Introduction

The NHS is a large multi-functioning health care service that deals with over 1 million patients every 36 hours

¹

. The NHS sets out to provide quality health care which include three important parts; Clinical efficiency, patient safety and patient experience

²

. The need for even greater quality health care in the NHS saw a shift in focus towards a more patient centric NHS

³

. This is because they believe a

patient centric care

, care that encompasses the patients’ needs and values and allowing this to shape and guide all clinical decisions

⁴

, will allow for a better quality of health care.

This essay will explore how patient centric the NHS really is in terms of the different departments it encompasses, policies, laws and overall

patient satisfaction

. It will also investigate whether there are certain areas that the NHS needs to improve in terms of patient centric care and exploring if this is the case how to do so.

Departments

The NHS is made up of many departments
and collaborates with a wide range of organisations such as the National
Institute for Health &. Clinical Excellence (NICE)

⁵

. The structure
can be described as complex and can cause confusion for patients trying to
access these services

⁶

. In addition the
complex structure makes the health care provided by these, less efficient and
effective in the health services they are providing; and brings about questions
of who is really responsible for the care of the patients

^7-10

In 2014 the NHS released the Five Year
Forward View

²

, which outlines
planned improvements for various areas of the NHS. Since the five year forward
view plan was released, there has been a focus of new models and an increased
focus on integrated care

⁷

. This emphases a more holistic approach to
health care and looks to encompass all services

¹¹

. Integrated care
sets out to bring together a range of services so that all aspects of the
patients’ needs are more closely met

¹¹

. One of the new
care models, called Vanguards has been set up around the country

¹²

. Vanguards aims
to trial new integrated care methods which were presented in the five year
forward view. Some of these new integrated care methods include Sustainability and
Transformation Partnerships (STPS)

¹³

and Accountability
Care Systems (ACS)

¹⁴

. STPs are there
to help organizations including GPs, hospitals, local authorities to work
together and have unified services for the most vulnerable

<sup>1


3</sup>

. ACS’ have been
developed to co-ordinate services under a set budget for organisations outside
the NHS that impact health, this includes working with housing and social care organisations
to create accountable care to assure that patients needs are being met

⁷

.

Quality Surveillance groups (QSGs)
identifies risks to patients in terms of quality and safety of the health care
being received from the NHS and associated organisations acts as
safeguarders

¹⁵

. This creates
accountability for those providing health care services to the public. One
individual organization within QSG is Care Quality Commission (CQCs). CQCs
regulates the health and social care act, directly relating to patient centric
care within the NHS as  regulation act 9
with this act says that providers must take action to make sure every individual
has access to personal care treatment

¹⁶

. If this not
being provided the CQC can take regulatory action, this provides further
evidence that the NHS is patient centric as they are constantly monitoring the
quality of patient care.

Another QSG group is the clinical
commission group (CCGs) this group, led by GPs commissions services on the
behalf of the NHS, works to improve the health of the population in their area.
CCGs are important because they allow the clinicians (GPs) that have knowledge
on the needs of that particular area to provide the required healthcare services

<sup>1


7</sup>

. An example of
this is the provision of integrated care within Oldham to provide a budget for
vulnerable people to have fuel in the winter

¹⁸

. Although CCGs
have been widely successful in terms of some of the services its commissioned,

¹⁹

one year after
the creation of CCGs, a report commissioned by King’s Fund and Nuffield trust
saw that less than half of GPs felt that CCGs reflects their views

²⁰

. This report questions
the patient centrism of CCGs as one of the reasons that CCGs are led by GPs is
that they’ll have a better understanding of the patients’ needs in that area

²¹

, if GPs are not
being consulted then this could also lead to less patient centered services.
Furthermore, CCGs recently have had to make difficult decisions which have led
protests from the public. One such decision is the closure of  Accidents and Emergency’s across the country

<sup>2


2</sup>

. CCG have
decided these  A &E’s are
unsustainable and are creating a larger deficit than necessary

²³

. This has led to
dissatisfaction from the public and feeling like their voices in regard to this
matter is not being heard

²⁴



.This
goes against patient centered care, which is there to involve the patient in
every step of care

¹

. However, this is only one issue, overall the
CCGs are a step in the right direction toward a more patient focused health
care services for the NHS. With further consideration of GPs and the public
views the CCGs can become an effective tool for building a patient centric
health system.

Policies and
Legislation

There are several laws in place that
are there to protect the patient but also to put the patient at the forefront
of every clinical decision that is made in the NHS. The health and Social Care
Act 2012

²⁵

allowed for the
patients to be more involved in their care on every level. It does this by
allowing patients support to manage their health in their everyday lives, it
also gives them control over the care that they are receiving and also treating
each patient as an individual with an individual circumstance

²⁵

. In addition, this
Act allowed for the establishment of Healthwatch England which will provide
crucial information to the CQC on the opinions of the patients using their
service

²⁶

. To a certain
degree this has been successful as Healthwatch England has published 1450
reports as of 2016

²⁷

and has worked
with local health ministers and the public to implement the care that is wanted
by the patient. They have also worked closely together with CQC to provide
information on which health services in which area need to improve

²⁸

.
However, they have only engaged 385,000 people

²⁸

to find out
their view. Although this seems like a large sample the total amount of
outpatients the NHS had in 2015/2016 was 89.436 million people

²⁹



and so this is a
relatively small sample of the people treated by the NHS views which are being
heard and so those which have the most need for improvement in the health care
services may not be heard.

Other legislation which provides the
case of a patient centric NHS includes the Social Value Act

³⁰

, This encourages
commissioners of public services to think about how the services will benefit
the public. The use of the Social Value Act in policy and practice can only be
clearly shown by 13% of the CCGsand 43% of CCGshad no
policy or were in the process of making a policy on the Social Value Act

³¹

.To
improve to become more patient centric, the Social Value Act could be
implemented on a wide scale basis into main policy of NHS England but also
within the framework of QGS`.

In addition to the previous laws, The Equality
Act

³²

, which protects patients from
discrimination and permits them to get quality health care, also helps a
patient centered NHS. It Allows for every Citizen of England no matter their
culture and values to have health care which is free and of quality. These legislations
are designed to make the NHS patient centric through creating a patient- NHS
relationship free of discrimination and allows for the patient’s values and
opinions to be respected. Although there could be some improvement on the
implementation such as making sure these laws are practiced this can be done by
setting up accountability groups and incentives for healthcare professionals to
provide better patient centered care, these laws go a long way in making the
patient the focus of the NHS healthcare

³³

Patient
Survey

Patient experience has been
seen as vital to the care provided by the NHS

³⁴

. Listening
and taking action on a patients’ feedback about their experiences of health
care is seen as critical to making sure that care within the NHS is centered
around the person

³⁵

. patient
reported information can be described as Information which comes from the
patient or family and Carers as an account or through surveys

³⁶

.
There has been increase in the number of surveys carried out by the NHS but
have found that GPs were resistant to feedback which was to do with the patient
or was dismissive questioning the validity of the report

³⁷

.
However there have been positive reports on services attempting to improve due
to feedback from Patients

³⁸

. This Creates a more patient centered
NHS as they are listening to the feedback and taking action to it, meaning the
views and experiences of the patient are valued.

Conclusion

To conclude, The NHS has had
a shift in view towards a more patient centric NHS, this can be seen as widely
successful due to the policies and legislation its placed but also different
quality surveillance groups and the listening of patients’ feedback. Although
some improvement could be made in terms of CCGs and a straight forward pathway
for the patient, the NHS can be seen as patient centric.

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