Integration ahead

DH's recent evaluation of  the integrated care pilots has been found wanting in several quarters.  GP magazine put in a Freedom of Information Act request for clarity on DH's claim that this telecare route will offer £1.2 bn savings, but was turned down.  A lesss investigative approach from Nick Goodwin of the King's Fund echoes the less than enthusiastic response: "It is fair to say that the collective results of these pilots have been mixed."  He also observes that these pilots suffered from a common problem with integrated care, where the process of integration gets priority over the experience of care.  Another significant finding from the report was that emergency admissions increased over the period studied, while outpatient and elective admissions decreased.  The King's Fund is itself currently looking for case sites in its study of co-ordinated care for people with complex chronic illnesses.

The right measure

The new NHS framework for patient experience offers, suggests Jocelyn Cornwall of the King's Fund, a secure evidence base for measuring and improving this key aspect of healthcare. She also argues that measures of patient experience should be aligned with clinical level data on processes and outcomes and embedded in the new NICE quality standard. A discussion paper from NHS Confederation aims to stimulate debate on what it calls the uneasy consensus between patients, citizens and the NHS. While patient experience is not entirely about keeping people happy, some research on the shape of happiness over the lifecourse may be of interest: a survey by ONS shows that happiness is a U-shaped curve, highest amonst teens and people in their 70s.

Ratings

A bad TripAdvisor review can strike fear into the hearts of owners of hotels or restaurants, but does this kind of feedback bear any relation to more formal quality assessments? A team from Imperial College matched feedback given via NHS Choices to a range of hospital quality measures and found there to be a reasonable level of agreement, especially as regards mortality and infection rates. DH announces that "the Government welcomes these findings". A study from the US looks at the relationship between patient satisfaction and healthcare use. A systematic review of the impact of patient and public involvement on NHS healthcare finds there's still room for improvement.

Trying to be heard

A paper from the NHS Confederation and the Royal College of Paediatrics and Child Health considers options for involving children and young people in decisions about health and wellbeing services. Looking back at survey data since 2000, it seems that "the voice of under 16s is not included in most national surveys". A study based on experience at Sheffield Children's Foundation Trust assesses effective surveys to measure patient experience amongst children and young people. Meanwhile, Penny Woods from the Picker Institute explains in Pulse how this survey forms the basis for the Children's Patient Experience Questionnaire, from which the new Outcomes Framework indicator on young people's experience of care.

Patients, consumers or guinea pigs?

The need for effective public engagement is never more pressing than in this chilly economic climate, argues thinktank Involve. The NHS Confederation offers some advice to CCGs on how to make this work in the new commissioning landscape. Pressure Group the Patients Association has also done some research on the matter and amongst its concerns is how to reward and support patient representatives in CCGs. Elsewhere, the announcement that the government wants to foster innovation by releasing NHS patient data to researchers has not played brilliantly. Some have pointed out that the proposal to make every NHS patient "a research patient" does not sit particularly well with the patient empowerment agenda.

Experience counts

A useful survey of the state of play on measuring patient experience in primary care is provided by King's College London's Policy+ newsletter. Research published in Quality and Safety in Healthcare looks at the reasons why patients from ethnic minorities and some other patient groups "consistently report lower scores on patient surveys." While a substantial element of the difference for BME patients "reflected concentration of ethnic minority patients in low-performing practices," this was not the case for younger patients and those with poor self-reported health. Telling patients when mistakes have been made is likely to be a contractual obligation, if government proposals are adopted. DH has issued a consultation paper on implementing a duty of candour for NHS providers, as part of its efforts to enhance accountability. Patient safety group Action Against Medical Accidents has expressed concern that this duty should be statutory rather than contractual, according to HSJ.