Why listening is integral to improving the quality of care

As the NHS turns 75 this week, we should celebrate all the institution does for us and all the fantastic work its 1.2 million workers do to treat and care for us. But, we should also reflect on its challenges and how it needs to change to continue delivering safe, high-quality care for all.  

I will debate this question at the Kings Fund conference, Quality in a system under stress, where I will make the case that the NHS cannot deliver quality unless listening to patients and carers, and acting on their feedback, lies at the heart of its culture.  

Why is listening so important? 

An NHS, informed by the views and experiences of those who use it, can harness user insights to improve the quality of care and design services that deliver what you need, not what professionals think you need.  

This insight can also help NHS planners keep pace with changing trends, expectations and populations so that the services of tomorrow are equipped to support us and our communities.  

Granular information about people's needs and preferences is also essential to delivering personalised care. For example, all too often, people with communication needs - that can result from having a disability, impairment or sensory loss - tell us these needs are not recorded or supported by services. This means they miss out on important information about their treatment. Clear, understandable information is fundamental to help you decide about your health and care and get the most out of services.  

But, above all, listening to patients and their loved ones is key to safety.  

Ten years ago, the findings of the public inquiry into the failure of care at Mid-Staffordshire NHS Hospital were published. Failures that saw patients die because of poor care and action not being taken quickly enough despite the warning of both patients and staff.  

The scandal unequivocally showed how failing to listen and act on people's concerns can result in catastrophic consequences. It also set in train reforms to improve safety and make the NHS more patient-centred.  

How far have we come? 

The health and care system has come a long way since 2013, developing new structures to support and monitor safety and quality. It has also developed better approaches to, and a stronger culture of, listening to patients and service users.  

But has the NHS fully grasped that a culture of listening needs to be central to the business of providing safe, high-quality care? 

I fear not. Last year, an investigation into the Maternity Services at The Shrewsbury and Telford Hospital NHS Trust highlighted tragic failures to listen to families and learn from clinical incidents.  

And, just last week, the Parliamentary and Health Service Ombudsman issued a new report on patient safety which found themes of 'clinical failings leading to avoidable death', including a failure to listen to the people's concerns.  

Although the vast majority of NHS care is safe, embedding an NHS culture of listening is more critical than ever.  

Firstly, the system is under massive pressure, facing record waiting lists and staff shortages, which will take time to address and could increase the chances of avoidable errors in care. 

Secondly, the health and care sector has long-term questions to answer, such as how will it address the deep inequalities, which see factors like where you live, ethnicity or gender result in different health outcomes? And how can it adapt to provide the joined-up, efficient care that patients want and gives them more control?  

Health and social care decision-makers can't overcome these challenges and answer these questions alone. They need the public's input.

An opportunity to do things differently 

New integrated care systems offer an opportunity for health and care decision-makers to think differently about how they listen to and act on feedback, moving it from being a 'nice to have' to an essential part of how they work. 

But this requires a culture of openness. A culture where: 

• From the frontline upwards, staff are open to learning from every conversation with patients.  

• People's concerns and complaints are viewed as an early warning system to highlight safety issues, and organisations are open to acknowledging problems and learning from them.  

• Services that provide joined-up care, whether run by the NHS, local government or the third sector, are open to pooling their insight to understand how people feel about their support overall and where barriers exist.  

• Those who plan long-term services are open to listening to the views of every community about what they want from future services and working with them to make change happen.  

This culture does exist in our NHS, but it does so in pockets. As we celebrate all the NHS has done for us since 1948, let us all reflect on how we can ensure the NHS can remain fit for the future.  

Part of the answer is taking the opportunity to finish building a culture where listening to patients, service-users, and their loved ones is everyone's business.