Putting patients at the heart of care

I’ve always wondered about the concept of “putting patients at the centre” or “customers at the heart” of everything organisations do.  It seems too obvious, doesn’t it?  After all, without clients, customers, users, patients…..whatever term you’d like to use…..the provision of the service simply can’t happen.

I look around at the small businesses which have popped up local to me – some with great success.  Some not so.  The less successful – and ultimately doomed -businesses were lacking one simple thing.  Customers.  Without them, there was no business.  No income.  No wages. No point.

Back to healthcare – and as we all know, a lack of customers, or the de-humanising concept of “demand”, is hardly the problem.  It’s not a case of doomed local businesses whose proprietors stared gloomily from shop windows as yet another day passes where no one came in, no one asked for their services and they could palpably feel their overdrafts slipping into critical condition.  Every day the NHS has every opportunity to do what their endless straplines, visions and mission statements tell us they are there to do – put patients first.

And yet……how many times do we hear about occasions when the exact opposite is experienced by patients?  Whilst we all know the bad news is mostly what we hear.  The very fact that CCGs and NHS Trusts will all have, to some degree, internal programmes, initiatives, projects and quality assurance systems which seek to ensure that this “patient-centred culture” is a tangible reality, suggests that there is always more to do.

Many years ago, my mother was taken ill in Italy.  A stressful and emotional experience particularly as, at the time, my mother struggled with communication in English, the residual effects of an earlier stroke.  At no point, even with language barriers, a different healthcare system, a relatively remote location and the real fear that something serious had occurred, did we feel that we weren’t the entire focus of the team of staff who cared for her. They understood completely the difficulties her previous stroke had left her with and modified their approach accordingly.  All without access to any of her medical records or anything more than the limited explanations were were able to provide.

Tests, scans, explanations and prognosis were all seamlessly provided, involving a number of “providers” and locations, whilst my mother was admitted to a small ward, which was modern, spotlessly clean, well appointed and comfortable.  Two days later, we had a full set of records, test results and clinical opinion to take back to England and were waved off with good wishes which reassured us more than we could ever have expected.  More treatment and a subsequent minor operation was required in England.  By a quirk of fate, the receiving NHS consultant back in England had an Italian wife, so spoke the language and was given every opportunity to speak with the Italian physicians over the coming weeks, as my mother’s treatment was completed.  The Italian hospital was a state-provided facility, by the way.

Fast forward nearly 30 years; my father has Alzheimer’s. The care and support he has received so far has been OK.  But it seems to me, only because we question, double check, verify and chase up everything that he needs.   We are (with pleasure) doing all of the co-ordination and accommodation of his needs, not the multiple organisations who, I note, have these sorts of values as their “vision”.  

He doesn’t want to be an “expert patient”, or take part in surveys, focus groups or “co-design” sessions to be at the centre of the care he deserves.  He – and his family – simply want to feel like we did all those years ago in Italy.  That is, that despite the communication difficulties, everything was being arranged, co-ordinated and delivered by experts who understand his needs, focus on him and provide a seamless and efficient package of care which he understands.

Now wouldn’t that be truly putting patients “at the heart”?