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What if the NHS routinely used patient accessible language?
What if the NHS routinely used patient accessible language? Why does the NHS routinely use medical language such as ‘Renal’ rath...
Wednesday 14 June 2017
Friday 2 June 2017
Words that annoy - BMJ blog and tweet chat
The British Medical Journal have a features section BMJ Opinion which is open access, and as part of that they host blogs on patient perspective. Link to it here
Tessa Richards, Patient partnership editor, The BMJ has written a blog about words that healthcare professionals use which annoy - well worth a read.
/bmj/2017/04/07/tessa-richards-words-that-annoy-phrases-that-grate
Monday 6 March 2017
The problem of “Did Not Attend”s
The problem of “Did Not Attend”s
Why do people miss their Health care appointments? As an NHS
staff member I know that there is a large problem with patients who “Did not
Attend” their appointment (DNA) as it can mean that patients are waiting longer
than they need to for appointments. There are often notices on view at
reception desks about the need to cancel appointments and the cost to the NHS
of missed appointments. There has also been talk of charging people for missed
appointments.
This is an area where there is a real opportunity for the
NHS to save money, and also to help patients receive better care but having
done a very quick search to look at NHS DNA improvement efforts, there was no
obvious evidence base being drawn on as to why patients miss appointments in
the examples I came across. The main assumptions seemed to be patients
forgetting or not caring. There was some work testing interventions to help
patients remember their appointment which showed good results, and behavioural
change interventions which showed having the cost of a missed appointment in a
text reminder helped a little, however I can’t help but wonder if these are
totally irrelevant for many people.
Some research I found into why NHS appointments were
missed in mental health service users in Surrey showed that reminders and then
choice and ease of access were the preferred improvement options in this group
of patients, but I expect that the reasons will vary between different patient
groups and different locations. Surely more effort should be made to understand
why people miss appointments before making wholesale changes?
There has recently been a move to acknowledge the issue of
those who need to be brought to appointments such as children or vulnerable
adults, and to change from DNA to “Was Not Brought” (WNB), as there may be
safeguarding issues. In an abstract I came across looking at reasons for US family’s
not attending appointments, the main reasons cited were transportation problems, wait times, and not knowing the
reason for the appointment.
Personally I hate the “ x Missed appointments at this
surgery has cost the NHS £xxx” message which seems to be up at every reception
area. The people reading these ARE attending (or trying to), and it makes me
feel like I should not be taking up valuable time going at all. Is that really
the message the NHS should be sending out? In fact one of the improvement
projects I came across tested changing these signs to instead show the high
number of appointments used instead, and recommended this approach as more
effective.
In the past I have been so late that I have missed
appointments due to being stuck in traffic and not being able to park anywhere
near (and when phoned to let them know this, being told it will be the end of the clinic by the time
I get there so won’t be able to be seen). My initial thoughts on how to
help reduce missed appointments would be to improve parking and transport, but
this doesn’t seem to be considered an issue by the NHS.
Do people understand enough of the information about when
and where the appointment is, and why they need to attend? Could they be
getting lost or have the wrong time? Is
it true everyone can or will use the telephone to re-arrange an appointment?
What if that person does not have the opportunity to make a private telephone
call during working hours? What if they have no credit on their phone? What if
they are too ill to phone? What if they are being prevented from attending? Surely we should not be quick to judge, but instead try to understand what is
going on.
Friday 24 February 2017
Just who is this an improvement for?
Why designing ‘better services’ needs user input.
A recent Kings fund blog talks about pressures on GP services,
specifically the problem of providing both rapid access and continuity of care
reminded me that the need to treat patients as individuals is important at a
system level. Here are some of my personal experiences and opinions of accessing
NHS services.
Personally I have had so many changes in staff at my GP’s
that there is little hope of continuity of care, and for most of the time it
has not mattered in the least to me, but for other people this will be a
different story. We are all different with different needs and priorities: while
my elderly neighbour with a complex medical history is happy to fit around her
GP’s availability, I would rather that appointments fit around my busy life. I
have a feeling that trying to provide services to meet pre-conceived ideas of
what patients want just leads to causing problems elsewhere. In the days when I
had a long commute to work I wished that my health records could be shared or
held by me, and I could visit a GP near work sometimes and near home at other
times, I was not at all bothered by who I saw.
One of the recent
changes at my GP’s is to have a call back from a member of staff if you have an
urgent problem as not all patients can be given appointments on the day. This
sounds great, but it seems to assume that you will be able to take a phone call
at any time. My experience was that firstly despite me requesting that my
mobile number was used the home phone was called and I missed it and spent all
day in a cycle of missing and trying to return calls. I would have much
preferred to go and sit in the waiting room for a few hours actually.
This made me wonder about some of the reasoning behind the
changes – what are the assumptions at work here? When coming up with the new
ways of working is there an assumption that if you need an appointment with GP
or nurse that you won’t have responsibilities like dropping kids off at school,
having to go out and buy things, another appointment to go to, or even work and
leisure activities perhaps? I understand that services cannot take into account
every individual situation, but without user involvement there is a risk that
despite best intentions new ways of working eg telephone triage will make it
even harder for some patients.
Friday 13 January 2017
Health Literacy Briefing by CHLFoundation
Re-posted from Health Literacy Policy Briefing March 2015 by http://www.chlfoundation.org.uk/
Health Literacy – the agenda we cannot afford to ignore
A joint briefing from the Community Health & Learning
Foundation and the Health Literacy Group UK March 2015
This briefing provides an overview of the important agenda
of health literacy and outlines the extent of the level of need and its
economic impact. It concludes with four key priority policy actions. It is a
key point summary of a longer policy briefing from the Community Health &
Learning Foundation.
What is health literacy?
The World Health Organisation definition is: ‘… the
achievement of a level of knowledge, personal skills and confidence to take
action to improve personal and community health by changing personal lifestyles
and living conditions. Thus, health literacy means more than being able to read
pamphlets and make appointments. By improving people’s access to health
information, and their capacity to use it effectively, health literacy is
critical to empowerment.
Health literacy is central in the complex links between
health inequalities, income and skills and is critical to inclusive growth for
local and national policy as the economy moves out of the recession. It
recognises a shared responsibility between government, local institutions,
employers and people in addressing the socio/economic factors that impact on
health.
The scale of the problem
Recent research on the mismatch between the population’s
health literacy and the skillsiii needed to navigate and understand the system
shows that 43 per cent of people aged 16 – 65 are unable to effectively
understand and use health information, this rises to 61 per cent if maths is
involved. This means that between 15 and 21 million people of the working age
population in England may not be able to access the information they need to
become and stay healthy. This is significantly higher than those who lack basic
literacy and numeracy skills and highlights the multi-dimensional nature of
health literacy The economic implications Low health literacy is expensive.
American research shows that the cost of poor health literacy is between 3-5
per cent of the health budget a yeariv . It found that at a patient level the
additional expenditures per year for each person with limited health literacy
as compared to an individual with adequate health literacy range from $143 to
$7,798. In England, the NHS budget is £95.6 billionv - a 2 saving of 3-5 per
cent from effective health literacy would be in the range of £2.87 billion to
£4.78 billion.
Implications for the NHS
Low health literacy
leads, among other things, to widening health inequalities, patients not
understanding written information, patients not understanding what health
practitioners tell them, patients not adhering to medication instructions, people
not being able to follow healthy lifestyle advice and patients being passive
recipients rather than active partners in their care. This, in turn, has
significant clinical and financial impacts e.g. patients by default going to
A&E (cost £111 per visit) or dialling 999. An emergency ambulance call
costs an additional £455. In comparison, a GP attendance costs £32.
What needs to change?
Health literacy is a complex issue and needs collaborative
cross-sectional approaches, particularly between the health and learning
sectors. At the Community Health & Learning Foundation and the Health
Literacy Group UK we have identified three priority actions needed at a
national and local level to ensure effective health literacy:
· a
cross-government strategic approach to recognise the economic and social impact
of health literacy and its role in addressing health inequalities and
wellbeing;
· the
integration and adoption of health literacy as a core literacy within education
and skills policies;
· the
development of a health literate system with clinical commissioning groups
prioritising practitioner awareness.
World Health Organisation (1998) Health Promotion Glossary:
http://www.healthliteracypromotion.com/upload/hp_glossary_en.pdf
For a detailed discussion see Benzeval M et al. (2014) How
does money influence health? JRF
http://www.jrf.org.uk/publications/how-does-money-influence-health iii Rowlands
et al (2012)
Defining and describing the mismatch between population
health literacy and numeracy and health system complexity2014 submitted for
publication – a note of interim findings available at
http://www1.lsbu.ac.uk/php5c-cgiwrap/hscweb/cm2/public/news/news.php?newsid=115
iv Eichler, K., Wieser, S., Brugger, U. (2009).
The costs of limited health literacy: a systematic review.
International Journal of Public Health,
http://www.springerlink.com/content/n7327r1tl81665t3/fulltext.pdf v
http://www.england.nhs.uk/allocations-2013-14/
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