How much evidence is there that UK healthcare professionals believe patients are resistant to being treated in hospitals that are a significant distance from their home?
This is a generally accepted piece of received wisdom amongst clinicians and care professionals, which MindMetre validated through a series of qualitative interviews that preceded our quantitative study.
Of course people would like to have both clinical excellence and an extremely safe acute treatment environment available on their doorstep. However, the culture of the NHS is changing, and the notion of a general hospital offering all services and specialisms in each local catchment in the country has been seen to be unaffordable and undeliverable in the future.
Many representative organisations have made public statements on this change. Our research shows that patients recognise the divergence between ideal situation (the best safest treatment on their doorstep) and real life. So when it comes to avoiding healthcare acquired infections, any desire to be treated locally goes straight out of the window.
Please can you explain what prompted MindMetre’s research into this topic?
As part of its social responsibility programme, MindMetre conducts independent, unsponsored research into a number of key public issues that the firm considers important and under-researched.
One of these is the issue of healthcare acquired infections and the importance of prioritising effective infection (HCAI) reduction strategies.
As patients in the NHS are afforded more choice, they will naturally demand to be treated in acute centres that offer them the best clinical quality and the safest treatment environment.
While this is likely to give acute Trust planning something of a headache, it may also act as an additional incentive to push infection control even higher up the priority list.
What did your independent research involve?
MindMetre surveyed a representative sample of the population (over 2,000 people representative by age, gender, region and social background) and asked them questions on two key issues: how important did they feel HCAI reduction was amongst other demands on the NHS purse; and how far would they be prepared to travel to avoid treatment at their local hospital if that hospital had a poor record for HCAIs.
What were your main findings?
The headline finding from the research is that 96% of British citizens believe eradicating all HAIs should be an NHS top ten priority.
Positioning HCAI reduction amongst other perceived priority healthcare activities revealed that British citizens believe eradicating HCAIs is more important than "better sharing of patient information" (76%) and "reducing waiting times" (68%), and of roughly equal importance to "increasing the nurse:patient ratio" and "researching new cures and treatments".
The key research finding revealed that 76% of British citizens say that if they learned that their hospital was a low performer on HCAI reduction, they would insist their GP referred them to a hospital with a better record.
Given the recent developments in wider publication of a variety of hospital safety performance statistics, the impact of widespread patient defection from their local provider could seriously upset that Trust’s economic model.
However, how far would they be prepared to go? The answers made it clear that people were prepared to go serious distances to avoid a poor HCAI record.
- 83% would be happy to travel 20 miles to be treated in a hospital with a better HAI reduction record than their local hospital
- 62% would be happy to travel 50 miles to be treated in a hospital with a better HAI reduction record than their local hospital
- 48% would be happy to travel 100 miles to be treated in a hospital with a better HAI reduction record than their local hospital
Were you surprised by these findings?
We suspected that, when faced with a serious health risk, in the form of HCAIs, people would travel some distance to avoid them. We were, however, astonished at how far people were prepared to go.
In some way, this must be held as testimony to greatly increased public awareness about the threat of HCAIs, and increased patient awareness that they have the choice to go to acute centres other than their local Trust.
How do you think this research will impact the healthcare sector?
The experience with MRSA reduction has shown that mandatory active screening of patients on admission has proved extremely effective.
Spotting infected parties and treating them rapidly, with the most appropriate antibiotic, and isolated from uninfected patients, is clearly a key strategy in HCAI reduction, with a commitment to its continuance in the Department of Health Operating Framework (“The zero tolerance approach to all avoidable HCAIs will continue”).
Active screening has been mandatory in England and Wales since 2010. Around this time, some pioneering Trusts also introduced rapid screening for other associated infections, such as MSSA. However, screening programmes routines are not yet addressing emergent HCAIs, a good proportion of which are presenting antibiotic-resistance.
Perhaps the major worry from these research findings, though, is the future economic impact of the evident and surprising patient mobility. The findings present a major potential headache for acute NHS Trusts, in that there is a possibility of them losing ‘business’ to other Trusts with a better reputation, whether for a clinical specialism or a safer overall environment.
What can NHS Acute Trusts learn from this research?
Concern about HCAIs appears to be a powerful factor in patients’ choice of where to be treated. This raises a warning flag to NHS management that the resourcing of HCAI reduction is not a trivial matter, and ignoring the issue (or not giving it enough emphasis) stands to potentially have a major impact on an acute Trust’s finances in the new NHS commissioning structure.
Reform of UK acute trusts is in progress, and competition between acute trusts has been enabled. This makes the control of HCAIs all the more urgent.
The Health and Social Care Act 2012 requires Clinical Commissioning Groups to ensure good practice, to promote and protect patient choice, and to improve services for patients. A hospital that is not seen to be striving to reduce HCAIs, or is showing a rate above that of peer institutions (even those relatively distant from the patient’s home – as shown in this report) is likely to see reduced commissioning from CCGs over time.
Sending patients to an acute care institution with a high HCAI count can hardly be seen as consonant with the CCG’s, and the individual GP’s, statutory duties.
What are MindMetre’s plans for the future?
We are currently in talks with a number of acute Trusts who are taking this issue very seriously indeed, have invested in tighter controls and better, faster screening turnaround times, thereby seriously improving bed/ward availability and radically reducing the costs of dealing with infection outbreaks.
We intend to capture the hard improvement data from these examples, then model this best practice across all Trusts to highlight the national benefit to be gained from widespread improvement in HCAI management. This report is likely to be published by Summer 2015.
Where can readers find more information?
Readers can download the latest report from https://www.mindmetreresearch.com/
About Paul Lindsell
In 1993 Paul founded the first of a number of marketing services businesses. Since 2009, he also devotes his time to running and developing MindMetre Research, a market research company with clients in healthcare technology, finance, retail and a number of other sectors.
MindMetre helps its clients research insights that allow them to compete ahead of market developments, now operating across countries from the USA, through Europe, to Russia, India, China and Australia.
Paul has ensured that, as well as its commercial work, MindMetre makes a contribution to society by conducting and publishing unsponsored, independent research into key social issues. In the healthcare sector, these currently include the safety of healthcare workers, patient safety and sexual health.
Throughout his career, Paul has mentored and guided the marketing function- on a pro bono basis - for a range of charitable organisations.
He is also co-founder of The Data Governance Forum and founder of the European Supply Chain Finance Forum.
http://www.nhs.uk/safety/search/
See, for instance, Blackpool, Fylde and Wyre Hospitals, Blackpool Hospitals first in the UK to screen for superbug MSSA, 30 Jul 2010
Female physicians may offer improved patient outcomes