world to introduce medical revalidation - whereby
every practising physician is subject to an annual
check on his/her performance. This applies to all
doctors whether they work in the public or
private sectors. Every five years each doctor has to
be signed off by a Responsible Officer (a senior
doctor) who has statutory authority to
recommend (or not) to the regulator (the General
Medical Council) whether the doctor should
retain his or her licence. The programme has
stimulated a major reform of clinical governance
arrangements in the UK healthcare systems.
In addition, the government is currently
considering a new bill on Health Service Safety
Investigations. This Bill would establish an
independent investigations body to respond to
healthcare errors, finding answers and helping to
embed new practices. The ‘no blame’ approach will
aim to mirror the practices of the Air Accident
Investigations Bureau, allowing individuals to
share information freely without fear of disclosure
in order that investigations can find answers
quickly and accurately.
those who have recently used maternity services
are also encouraged to get involved. Experts by
experience attend inspections of health and care
services, talking to staff, patients and families and
observing how services are delivered. Their
feedback is then used to support and inform the
judgements of inspectors. Patient involvement is
part of the CQC framework for assessment, so these
inspections will also be looking at how effective the
organisations they inspect are at involving patients.
Another organisation that seeks to use the
experiences of patients to improve services is
HealthWatch. They act as a “consumer champion”
for health and care services to help ensure that
patients’ experiences are heard and used to
influence those with power to implement change.
The NHS in England runs a number of surveys
including the friends and family test (REF), which
assesses whether patients and staff would
recommend the institution to their loved ones.
Independent of government but now well used
within the NHS are various means of collecting
contemporaneous patient feedback. The company
Iwantgreatcare.com enables patients to rate their
doctor and also operates in hospitals with patients
able to comment on nursing and other aspects of
care. There has been some resistance from the
medical profession to certain aspects of this very
public form of assessment, but the direction of
travel is clearly towards greater transparency about
the performance of both individual professionals
and the institutions and systems in which they work.
The NHS in England runs a number
of surveys including the friends
and family test (REF), which
assesses whether patients and
staff would recommend the
institution to their loved ones
Could you present us the two/three
expectations that your organisation/country
have today on improving the quality of
healthcare using the experiences and
competencies of patients?
Patient involvement and experience are built into
the NHS national contract and so must be included
in hospital’s quality plans at a local level. They are
also built into the competency frameworks of local
commissioners (CCGs).
In addition, the quality regulator, the CQC,
recruits members of the public to act as “experts
by experience” as part of their inspection regime.
These individuals may use health services
themselves, for example those in the early stages
of dementia, or with a learning disability, sensory
impairment or mental health condition. They may
also be carers for people who use health services.
Children and young people who use services and
united kingdom
Total health expenditure as % of Gross Domestic Product (GDP)
Percentage of current public expenditure on health as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Out-of-pocket expenditure, % of current expenditure on health
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practicing physicians per 100,000 inhabitants
Practicing nurses per 100,000 inhabitants
38
HHE 2018 | hospitalhealthcare.com
2000 2008 2015
6.0%
7.7%
9.9%
79.3%
82.6%
79.7%
n.a
n.a
41.8%
11.5%
9.7%
14.8%
408.0
333.0
261.0
n.a
n.a
n.a
10.9
13.0
12.5
7.7
6.3
6.0
196.0
256.0
279.0
901.0
960.0
79 0.0