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Blog Mary Agnew


Honesty, openness and improvement

Posted by: , Posted on: - Categories: Blog, Francis, NHS, Uncategorised

I’m often asked when talking about Francis questions on the lines of “There have been inquiries into serious care failings in the past. How can we be assured lessons will be learnt this time? What will be different?” An important part of the answer to enabling genuine learning and improving services lies in the combined power of transparency and patient voice.

Transparency is a dull word for an actually pretty revolutionary concept for healthcare. Not a new concept of course, but one where we seem to be at a tipping point in making it the norm. If we can really see and understand the information on how well services are performing down to ward and specialty level, and if we can reflect on the comments, concerns and feedback from people using services, we can better understand excellence and be honest about failings. Technology now enables the service to do this in a much more sophisticated, rapid and powerful way.

Earlier this month saw the publication of Professor Sir Bruce Keogh’s review of the quality of care and treatment provided by 14 hospital trusts that are persistent outliers on mortality indicators. Whilst this identified pockets of excellent practice in all of the trusts reviewed which should not be lost sight of, it highlighted concerns and areas needing urgent action, setting out eight powerful ambitions for improving services which everyone can learn from.

This review was done in a completely new way – with total transparency and extensive involvement of the public in assessing hospitals. Everything has been published on the NHS Choices website, including videos of presentations by the review panels to the risk summits and the subsequent improvement plans.

A new approach to inspection is an important part of how we are responding to Francis. Professor Sir Mike Richards, the new Chief Inspector of Hospitals, has just issued a ‘call to action’ for people to sign up to be part of his inspection teams. These bigger teams, headed up by clinical and other experts that include trained members of the public, will spend longer inspecting hospitals and cover every site that delivers acute services and eight key services areas: A&E; maternity, paediatrics; acute medical and surgical pathways; care for the frail elderly; end of life care; and outpatients. The inspections will be a mixture of unannounced and announced and they will include inspections in the evenings and weekends when we know people can experience poor care. If you are interested in being involved in this important work, you can get in touch with Mike’s ‘inspection army’ to find out more.

The NHS Friends and Family Test, currently being extended across the NHS, is a key way you can give feedback on whether you would recommend a service to your friends and family. The first set of data from the test will be published tomorrow and for the first time we will be able to see what patients think of services right across the country, right down to ward level. You can also drive changes by sharing your views and stories on NHS Choices and on sites  such as Patient Opinion.

All of this may seem rather dry and general, but this renewed spirit of openness and stronger commitment to acting in partnership with people using services marks, I think, a real shift. I’d be really interested in your reflections on creating an open NHS and working in partnership with people who are experts through their own experiences as patients and carers. I will follow up in subsequent blogs with insights from guest contributors about the changes underway to bring this theme to life and to share their expertise in understanding and responding to feedback, meaningfully involving people in their care and in shaping services.

Finally, the comments thread has gone suspiciously quiet! I am genuinely interested to hear your thoughts on both the themes I am covering, and the blog itself. Do add your reflections below or you can email the team directly at

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  1. Comment by Harriet Wallace posted on

    Hi Mary great stuff. This is so so important. Harriet

  2. Comment by Mary Agnew posted on

    Thanks. Important and exciting. But not easy!


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