Speech by Minister James Reilly – 2010 National In-patient Survey ‘Measuring the Patient’s Experience of Hospital Services’

Ladies and Gentlemen,

Someone said to me recently that I need to take a couple of days off this summer (wouldn’t that be a fine thing?) in order to watch a boxed set of the old TV programme Yes, Minister.

Apparently there’s one particular episode where the performance of a hospital comes up for discussion with the Minister.

The lead civil servant, Sir Humphrey, praises the hospital to the skies.

  • Works like a clock, he says.
  • Has won several hygiene awards, he says.
  • Best administered hospital in the country, he says.

But, the Minister points out, it has no patients.

No patients at all.

As far as Sir Humphrey’s concerned, that’s a minor issue.

Because why?

Because the system works perfectly. Having patients in the hospital would muck up that perfect system.

Even though the script was written thirty years ago, it’s clearly just as relevant today. Because of an organisational truth.

An eternal verity is that systems, unless vigorously and regularly kicked, tend to turn inward to serve themselves, rather than the people they were set up to serve.

The best and most productive form of system-kicking is the evidence of those people – the ones the system was set up to serve.

That’s why this survey’s so important.

Because it asked almost twelve thousand people about their experience and almost 44% of them responded.

I’m told that patients recently discharged from 25 public hospitals either managed by the HSE or run by voluntary organisations were selected to participate in the survey.

The majority of the patient group were funded as public patients during their stay in hospital (69.7%), followed by 29.8% funded by private healthcare insurance and 0.5% availing of the National Treatment Purchase Fund (NTPF) Scheme.

The good news the survey delivers is that the majority of patients:

  • Were satisfied with the services they received during their hospital stay,
  • that they’d go back to the same hospital if necessary and
  • that they’d recommend it to a friend or family member.

The news isn’t all good, and we’ve got to learn from the bad stuff.

Capturing the good stuff, so it happens more widely and learning from the bad stuff so it stops happening: that more or less sums up the task facing all of us in healthcare.

  • Improved care of patients is at the core of what we are about.
  • Improved care through listening to patients is at the core of what we are about.

The Report of the Commission on Patient Safety and Quality Assurance, in 2008, said patients, carers and family members had to be at the centre of all that’s done in the Irish health service. Their voices must be heard more effectively in the future, and they must influence policy-making and service delivery.

The perception of healthcare goes in waves.

  • There was the wave where pharmaceutical magic bullets solved everything
  • More recently, there’s been the wave of faith in high-technology.

But the reality – first, last and always – is that healthcare is about people.

Healthcare professionals are the human face of the service.

Many of us will be a “patient” at some time in our life, whether it is in a hospital, nursing home or General Practitioner’s surgery.

As patients, we’re entitled to expect to meet competent professionals whose skills are up-to-date, in the right kind of facilities that are properly run and regulated.

We’re also entitled to expect that those competent professionals will treat us as individuals. Will listen. Will show us respect.

In that context, it’s important to register – about this survey – that while the majority of patients were satisfied with the manner in which their diagnosis was communicated to them, a small number reported that they had questions they’d like to have asked, but didn’t. Why didn’t they? Because staff seemed too busy or just simply weren’t available.

Ah, the unasked question.

The unexpressed worry.

The silent dread.

That’s what we must constantly seek to prevent.

Because if we don’t give the information a patient really needs, they’re going to be markedly less receptive when we give them information we think they need.

If we haven’t paid attention to their worries at an early stage, than if anything goes wrong in the course of the treatment, everybody’s in a much worse situation.

A patient safety incident, for example can prove to be a hugely traumatic experience for the patient and their family. Fear and distress are compounded by the natural anger felt when something happens that shouldn’t have happened. For the health professional, the aftermath of a serious patient safety incident is a difficult time, professionally and personally.

But what’s pivotal in managing adverse events generally is the capacity to listen and tell the truth in a way and at a time which allows the patient or their family to absorb it.

I seem to be placing a heavy emphasis on communication. I am. Because everything a medical professional does is a form of communication that feeds into the patient’s understanding of their situation.

Let me give you just one example.

Any time a patient sees members of their healthcare team wash their hands prior to carrying out an examination on them, what’s communicated is professional care. Any time they don’t see that, the message sent is one of sloppy unsafe practice – and patients remember those messages.

They remember them because increasingly, patients “get it.” They “get” the reality that no matter how high-tech the context, no matter how elaborate the pharmaceutical regimen, one medical professional failing to wash their hands between patients can spread a lethal hospital bug.

While I welcome the decrease of 48% in the number of MRSA cases reported between 2006 and 2010, that’s just the beginning of the fightback.

Now, I want to touch briefly on The Special Delivery Unit set up on 2nd June. The SDU is a key part of the Government’s plans to radically reform the health system in Ireland, with the ultimate goal of introducing a system of Universal Health Insurance (UHI).

Dr. Martin Connor, advisor to the SDU, has extensive experience in the NHS and led a similar initiative in Northern Ireland with considerable success. His principal task will be to build-up the SDU and to prepare proposals on how best it can be placed on a permanent footing within the next six months.

The SDU will work to unblock access to acute services by dramatically improving the flow of patients through the system, and by streamlining waiting lists, including referrals from GPs. The SDU will work closely with the HSE, building on initiatives already underway. These include the clinical programmes developed by the HSE’s National Directorate for Clinical Strategy and Programmes.

The priorities for the SDU include:

  • Emergency Departments – waiting times for admission have been unacceptably high in a number of hospitals, often breaching the current 6-hour maximum waiting time target
  • In-patient waiting times – the trend has been upwards recently, despite the work of the NTPF
  • Out-patient waiting times – the time from GP referral to an appointment with a consultant is unacceptably long in many specialties
  • Access to diagnostics – this forms an essential part of the patient journey for all of the areas of access above

Sometimes, in the midst of much review and criticism, we can forget that we get a lot of things right. A significant cohort of people throughout the health sector are providing or supporting the delivery of high quality healthcare services.

Good care can bring such uplift into our lives. It can make the difference between enduring life and enjoying life and that instinct to offer care is one of our finest and noblest human attributes. If we lose that instinct, we lose our humanity.

Excellence and compassion are found in abundance in our healthcare employees. The challenge is to embed them as core values in our healthcare organisations.

Surveys like today’s can help us catch ourselves doing things right and help us repeat them – they can also help us correct errors and fill gaps.

So we must commend the co-operation between the Irish Society for Quality and Safety in Healthcare, the HSE and the Health Research Board which part-funded this initiative.

This report shows much that is good in our health service for those with access but we must improve. What it doesn’t show is the real difficulty of accessing care and that is something which I am determined to tackle through the SDU.

I hope the next survey will include assessment of how long patients waited for their treatment from first presentation to their appointment to completing their treatment.

Knowledge is power and the survey informs and empowers us to change and improve our services to the benefit of patients – but only if we act on it.

Lets do that so that we can feel proud of our health service and our friends and our loved ones can feel safe in it.

Thank you