A vision for health and care: What do patients want?

Debates around the future of health and care are likely to intensify as political parties gather over the coming weeks, from Bournemouth to Manchester, Liverpool to Brighton, in what could be the last annual conferences before the next General Election. Leaders of the Conservatives and Labour have squarely placed the NHS in their respective top five aims, and all parties will be shaping their health manifestos in coming months. 

As they hone these plans, we will be urging them to heed patient and public experience, expectations and views. Around 10 million people have shared their health and social care stories with us or received our advice since the Healthwatch network was launched in 2013.  We use this formidable evidence base to identify and campaign on the public’s top priorities, and we will be using it to develop a vision for what health and care services could look like for patients by 2030 with the right interventions by the next government.  

What, then, is this vision likely to focus on? Below, we outline five key themes, with recommendations for political parties on what manifesto commitments they may wish to consider.

1. Access 

The issues:

Getting appointments with GPs and dentists are the top two concerns people report to us. The 8 a.m. phone rush, inconsistent digital access, ‘dental deserts’ and wider workforce shortages all contribute to poor experience.

How could manifestos address this?

• Give patients more choice and control over appointment booking.
• Fund and train more admin staff to speed up and improve appointment booking.
• Fundamentally reform the NHS dental contract to ensure that dentists are sufficiently incentivised to take on complex cases as NHS patients.

2. Inequalities

The issues:

We continually hear that certain sections of the population have worse experiences than others.  Disabled people don’t always get accessible information from the NHS or reasonable adjustments to help them attend appointments. Women, people from ethnic minorities and those on low incomes report longer waits for planned care.

How could manifestos address this?

• Better NHS analysis of how patient experience differs for different demographics.
• More funding for outreach and engagement to understand the needs of diverse communities.
• Better involvement of the public in designing services and removing barriers.

3. Communication

The issues:

People referred for specialist care feel forgotten as they wait to hear about an outpatient clinic date or struggle with pain, anxiety and other life impacts while waiting to get their operation. People discharged from the hospital to social care become frustrated at having to repeat their stories to different professionals or find that vital information hasn’t been shared between services.

How could manifestos address this?

• Invest in admin teams to provide updates, care navigation and signposting to support.
• Join up electronic records so all services can see the same picture of a patient’s journey.
• Start measuring people’s experience of moving across services.

4. Culture

The issues:

The public tell us more about problems with accessing services than concerns about quality of care. But a significant minority of people still experience defensiveness from professionals or services, delayed responses or resolutions to complaints and, in the worst cases, serious harm or death. These are reflected in recent public inquiries on maternity and inpatient mental health failures.

How could manifestos address this?

• Create a stronger listening culture across health and care to ensure concerns are dealt with swiftly and seriously when patients raise them. This should include the teaching of listening skills as part of medical training.
• Review how complaints procedures are working from the patient’s point of view.
• Robustly support staff whistleblowers and hold managers’ behaviours to greater account.

5. Confidence

The issues:

Our latest research shows declining public confidence in the ability to access health services when they need them. The workforce also feels demoralised and undervalued, as evidenced by industrial action taken by various staff groups over the past 10 months.

How could manifestos address this?

• Develop a new, long-term vision for the NHS and social care, to replace and update the NHS Long Term Plan.
• Review and refresh the NHS Constitution.
• Develop better measures of patient experience, rather than just counting NHS activity.

Putting patients at the heart of the NHS

One of the key principles in the NHS Constitution, putting the patient at the heart of everything the NHS does, remains unarguable. But many rights and pledges to patients in the constitution – like the four hour A&E target or the 18-week referral-to-treatment waiting time - are now routinely missed, meaningless or not an option under current pressures. This mismatch between rights, many set years ago, and reality on the ground means low public confidence is a serious concern.

A refreshed compact between politicians and the public on the shape of NHS and social care services in a post-pandemic and increasingly digital world must make clear there’s a plan to return to ambitious standards of care. It must focus not just on what is provided to patients and service users - but also on how.

Over the coming months, we will set out our 2030 vision of patient care and the steps we believe policymakers, providers, commissioners, staff and the public need to take to get there.