Hoovering up more patient experience data isn’t the answer, it’s what the NHS does with it that matters 

The NHS 10 Year Plan talks a good game about the role of patient experience, arguing that this Government sees it as one of the key measures of success for services.  

The plan backs this up with some important commitments like:   

• Enhancing the role for PREMs and PROMs, starting in maternity but looking to build these into the heart of how we measure the success of things like Neighbourhood and the Modern Service Frameworks.  

• Creating a new Director of Patient Experience role within the DHSC to bring patient voice “in house” and give it greater profile within reformed national structures 

• Exploring how the NHS App can be used as a vehicle to capture more granular and real-time feedback, and use those insights to support other patients when making choices about their care.  

• Linking patient experience data to payment mechanisms to raise the stakes for commissioners and providers in terms of improving their scores. 

But the widespread challenge of the Plan has been that it doesn’t really set out much more detail on how these changes should be delivered. This is scheduled to come over the following weeks and months.  

Yet last month’s Medium Term Planning Framework, in our view at least, raises more questions than answers about the role of experience data and patient voice. As one sector colleague said to me, it feels like its “been sprinkled with the ‘patient experience’ pepper grinder, rather than it being coherently baked-in as a principle.” 

In a similar vein, the Strategic Commissioning Framework published last week is really positive about commissioning for outcomes, but is worryingly light on details about improving experiences.  

My hopes are now pinned on the National Quality Strategy (currently under development and due for publication in 2026) to set the direction on how the sector might actually coherently measure and use patient experience. So where should that work start?  

Get a grip on what’s already happening 

Lord Darzi in his review back in the summer of 2024 argued that one of the biggest issues facing the NHS is that the “patient voice isn’t loud enough”. But when I sat down and went through the annex (yes, I am that kind of guy), I only found 5 out of 319 charts used to evidence the review were actually about patient experience. No wonder Darzi drew that conclusion.  

However, I would argue it’s got nothing to do with how loud patients or communities are, but how much the system wants to listen. Indeed, when you actually look, there is stacks and stacks of experience data being gathered. From the 1.5 million people each year contributing to national surveys, and a conservative estimate of 20 million Friends and Family Test responses, to the quarter of a million formal complaints raised annually, the volume of feedback is immense. And that’s just inside the system. The VCSE gathers huge volumes of feedback, often from communities who go unheard by statutory services, like the 10.5k respondents to Carers UK’s annual survey. Insight from patient information and advice services, like Macmillan which helped 484k people last year, can also shed light on issues about patient experience that statutory partners may overlook.  

So whilst I support the 10 Year Plan’s direction on patient experience, to make it work the Quality Strategy really needs to start with a good audit of what is being captured and how it is being used at the moment. In fairness, NHS England have been trying to commission this strategically critical piece of work, but like so many things its stuck in the ongoing budgetary review processes. My worry right now is that both the Secretary of State and the Chair of NHSE have clearly made patient experience a priority, but those in operational control have failed to grasp the need for the underpinning work.  

Take a mixed method approach  

Once senior leaders have a solid idea of what is being done, then we need to avoid the temptation to over streamline or simplify data collection and analysis.  

After all, Government clearly wants to use patient experience to support both quality improvement and performance management, and those will need slightly different tools.  

And in my experience a mixed method approach to gathering evidence is always best for identifying what patients are experiencing, figuring out why it’s happening and then working with patients and communities to fix the underlying problems.  

As a rough outline we need a patient experience system that supports a coordinated approach across three types of data collection:  

1. Robust and representative national surveys – these provide large scale, robustly sampled and reliable responses that can be used to track performance over time and help allocate resources. They are also good for regulation. But they can also be slow, so are not the best for driving rapid evaluation or quality improvement. We probably do need to review the current national surveys programme, to make sure it is returning what the system needs. In particular, we need to explore ways surveys can deliver insights more rapidly between fieldwork and reporting. We also need to ensure more surveys start to look across pathways and the gaps between services, like NHS England’s Integration Index work.  
2.  Mechanisms for feedback that are always open – this could include things like the NHS App, or VCSE forums, where patients and communities are sharing feedback about the things that matter to them unprompted by the system. It is important that we factor in multiple channels here to ensure we are hearing from diverse communities. In many ways this was one of the major strengths of the Healthwatch model. The network of 153 local organisations are out in their local communities all the time, listening to what matters to people and providing an independent interpretation of that data to help system leaders improve care. From a personal perspective I know it is my exposure to that rich data that has resulted in me working on issues like patient admin that would likely never have seen the light of day otherwise. Bringing the Healthwatch functions “in-house” into ICBs and DHSC leaves some big shoes to fill. Will the teams picking this work up have the skills and the freedom to really engage on the topics that matter most to people?  
3. Solicited qualitative engagement – again this could be through more advanced use of the App to target particular communities or cohorts of patients, or it could be through commissioned coproduction exercises. Whichever route systems go down, this is about creating forums to really understand what people are saying and to work with them to fix problems. The challenge here is likely to be a combination of resource and time. The NHS always talks about wanting to deliver things “at pace,” which is hard when you are looking to work with communities who lack significant trust in the NHS right now. The way to shortcut this is to work with local community groups and VCSE organisations, but this needs to be financially supported otherwise these routes will cease to exist.  

Avoid relying on a single source  

We are starting to see an increasing use of the ONS Health Insights Survey to report and assess progress against some of the government’s ambitions. 

For example, this piece in the HSJ in October based on the survey’s findings said that we have reached a “tipping point in mode of contacting practices” with more people reporting they are contacting their GP practice online than by phone for the first time.  

The piece does acknowledge that “phone” remained more popular as a mode of contact for those in the most deprived areas. However, all of us need to continually look for bias in the data we are presented with. In this case, for example, the sample is online only so by its very nature the data is already skewed toward respondents who are more digitally savvy and therefore positive views of online NHS services should come with that health warning.    

The ONS survey does offer something different to other surveys in the sense that it takes a longitudinal approach, and I do think there is merit in that. But it is also worth noting that the sample has fallen from over 100k people to around 76K people, which is a concern. It is also not particularly representative, with just 4% of respondents from an ethnic minority background, compared to 17% of the population.

Culture will be the real challenge  

In the end patient experience data can be the most comprehensive and robust ever collected and it will still come up against the barrier of culture in the NHS.  

As my fellow patient experience champion, Dan Wellings, Senior Fellow at the King’s Fund, has said on numerous occasions, you tend to get one of two responses to reports about negative patient experience:  

• People either say “We already knew that”, begging the question why haven’t you tried to fix it already then? Or… 

• They attack the methodology, concentrating on undermining the message rather than listening to it and taking action.  

To overcome this barrier, the forthcoming Quality Strategy will have to set out how it is going to hardwire patient experience measures into the very DNA of the service.  

It must outline how robust collection methods will be established and properly resourced at Neighbourhood and ICB level, and how these will feed into a much more sophisticated national infrastructure. This structure will then need to have the weight and the power to hold leaders to account, ensuring they take action on feedback data and that it leads to improvement.  

Ultimately, in a world where public satisfaction with the NHS is at an all-time low, this is the only way to know for sure if the Government is delivering on its promise in chapter 6 of the 10 Year Plan to “put patient choice, voice and feedback at the heart of how we define and measure quality.”