In February 2013, The Francis Report was published following a formal inquiry into high-profile failings at Mid-Staffordshire NHS Foundation Trust. The report detailed a series of recommendations to improve standards of care across the National Health Service. These included measures to ensure the patient is always put first, and to create a new culture of openness across the NHS.
In response to the report, NHS Central Eastern CSU resolved to find a way to allow patients and GPs to comment and complain – easily and anonymously – about their experience of healthcare services, so that targeted improvements could be made.
“We wanted to find a way that people could raise a concern anonymously – feedback that would be fed to a CCG’s quality directorate, for example,” explains Mark Peedle, the CSU’s Head of Operational IT. “This would allow trends to be identified – so that, if there was a flurry of complaints about rejected referrals to a hospital, action could be taken.”
Although NHS Organisations have Patient Advice and Liaison Services, there isn’t a mechanism to provide incidental, anonymous feedback. “The only way for someone to comment until now has been to phone or send an email, giving details as well as their contact information, a process that will have put a lot of people off making complaints,” Mark notes.
Innovation through partnership
NHS Central Eastern CSU’s vision was to create a very simple application that Trusts could embed within their own websites or intranets, or offer as an easily downloadable PC or mobile app. This would allow patients – or GPs or other service providers – to log comments or complaints quickly and easily, but without revealing their identity. “The idea was to make it as easy as using Twitter,” Mark continues. “But the anonymity was critical.”
The CSU’s IT department took its requirements to the market. “We were looking for a company that was interested in partnering with us to develop the software,” Mark explains. “The idea was that we would develop something simple that could be taken up widely across the health service, allowing us to sell on the application. This would allow us to keep the initial costs down, and give both us and the developer an income from new uses of the software.”
One Beyond, one of the companies being considered, embraced the partnership idea. “They believed in what we were doing and gave us a very reasonable price to develop the application,” Mark says.
One Beyond specialises in creating high-quality Microsoft .NET and SQL Server web applications and back-office business database applications. Technical Director Nick Thompson took on board the requirement to protect individuals’ anonymity, but suggested that this could be done in such a way that would also allow for a reply.
Nick explains: “Rather than simply have a one-way message, we proposed that we could still provide complete anonymity while allowing the person providing the feedback to receive a response – even if this is just an acknowledgement that their comment has been received. The CSU liked this idea, so we created a way for individuals to enter their mobile number – but without anyone being able to see this number or connect it to an individual.”
Working in close collaboration with the CSU, One Beyond developed the agreed application – iNotify – within just three months. “This was excellent – beyond my expectations,” Mark comments. One Beyond wrote the application, which is based on SQL Server technology at the back end, using Microsoft .NET, a rapid development environment.
Giving GP’s a voice
The first user of the solution is a local CCG. Its version of the tool is installed on GPs’ PCs so they can anonymously report issues related to booking hospital clinics. In this case the application self-installs automatically from the web once selected. Any updates to the software will also happen automatically. The program is completely secure, being run on servers hosted in One Beyond’s data centre. Anonymous messages sent between the GP and the quality directorate are encrypted, and no one can see the content other than 1-2 designated people in this team – but even they cannot see where the feedback has come from.
If I had to describe the company in a word it would be professional. The delivery was fantastically efficient.
Next, NHS Central Eastern CSU would like to see Trusts extend the facility to patients. “Anyone could deploy the solution, as long as it is connected up to someone who can receive and respond to the feedback.” Mr Peedle notes. iNotify does not use the N3 NHS network, running instead over the Internet more widely. “This means it can be deployed and used anywhere,” he explains.
It is by selling on the solution that NHS Central Eastern CSU will recoup some of its investment. One Beyond, which will retain ownership of the application for the first year, will get a proportion of the licensing fee associated with any resale agreements. These additional earnings will supplement the very modest initial development fee. “This was a very affordable application,” Mark notes. “One Beyond made us a great offer. We spent public money to get this application developed so it was important we got value for money.”
As to the benefits of iNotify, these will be to the patient first and foremost, he says. “By making it easier for patients to provide comments and feedback, we will be able to better target our resources and improve services promptly and in line with what patients deem to be most critical.”
On his experiences of working with One Beyond, Mark describes the partnership as a ‘great fit’. “If I had to describe the company in a word it would be professional,” he concludes. “The delivery was fantastically efficient. Most importantly, Nick Thompson immediately bought into what we were trying to achieve and was very enthusiastic about the project, which was critical to its success.”
An anonymous patient feedback facility that NHS Trusts can embed within their own websites or intranets, or offer as an easily downloadable PC or mobile app.