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'Shifting Gears': Towards a 21st century NHS

  • Launch date:
    1 May 2000
  • Closing date:
    1 May 2000
  • Creator/s:
    Department of Health
  • Audience:
    Health and social care professionals
  • Copyright holder:
    Crown
  • Product number:
    22101 (ISBN: 0101481837)
  • Gateway number:
    Not required
  • Outcome published:
    14 June 2000

This report outlines the findings from a major listening exercise in May 2000 to identify patient, carer and public views on priority areas for improvement in order to inform the NHS National Plan.

The Department of Health commissioned the Office for Public Management to:

  • Look at public and patient perceptions of, and aspirations for, the NHS
  • Identify priority areas for improvement
  • Obtain views on the National Plan and key modernisation challenges.

The drive to improve and develop the NHS and make it more reflective of the health needs of England today, has been a central driving force since this current administration came into office. In order to ensure that as many views as possible were listened to, on how the NHS needs to evolve, a consultation exercise was carried out in May 2000.

Key messages

National Fora

The main themes arising from the national fora were:

  • Concern about current levels of (under) performance - People are worried about problems and variations in access and quality across the country. They are keen to promote standardisation of care and ways of making professionals and organisations accountable for what they do
  • Responsiveness to need - Key priorities are ways to enhance the efficiency of delivery (speed for urgent cases, shortening waiting times, etc.) and ensuring that those who need care get the attention they deserve
  • Poor communication - Professionals and organisations must do better at communicating with each other and with patients and carers to deliver better care and consistent messages throughout the 'health journey'
  • Valuing the NHS - Services must improve so that the NHS returns to being the unique and valuable institution it should be and a beacon for the rest of the world
  • The principles of care - Underlying the future NHS, there should be a culture that promotes a caring, flexible service equipped for modern lifestyles and built around individual needs.

Focus Groups

The main themes arising from the focus groups were:

  • Keep the NHS, make it a truly national service with high quality treatment wherever you are - People want to be confident that the NHS will provide excellent treatment and care which is consistent across the country
  • Treat the patient as well as the symptoms - The public feels that medical professionals patronise patients and their carers and need to adopt a holistic caring approach
  • Bedside manner is crucial - Many people experience medical staff as discourteous and insensitive. There should be core and continual training to ensure that staff are able to communicate effectively and sensitively
  • Local services for local people - Losing small local hospitals means that people have to travel long distances for health care. The Department of Health should consider re/opening small hospitals to enable local people to access care closer to home
  • Too much (mis)management, not enough nurses and doctors - Too much money is perceived as being spent on managers who do not use the resources effectively. This is seen as having a direct and negative impact on the numbers of nurses and doctors in hospitals
  • Bring back Matron - Someone needs to 'take charge' on the wards, someone who is qualified and responsible for staff and how they work. Patients want someone to talk to and to whom they can complain if necessary. The organisation should be able to learn from and take immediate action when and if things go wrong.

Interviews with stakeholder representatives

The main themes arising from the interviews with patient, carer and public interest organisations were:

  • Patient-centred services - Services need to be realigned, and professionals supported to deliver care and treatment for individuals sensitive to their multi-faceted needs
  • Patient-centred policy - The patient experience is central to processes of ensuring quality. The things that matter to patients - access, the 'human aspects of care' as well as effectiveness - should be central to developing and monitoring performance
  • 'Root and branch' reform - We need to tackle the major barriers to a patient centred service, such as professional power and organisational defensiveness: 'The cause of poor joint working is defensive practice around resources and old style professionalism'
  • Supporting lay involvement - A more coherent approach should be taken towards patient, carer and public involvement at a policy level. This may mean developing a strategy for patient, carer and public involvement that includes supporting the use of better engagement methods and clarifying and enhancing lay representation at all levels
  • Independent regulation - Independent and effective monitoring and regulatory mechanisms across all sectors, and perhaps professions, are keys to rebuilding public confidence. Lay involvement in these bodies are central to success
  • The Plan needs to 'fit' with other activities - clinical governance, implementation of National Service Frameworks, National Institute of Clinical Excellence (NICE) - in order to deliver coherent aims and plans for the service. Otherwise, people will not be able to keep up with the pace of change. The modernisation challenges are a good device to begin dialogue, but should be integrated within an over-arching framework that incorporates the governance agenda
  • The Plan is more than the sum of its MATs - Principles need to be laid down for the future, sensible strategic decisions need to be made and a plan of action should follow soon. The sorts of recommendations arising from this exercise can provide a framework for the development of a truly patient led agenda.

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