Improved patient focus

Accepted.
A central theme of Monitor’s Quality Governance Framework is whether the Boards of NHS organisations actively engage patients, staff and other key stakeholders on quality. From April 2013 it is also a licence condition that Foundation Trusts actively engage with patients on the quality of care and take into account their views. Monitor’s assessment process includes reviews of patient surveys and the NHS staff survey, meetings with staff and patient groups, review of access and outcome metrics, local media coverage and interviews with lead commissioners, the Care Quality Commission and external and internal auditors. Monitor also writes to local MPs and Healthwatch to see if they have any concerns they wish to raise. As part of Monitor’s Quality Governance review they seek to understand the Trust Board’s arrangements to actively engage with patients. Levels of service performance and standards of care quality form part of Monitor’s regular risk assessment of Foundation Trusts including the Care Quality Commission’s judgements on the quality of care provided. Monitor also expects licence holders to notify them in the event of any incident, event or report that may raise potential concerns over compliance with the licence. Regulatory action may also be triggered by information from local patient groups if it represents a material concern. This is underpinned by two-way sharing of information on patient complaints by Monitor and Care Quality Commission and sharing of intelligence on the quality of care by regional and local Quality Surveillance Groups. Where enforcement action is required further intelligence may be sought including seeking the views of patient representatives and undertaking further analysis of the complaints made to the Foundation Trust, Monitor and Care Quality Commission.
To further embed patient involvement in Monitor’s processes, Monitor is currently engaging with the Department of Health on the recruitment of a Medical Advisor and Director of Patient and Clinical Engagement, and has developed three patient engagement work strands which will be taken forward over the next 12 months.
Projects are underway working with a social research consultancy, patient representative bodies, Healthwatch and other national level health organisations, to help Monitor better understand what good practice looks like when engaging and consulting with patients, the public and their representatives.
Monitor has also pledged to build the use of patient intelligence and complaints into their regulatory approach, working closely with the Care Quality Commission, and will put in place a plan to ensure that ‘patients first’ is embedded into its culture and ways of working.

NHS Monitor has now merged with NHS England.

NHS commissioning organisations have a legal duty to involve the public in the commissioning of services for NHS patients (‘the public involvement duty’). Duty to promote involvement of each patient is required under s.14Z36. In 2023 NHS England produced guidance for ICBs, FTs, Trusts and NHS England to assist in complying with their involvement obligations

NHS commissioning organisations are required to publish an annual assessment of how well they are meeting this duty as part statutory annual reporting.

NHS England hosts the NHS Assembly, a body of some 50 members who include people with lived experience of healthcare and leaders of patient representative organisations, as well as professional leaders in healthcare.

Monitor appointed Hugo Mascie-Taylor as Medical Director and Director of Patient and Clinical Engagement in May 2014. A good practice toolkit to guide Monitor’s patient engagement has also been developed and a patient awareness programme undertaken including an all staff event on making a difference for patients. ‘Patients first’ is now one of Monitor’s five values and further work is planned to embed the values into Monitor’s everyday work.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government referred to Monitor engaging with the Department of Health on recruitment of Medical Advisor and Director of Patient and Clinical Engagement, as well as development of patient engagement work strand. The Government said that Monitor’s assessment process included review of patient and staff surveys, meetings with staff and patient groups, local media coverage, interviews with lead commissions external and internal auditors and writing to local MPs and Healthwatch. The Government also referred to Monitor working with patient representative bodies and using patient intelligence.

In the February 2015 Culture Change Report, the Government said that Monitor had appointed a Director of Patient and Clinical Engagement in May 2014, as well as developed a good practice guide to guide patient engagement. “Patients first” was said to be one of Monitor’s 5 values.