I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

For many people the NHS is like marmite, but whether we love it or hate it, we all end up using it one day, one way or another.

Students are one of the most outspoken, actionable social groups around, so when asking a number of them for their opinions on health services – an outspoken answer was what I got.

It has been an interesting few days hearing student’s thoughts on their health services. Below is a film the students I met, sharing their views – but not everyone was happy to be filmed, and as you’ll read below, there were quite a range of views!

International students, on the whole told me that they thought the NHS was great. When asked why, they mostly replied, ‘because it is free and available to all’. Interesting, a majority of the international students I spoke to also felt open minded to the idea of reforms and privatisation of the NHS.

In comparison, British students were a little more sceptical. But, overall they also agreed that the NHS was a great thing, although they did say that there are improvements to be made – all of which can be done with the help of patient feedback.

Elizabeth Etheridge who is studying French at the University of Sheffield, told me how her Nan had recently been in hospital but she felt the only reason ‘things were being done quickly’ was because her mum ‘knew the right people and could pull a few strings’. However, when speaking of the University health service, she could not speak highly enough, ‘fantastically well run, great service and really pleasant doctors.’

Interestingly, when I asked her about her thoughts on Patient Opinion, she said, ‘I’ve never heard of it but I think it’s a great idea. Change always starts from the bottom.’

One group of students I have been eager to speak to are medical students. Fortunately, I did manage to speak to a few outside the University Information Commons on Wednesday.

Although they didn’t wish to be filmed or be directly quoted, they did speak to me and pass on some really intriguing information. One male student who was in his fourth year of medicine told me of how he was intending to leave the field before he had even started because of ‘all of the bureaucracy’. His course mate told me she would be sticking with it but was sceptical of her future as she said, ‘the NHS isn’t what it used to be’. She also told me how all the medical students she knew were in uproar over the current proposed changes.

Speaking with students about their experiences of health services and their thoughts on the NHS, has made me see that students do care about their services and would like to see change. What is more important I think now, is that a site such as Patient Opinion try and expand its reach to students. Students are the next generation and with their strong political ideologies and desire for change, their work and interaction with PO could be surprisingly influential.

 

During my regular mid week date with One Born Every Minute last week, there was a moment that got me thinking about what part love plays in health care.

Shortly after giving birth to a baby boy, one of the new mums seemed flustered when the attending midwife reached over and embraced her with a kiss on the cheek, telling her that she was proud of her. It was intimate, warm and loving and not something I've seen happen during any other labour featured on the show. It’s certainly not something you'd expect from other health care professionals, a kiss and a cuddle from the surgeon who'd just removed your kidney stones would be fairly unusual.

This may not fit with everyone's definition of love, but in my interpretation it is without doubt a loving and affectionate gesture and behaviour that falls outside of the standard role of the midwife. I’m sure it’s more a reflection of the midwives personality than the circumstances, but it got me thinking about the part that love has to play in health care.

People often talk about their professional personas and how much they differ from the personalities they express outside of work. Acting 'professionally' has connotations of suppressing the softer side of your character and portraying a more corporate, task focussed demeanour. But in a world where teachers are warned that hugging a crying child who has fallen in the play ground is acting outside of 'professional boundaries', are we forgetting how important it is to be human at work?

In the report we released this time last year, it couldn't have been more conclusive that the attitudes of staff and a lack of care and compassion were the most frequent causes for complaint or concern for patients of our health service. The same is true for compliments; what people are most thankful for when receiving health care is feeling like the staff cared about them.

So people certainly notice and appreciate kindness, affection and loving behaviour but is there any evidence to suggest that this has any impact on health outcomes?

The King's Fund Point of Care programme(2009) noted that:

'Research evidence suggests that compassion affects the effectiveness of treatment. For example, patients who are treated by a compassionate caregiver tend to share more information about their symptoms and concerns, which in turn yields more accurate understanding and diagnoses (Epstein et al, 2005).

'In addition, since anxiety and fear delay healing (Cole-King and Harding, 2001), and compassionate behaviour reduces patient anxiety (Gilbert and Procter, 2006), it seems likely that compassionate care can have positive effects on patients' rate of recovery and ability to heal.'

It's clear that experiencing compassionate care, and in this context love, from health care staff matters enormously to patients, both in shaping their impression of health services and in their recovery.

For staff, showing compassion to people at their most unwell or vulnerable is often at the heart of their motivation for joining the NHS. It's my impression from reading the stories we receive that the majority of staff are striving to show patients the affection and kindness that makes all the difference, but that staffing issues sometimes get in the way. So how can we help to ensure staff always feel comfortable and capable of delivering this level of care?

The King's fund paper goes on to suggest that:

'In the practical circumstances in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to do just that one thing for the patient that makes her or him feel cared for. Enabling staff to feel and be compassionate towards patients in their care, at all times, requires action on multiple levels.

One of the most powerful resources that healthcare professionals consistently cite is patients' stories.

Every day here at Patient Opinion we continue to make available stories from patients that detail how it feels when compassion is lacking and what truly compassionate care looks like. I'm reminded of a beautiful quote from a story we received some time ago which recorded a moment between a member of care staff and the author's nan:

'One day I heard one of the staff, Tracy, talking to my nan as they were bathing her. Tracy was lovely with her and so caring and sensitive - I can't imagine it's easy to bathe a grown person. Tears came to my eyes, I was touched by the care and respect demonstrated. No one knew I was close to the bathroom door and could overhear what was being said, this wasn't a demonstration put on for my benefit.'

Thinking back to the midwife on One Born Every Minute, her attitude, warmth and willingness to give a little bit of herself makes me hopeful. The interaction between her and the new mum on the bed depicted everything that I know to be the right way to treat a person and I'm reassured to see that either in line with or in spite of policy, treating a patient with love prevails.

If you havn't yet seen it, our director James Munro wrote a great peice for The Guardian this morning. It's a gentle but optimistic warning about the problems the Government might encounter as they bring in a ratings system for care homes. Worth a read, even if we do say so ourselves.

James' peice for The Guardian - "Beware of the pitfalls of rating care homes" (15/12/2011)

I went with a family member to a non-urgent ultra-sound at our local teaching hospital last week. The appointment was part of an extra session run on a Saturday morning and it was great they had organised it. But – perhaps because it was a non-routine Saturday morning - the system at the clinic was chaotic and we ended up waiting more than 90 minutes. We fumed about how what we needed was an iPhone app so we could tell Patient Opinion how bad their system was right there and then.

But when it was all over an interesting thing happened. ‘So you’re going to tell them how lousy their booking system is on Patient Opinion right?’ I asked. To which the answer was ‘No, of course not!’

Unpicking this it became clear that frustration had quickly transmuted into gratitude and loyalty. And I realised that this was a good thing. Having an app to fire off about our immediate frustrations would in the end have left my companion feeling worse, not better, about the NHS – and that it is not in her long term interest.

So what we need to do is to recognise that people feel a whole range of things about their care and that gratitude, loyalty and desire not to bite the hand the cares for you are as important as frustration, anger and disappointment. What we at Patient Opinion need to do is to find a way to help people to share the totality of their experiences. To make sharing suggestions for improvement an essential part of being loyal and grateful.