How communities help break down barriers to better care

Louise Ansari profile picture

08 March 2024

Louise Ansari
Chief Executive
Healthwatch England

Four in 10 people do not agree that the NHS can meet the needs of the whole country, according to our latest research.

Given the challenges the NHS faces regarding access to care and widening health inequalities, this lack of confidence may not be surprising, but we should not let this become the new norm.

The research was released as part of our Healthwatch report, What patients want: a vision for the NHS in 2030.

Distilling the views that patients share with us from every part of England, the report sets out the key challenges that patients face and the steps the NHS can take to deliver the safe, effective care everyone wants.

Creating a patient-centred culture

One key focus is for the NHS to do more to listen to patients, especially those facing health inequalities. Then, harness this insight to help improve the delivery and planning of care.

The rationale for building a patient-centred NHS culture is well understood.

By listening to those using health and social care services, commissioners and providers can more accurately identify and act upon the barriers to high-quality care. They can build safer and more effective services around people's needs and, in doing so, also increase productivity and efficiency.

There are some good examples where people do feel heard – and most patients feel that clinicians do listen and involve them in decisions.

But when you dig into the numbers, there are issues for those who face the most significant inequalities.

Our research shows that people who struggle financially are more likely to feel unheard by NHS professionals (21%) than those who described themselves as very comfortable (7%). They are also less likely to be involved in decisions about their care (18%), compared to people who are very comfortable (9%).

And, when you look beyond the doctor-patient relationship, to for example whether or not people feel supported while they wait for planned care, we often hear cases where patient concerns go unheard, or the needs of specific communities are overlooked.

An issue which, at best, results in services not meeting specific people's needs but, in the worst cases, can result in serious harm.

Supporting more people to share their views

One of the pleasures of working for Healthwatch is to see the difference that can be made when communities are supported to share their ideas and experiences and NHS services act on them.

For example, an NHS maternity service in Birmingham is taking action, including employing more diverse staff, to address problems after their local Healthwatch spoke to black African and black Caribbean women about their experience of using the service.

Some women felt they faced racism, discrimination, and poor postnatal care. They also said that forming trusting relationships with staff was hard because they kept seeing different professionals. This made discussing issues like mental health concerns difficult. This is just one example, but it underlines why listening to patients and seeing care from their perspective is crucial to spotting problems.

So, how can we support more people to be heard?

People often say they don't share their experiences with NHS services because they don't know how or are worried that it could negatively impact their care, or they don't think services will act on their feedback. One step we've taken to help address these issues is to launch a new campaign to help increase public awareness and confidence and encourage more people to come forward with their ideas and experiences.

Run in partnership with the Care Quality Commission, the 'Share for Better Care' campaign aims to support those whose voices aren't heard to speak up, especially those already facing deprivation, vulnerability, and poorer health. If you provide an NHS service, you can also help by supporting our campaign and promoting a culture of listening in your organisation.

Our vision provides some practical recommendations for policymakers. We want a future where:

  •  The NHS complaints system has been simplified and is more effective, so concerns are viewed as an early warning system to highlight safety issues. And organisations are open to acknowledging problems and learning from them.
  •  Those who plan and deliver services track patient experience as a matter of course to identify barriers and use it as a critical measure of improvement alongside other indicators like waiting times.

But you can also change your daily practice by asking yourself: how can you provide more opportunities to listen to every section of your community? And how can you demonstrate that you have used what they said to improve care?

The more we build trust and confidence with our communities, the more people will come forward to help highlight barriers, enabling the NHS to deliver the safe, effective care we all want.

I was pleased to chair a recent NHS Providers webinar on the role of co-production with communities as a solution for addressing health inequalities. The speakers highlighted the value for trusts in engaging directly with patients and communities to drive improvements and change in their organisations. It is great to see that NHS Providers is committed to supporting its members with this work and I look forward to their upcoming briefing exploring this topic in more detail, alongside case studies from trusts that have effectively embedded co-production models.


About the author

Louise Ansari profile picture

Louise Ansari
Chief Executive

Louise Ansari joined Healthwatch England in February 2022. Prior to this, Louise was director of communications and influencing at the Centre for Ageing Better, and has a strong background in communications and engagement.

Louise's roles span across local and national government, health bodies and charities including social policy and local services. She is passionate about ensuring the public voice makes a difference in shaping health and care services.

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