honesty within the hospital

46 For respect, honesty and openness to flourish between healthcare professionals and individual patients there must be a culture of openness and honesty within the healthcare system as a whole. The hospital as an institution must be open with patients as to what they can expect, where and to whom they can go if they do not understand something, and what they may do if they wish to pass on suggestions or comments. During our oral hearings, we heard the frustration of parents at not being able to discover what was happening as regards the care of their child. A hospital committed to openness would involve and integrate the parent (or patient) into the pattern of care, rather than exclude them.

47 One example of an organisation which has chosen to pursue the goal of greater openness in the delivery of its services is provided by Brighton Healthcare NHS Trust. The Trust's `Patient's Advocate' acts as `friend within the system' for patients, their relatives or carers. She sees her role as being to improve communication. Penny Dunman, the current Patient's Advocate, recently stated: `Almost always, lack of communication is at the root of people's anxieties'. [35] The service is designed to help patients and their carers to deal with problems which they encounter in relation to their care within the Trust. The aim is to increase the level of satisfaction with the Trust's services while reducing the incidence of complaints. The advocacy service now includes induction and other training for hospital staff at all levels. Significantly, the advocacy service has had the support of the Trust's Chief Executive since its inception, demonstrating that cultural change and strong leadership go hand in hand. The Brighton example is significant because it shows what can be achieved with a `one-stop shop' for patients: a place that both provides information to smooth the patient's journey, and acts as a source of support for early help and intervention to resolve patients' questions and concerns.

48 The Government's announcement in `The NHS Plan' of its intention to set up a Patient Advocacy and Liaison Service in every NHS trust and primary care trust is to be welcomed. The establishment of this service should be implemented in full as quickly as possible. Had such a service existed in Bristol, parents would have had a further place to turn to for advice and support when they needed more information or had unresolved questions about their child's care. We add, however, that such a service must be integral to the care of patients, not an optional extra. It is what patients and relatives are entitled to expect as they negotiate the unfamiliar and sometimes frightening environment of the hospital. And, as such, it follows that, as with other aspects of healthcare service, it must be given secure funding to enable it to provide an effective service to patients.

49 But this is only a part of a much wider approach which is needed. NHS trusts and primary care trusts must have systems which ensure that patients know where and to whom to go when they need further information or explanation. It is equally important that trusts themselves provide access to a wide range of sources of information, not limited to resolving concerns or complaints, which will guide and assist patients in the course of their care. The key is to ensure that the sources of information which are intended for patients, for example, the hospital's website, the liaison service and the various contact points throughout the hospital, are integrated and complementary. Moreover, there will be real opportunities in the future for the Patient and Advocacy Liaison Services, in a given geographical area, to collaborate so as to provide an effective, efficient and seamless service for patients. The provision of information for patients and the public would be a key area where such collaboration would benefit a local population. This opportunity must be grasped.

50 It is also vital that healthcare services routinely seek direct feedback from patients. This is not something to be feared but to be embraced. To hear, as we did during the oral hearings, the many comments and ideas that parents had about how they felt the care for their child could have been improved, and to know that there was no system at the time for capturing that rich vein of concern and advice, was to witness an enormous lost opportunity. The old culture of waiting until someone complains, then behaving defensively and changing reluctantly, has no place in a modern health service. That is why we strongly endorse the proposal in `The NHS Plan' that patients on leaving hospital be asked for their feedback. Further, rather than what we regard as old-style `satisfaction surveys', formal, systematic structured surveys of patients' full experience of their care should be routinely conducted across the NHS and the results made public. Very often in the past, patients have had no alternative but to use the complaints system, simply because there was no other way to convey their views about the service which they had received. Used, as it must be, and used wisely, information from patients and their relatives should help the hospital, and the NHS generally, to identify emerging problems and to anticipate matters that might become the source of complaint in future if not resolved. The contrast which we seek to draw is between a system in which all interaction with patients becomes routed through a complaints system, such that comments become complaints, even if they did not begin as such, and a system which allows multiple opportunities for communication between the hospital and those it serves. The future lies in the latter.

Footnotes

[35] `Nursing Standard' August 16-22 2000; vol 14 (48) p. 13