93. Evidence submitted by South East Coast
Strategic Health Authority (PPI 112)
Key Points
1. The over riding purpose of Patient and
Public Involvement is to improve the services which the NHS and
other providers offer and so improve the:
Experience that patients and carers have of
these services. Patient and public involvement also serves to
make the NHS more accountable and responsive to the communities
it serves and people who pay for it.
Patient and public involvement in various forms
has been around since the 1970's. The Health and Social Care Act
2001 has led to a greater effort and consistency of approach across
the many organisations within the NHS. The latest reforms will
strengthen and extend this to include social care, the regulatory
bodies and external providers. Then also seek to broaden the independent
scrutiny and monitoring of health and social organisations, so
that staff more actively shape the development and delivery of
services.
Conclusion: Engagement and a better understanding
of the NHS could extend into a wider public understanding of health
and social care issues. This would encourage a more active citizenship,
prepared to act on and take responsibility for improving their
local communities as well as improving their own health and quality
of life as individuals. Thus in the long term, people's involvement
and engagement with the public sector can make services and the
communities served more sustainable, based upon an increase in
social capital and the better integration of people's needs with
the services provided and a stronger ethos of partnership working
to tackle together some of the long term health and socio economic
problems.
2. Patient and Public involvement offers
good value for money when its approach is proportionate to the
desired outcome. It should operate across a number of levels from
information, through participation to partnership, and should
use a variety of tools and techniques based upon what works best
for those patients, carers, staff and stakeholders you intend
to engage with.
Having a range of voices taking part in planning
patient and public involvement should ensure the delivery of good
engagement processes.
Conclusion: NHS organisations need to
ensure they invest the appropriate time, commitment, resources
and drive to deliver good PPI throughout all the services they
provide. This will lead to the desired cultural change, putting
patients in a position to truly shape and influence service to
improvements for themselves and other people.
3. As a minimum, Section 11 of the Health
and Social Care Act 2001 places a duty on Primary Care and NHS
Trusts and Strategic Health Authorities to make arrangements to
involve and consult patients and the public:
not just when a major change is proposed,
but in ongoing service planning;
not just in the consideration of
a proposal, but from the outset in the development of that proposal;
and
in decisions about general service
delivery, not just major changes.
Recent changes to the Commissioning Framework
have resulted in an additonal duty to respond.
Section 7 of the Health and Social Care Act
2001 gave powers to Local Authorities to establish Overview and
Scrutiny Committees to:
take on the role of scrutiny of the
NHSnot just for major changes but for the ongoing operation
and planning of services;
refer contested service changes to
the Secretary of State;
call NHS managers to give information
about services and decisions;
report their recommendations locally;
and
be consulted by the NHS where there
are to be major changes to health services.
Section 11 requires that the NHS engage people
in all circumstances when the NHS are changing and improving services,
since this is a constant process of improvement for any public
service. In the NHS as in other public services there are many
and varied ways for patients, staff and the wider public to improve
the way the NHS and other providers offer health and social care
services.
Conclusion: Wider, formal consultation
is guided by the findings of Health Overview and Scrutiny Committees
(HOSC's) and is dependent upon such terms as "substantial"
and "significant" changes, which are difficult to define.
Therefore, there is often a process of negotiation to clarify
what should happen locally on a case by case basis and it is beholden
on local NHS organisations to involve HOSC's early in agreeing
what should be taking place.
Question 1
The purpose of Patient and Public Involvement
is to improve the patients' experience of health and social care
and to improve the services offered
1. Introduction
Members of the patient and publics who use NHS
services have been involved in commenting on how services are
delivered since the 70s. The original premise for this involvement
was for Community Health Councils to monitor and review the National
Health Service and to recommend improvements. Since the Kennedy
report on the Bristol Inquiry and the Health and Social Care Act
2001 the move has been to ensure that each NHS organisation has
a statutory duty to ensure patients, carers and staff are part
of team improving the NHS and its services by engaging directly
with them and listening to their views and ensuring they shape
the improvement of services. This has led to a significant increase
in the level of involvement and the consistency with which all
NHS organisations listen to patients and the public, there are
a variety of ways in which people are able to have an impact on
improving services from talking to Patient Advice and Liaison
Services to taking part in a review of services there are many
more opportunities for patients and carers to influence the way
services are delivered.
This paper describes the framework in place
in the SE Coast that is to support the transformation of public
patient and community engagement in the NHS from being an "add
on" to being an integral part of business. Whilst the recent
local government bill and changes in the commissioning framework
strengthen the need for the wider public sector to work in a more
integrated way with their citizens and service users to ensure
more sustainable communities. The nature of Patient Public Involvement
and evidence in this field, suggest that an evolutionary approach
that builds consensus and engages participation, leading to sustainable
action, is the most successful approach, enabling the local NHS
to fulfil its responsibilities under section 7 and 11. The question
we address is how will the proposed reforms add value?
2. Context
The NHS Plan 2000 clearly established
the Government's intention that patients should be "at the
heart of the NHS". The Government sees patient and public
involvement as central to service planning and provision and a
major driver for service improvement.
The 2005-08 NHS Improvement Plan Putting
people at the heart of public services set out the Government's
vision for an NHS that is modernised to meet people's increasing
ambitions and expectations for public services.
"An NHS which is fair to all of us and personal
to each of us offering everyone the same access to, and the power
to choose from, a wide range of services of high quality, based
on clinical need, not the ability to pay." (The 2005-08 NHS
Improvement Plan Putting people at the heart of public services)
The guidance Creating a patient-led NHS extends
the government's ambitions towards changing "the whole system
so there is more choice, more personalised care, real empowerment
of people to improve their healtha fundamental change in
the NHS relationship with patients and the public."
The recent white paper: Our Health, Our Care,
Our Say focuses on a strategic shift towards locating more
services in local community settings and closer to people's homes.
It will also change the way services are offered in the community.
During the consultation, people told the government they want
a more personal service rather than a one size-fits-all approachservices
that put them in control. So the NHS needs to provide care that
is led by the individual, not led by the system or restricted
by bureaucracy. And health and social care need to help people
with the information and support they need to take control of
their own health and well-being. And the recent local government
bill ensures that both health and social care will contribute
to a step change in empowering local people to shape local services
and to meet local needs.
3. National Vision and Principles
3.1 Principles
Creating a patient-led NHS sets out core principles
that underpin the shift in emphasis from the NHS providing services
for the public to an NHS that works in partnership with patients,
carers and the public to improve their health and wellbeing, together
with the services that support this.
3.2 Partnership between NHS and the Public
The idea of partnership between the NHS and
the public is not new. Much patient and public involvement is
already being carried out through delivering and improving services
and other activities within the NHS. Furthermore, some progress
has been shown in the results of patient surveys and the evidence
of service change based upon the views of staff, patients and
the wider public. There is a national PSA target for Patient Experience
for 2005-08 which informs part of NHS Local Delivery Plans and
service improvement, monitored through SHA's by the DH Recovery
Support Unit which states:
"Organisations should secure sustained national
improvements in NHS patient experience by 2008, as measured by
independently validated surveys ensuring that individuals are
fully involved in decisions about their health care, including
choice of provider."
To be effective Patient and Public Involvement
needs to be conducted on two levels:
the individual levelinvolving
patients in discussions and decisions concerning their own individual
care and treatment; and
the collective levelinvolving
patients, carers and the wider public in broader considerations
regarding the planning, provision and monitoring of services.
At both levels there is a continuum of involvement,
(see question 2) which breaks down into three broad areas: Information,
Feedback and Influence.
|
Information - where an organisation informs patients, carers and the public, to promote informed use of services and choice. |
|
Feedback - where an organisation collects feedback from the patient experience, through qualitative and quantitative methods. The purpose here is to improve the quality of service delivery and the patient experience. |
|
Influence - where an organisation involves patients, carers and the public in policy and planning, or in decisions concerning resources, planning and reconfiguration. The purpose here is to improve the quality of decision making and promote accountability. |
Question: Will LINKS provide a constructive
sustainable compliment for involving local people? |
Question: Will LINKS be able to
reach those traditionally distanced by mainstream systems? |
3.3 Long term cultural change and service
improvement
The involvement of patients, users and the public
has driven cultural change in the NHS over the last six years
putting individuals and communities "on the inside"
of the care system. NHS plans have deliberately emphasised that
the service should not only be patient centred, focusing on need,
but become a "Patient Led NHS" where patient and public
views shape and inform policy and services so that the NHS is
truly tailored to people's requirements.
The aim is to ensure that the NHS and care services
are transformed through better engagement with patients, users
and the public by engaging local people, regularly seeking out
and acting on their views and so creating responsive services
that people perceive to be improving. The overwhelming and ongoing
purpose of patient and public involvement or engagement is to
improve the patient's experience of health care. That tangible
improvement to services and systems will be made as a result of
peoples' views, complaints, involvement in changing services,
or choosing to volunteer or actively increase the range and support
of services.
3.4 Increased accountability and sustainability
the "fully engaged scenario"
With patients, partners and the public influencing
change in the NHS there is an increased public accountability
of the National Health Service. Fundamentally, citizens have a
right to be involved in decisions which affect their lives whether
as patients or carers or taxpayers, people should know about and
be party to decisions which affect their health and wellbeing
as individuals and as members of their communities. Research has
shown that empowered patients who understand the services and
the choices available to them make better informed decisions.
Derek Wanless in his papers for the treasury:
Securing our future health: taking a long-term view (2002)
and Securing good health for the whole population (September
2004), has clearly documented that one of the key means to achieve
sustainability is a "fully engaged"' population which
is capable of taking greater responsibility for maintaining and
improving their health and wellbeing, so that the finite resources
of health and social care can be used effectively to support those
who require additional assistance. This approach enables people
to sustain an independence and quality of life with adequate public
health and social care resources at our disposal. Rising patient
and public expectations will place increasing demands on those
providing healthcare, calling for continuous service improvements.
There is a wide spread recognition that the
health system needs to become more people centred with the interests
of the public, patients and customers given greater prominence
and more influence in decision-making at all levels. This will
create new opportunities for people to take an active part in
managing their own health and become "expert patients"
in managing their care with support from health professionals.
The Transforming Chronic Care Programme (TCCP)
in Surrey and Sussex conducted a survey of almost 24,000 people
with long term conditions or their carers which showed that: people
generally felt they needed more information about their condition
and their care, better access to services and more involvement
in planning services and care. They said they felt health and
social care services staff did not work in partnership and services
were not integrated. The TCCP set up a service user group comprising
over 100 members. Top of their agenda was to empower people with
long-term conditions to express their needs more confidently when
working with health professionals which they felt could improve
their involvement in planning their care. Delegates at a meeting
in September 2006 said they did not always find it easy to express
themselves when talking to clinicians and that this prevented
them from taking control of the management of their care, particularly
in a large county where there is a two tier system and Local Strategic
Partnerships in place. It will be interesting to see how LINKS
can add value to these current planning processes.
3.4.1 360 Evaluation
The NHS is a national service which is continually
striving to improveits overall services, its staff, technology
and techniques, and the overall patient pathway. This requires
constant and ongoing evaluation of the services currently provided,
identifying ways to improve and strengthen services and systems.
The expertise of staff, patients, carers and clinicians is needed
in order to make those improvements to systems and services. If
the patient and public perspective was missing from this evaluation
process, the learning would be limited and understanding incomplete.
Question 2
What form of patient and public involvement is
desirable, practical and offers good value for money?
1. Introduction
There is no single solution to effective patient
and public involvement. Best practice and experience show that
a suite of methods is desirable if engagement is to be meaningful.
Appropriate practical choices from that suite can be made to ensure
good value for money. At the same time the programme of involvement
should be systematic and consistent, supporting health communities
to:
Ensure high quality outcomes of value
to users and communities.
Transform services through continuous
learning and improvement based on people's (staff and stakeholders)
feedback.
Ensure improved services are responsive,
accessible and accountable to local populations.
Being responsive to patients' experiences as
consumers of our care and listening to people in local communities
is paramount to ensuring that where, when and how services are
delivered is appropriate to local need. Without first capturing
and being responsive to the needs and wishes of patients, users
and carers, we will continue to experience poor use of resources
and less effective care.
This continuum demonstrates the levels of engagement,
from giving information through to the fully engaged level of
"partnership". Good engagement should be at a level
proportionate to the expected outcome.
For example: a one-off focus group aimed at
mapping patient information, which leads to the implementation
of improved information, provided to patients in a timely fashion
is a valued outcome. Equally, the involvement of patients and
carers at the beginning of a cross sector service review which
continues through to implementation of a consolidated specialist
service in two centres of excellence is of value to the whole
health community and several organisations. An example of service
user engagement in the Renal and Vascular Review of services across
Kent and Medway appears in Appendix 1.
Both these examples benefit and improve the
patient experience, but they are each of a scale of time, resources
and involvement applicable to the needs and outcomes.
Good patient and public involvement and engagement
ensures patients and communities become more empowered, able to
make choices as consumers about how, where and when they access
and utilise services (or choose not to). Services need be customised
to individual needs. At the core of the fully engaged scenario
is the need for people to feel more confident in themselves and
their future in order to take more responsibility for their health
and make changes in their choice of lifestyle. It is also about
enabling people with long-term illnesses or medical conditions
to have a better quality of life.
In order for our stakeholders/patients to become
fully engaged we must:
Address problems that people have
with finding appropriate information about their health.
Ease difficulties people have in
considering the wider social costs of particular behaviour.
Address the inequalities that arise
from socio-economic or differences and ingrained deprivation.
1.1 How can we do it?
Not only must people take action to manage/maintain
their own health, but organisations such as the NHS, local authorities,
businesses and voluntary and community sector organisations must
also get involved in local partnerships. This will Increase the
social capital that a healthy active community can offer, not
just in terms of improved health and social care but in the broader
gain in communities which are actively trying to improve their
quality of life and socio economic standing.
2. The Role of the Strategic Health Authority
(SHA)
The role of the SHA is to ensure the local NHS
organisations in its area fulfil their statutory responsibilities
to ensure patients/users, carers and public are consulted and
involved in the commissioning, development, planning and operation
of services. The methods used may vary according to the type
of organisation and the nature of their relationship with users.
For example: Ambulance Trusts have a naturally transitional relationship
with many of the users and so rely upon PALS, and comments received
via surveys or occasional focus groups/events; whereas Mental
Health Trusts often have sustained relationships with service
users over a number of years, resulting in the users increased
ability to be involved in a variety of work at a number of levels
of governance and engagement.
The SHA performance manages the organisations
in its area and assesses their progress in the development of
PPI, identifying areas of strength and areas which require further
development. See Appendix 2.
The SHA is working with the organisations it
supports to ensure they:
Build infrastructures, systems
and processes to develop robust and systematic involvement and
engagement of a wide range of patients/users, carers, citizens
and communities in all aspects of the organisation's work.
Involve the patients and the
public in service planning, design, development, delivery, evaluation
and improvement, commissioning and contract/quality monitoring
governance, regulation and inspection, recruitment and selection.
Develop appropriate proactive
approaches to involving "hard to reach" groups with
particular emphasis on equalities and tackling inequality to ensure
organisations are responsive and accountable to all sections of
the community.
Develop and maintain an open,
two-way, ongoing engagement with patients/users, citizens and
communities to identify opportunities, challenges and options
for change in particular when consulting and involving patient/users,
citizens and the community from the outset of any reconfiguration
or service change.
Begin PPI from initial discussions
not when proposals have been drawn up.
Explain the need for change
quickly and clearly, creating an honest dialogue about "trade-off's"
and the potential impact of patient/public chosen/preferred options
on their health economy.
Demonstrate active engagement
in tackling discrimination, and reach out to work with differing
parts of the community where it is suitable and comfortable to
engage with them. Including the engagement of Patients fora, PPI
Forums and community representation in the development of strategy
and actions to tackle discrimination.
Publish regular reports detailing
what the organisation has done differently as a result of user/public
views, explaining why some suggestions may not have been taken
forward and responding to the varying needs of the communities
served.
3. The Role of the PCT's and Trusts is to
Ensure access to and choice
of appropriate services with high levels of support and information
for patients to make choices.
Encourage and support self care,
and wellbeing for the population served.
Support health literacy and
on going proactive information and communication.
Involve patients and public
in defining service requirements (health and social care) for
commissioning purposes including Practice Based Community (PBC).
Monitor quality of provision
(contract management) and ensure services are appropriately shaped,
through an interface with providers, and with the involvement
of patients/public.
Meet national standards and
National Service Frameworks
The Role of Foundation Trusts and other Trusts
and providers is to
Involve and empower patients.
Reach out to and engage with
local communities.
Be accountable to local people
through, for example, Membership of their Foundation Trust, governance
structures etc.
Ensure consideration of Overview
and Scrutiny Committee (OSC's), Local Strategic Partnerships (LSP's),
Local Authorities (LA's) and Patient and Public Involvement Forums
and potentially LINks (PPIF's) etc.
Meet Healthcare Commission standards.
Ensure membership will need
to explore potential interaction with LINks to engage wider communities.
4. Full Engagement in Service Improvement. In
some Circumstances, the SHA, PCT'S and Providers Need to Work
Together and Focus on Two Key PPI Actions
Ensuring a range of appropriate
and effective approaches is used to involve and engage patients,
users, carers and the communities from all sections of the population
particularly those from hard to reach communities and those with
communication difficulties.
Establishing a process for systematically
collecting, analysing and acting upon patient and public views
and ensuring this feedback directly influences and informs plans
and activities.
4.1 Key Criteria
To ensure a patient-led approach, all stages
of the work/planning should offer evidence to demonstrate that:
Patients and the public have
been involved in detailed discussionswhat mechanisms have
been used to actively engage users, patients, carers and the public?
Health communities have listened
to patients/users and the public and recorded their views in improvement
plans and activities.
Actions resulting from patient
and public feedback have informed plans and activities eg from
Patient Surveys, PALS, Complaints, Compliments, User and Patient
Engagement Groups, Focus Groups/Workshops, PEXIS etc (most Trusts
in Trent have Patient Experience Learning groups that routinely
collate and action feedback of this type).
The plan reflects patient, user
and public input. Where there is no input health communities need
to justify not including patient, user and public views.
Diversity is reflected, acknowledging
the wide range of community needs, interests and perspectives,
particularly those from minority communities and those with special
needs or communication difficulties who are harder to engage.
Expected benefits and outcomes
that patients, users and the public should see as a result of
the plan. ie an explanation of how plans will make a difference
to, and improve services, health and well-being, and experiences
for patients, users, carers and the public.
Plans are "patient/user-centred"
and grounded in the patient/user perspective on an ongoing basis
eg patient and public involvement in monitoring and evaluation.
4.2 Plans should also evidence appropriate
working in partnership with
Local Authorities particularly
Social Services.
Local Strategic Partnerships.
Local Authority Overview and
Scrutiny Committees (OSC's).
Patient and Public Involvement
Forums.
User, carer and citizen groups
and voluntary sector organisations.
5. Effective and Meaningful Involvement
It is important to build upon existing relationships
with patients, users, carers and the public, utilising groups
and processes already in place within health communities rather
than creating new mechanisms or activity.
Legislative policy and practice emphasise the
"independent" structures: Overview and Scrutiny Committee
(OSCs), Patients Advice and Liason Services (PALS), Independent
Complaints Advocacy Services (ICAS), Patient and Public Involvement
(PPI) Forums and more recently Local Involvement Networks (LINks)
which will formalise the existing relationships what the select
committee should consider is how these can continue to add value
to patient and public involvement within the NHS whilst retaining
their independence. This has been a strength of the Patient and
Public Involvement Forums who have mirrored the NHS structures
and in the SE Coast area, had a productive relationship with the
NHS organisations acting as critical friends able to work with
us as well as independently.
5.1 The approach
Under current Section 11 practice from Strengthening
accountability all organisations should have in place robust PPI
infrastructure, systems, methodology, and monitoring, this should
include:
PPI Operational Lead, Executive
Lead and Board level PPI "champion".
Ongoing PPI monitoring and evaluation
of activity.
PPI integrated into commissioning
processes.
PPI Policy/Strategy and Implementation
Plan.
Clear lines of accountability
for PPI and strategic fit with organisational decision-making
structure.
PPI integrated into HR processes
including induction, staff appraisal/KSF and objective setting,
recruitment and selection .
Ongoing PPI Staff and Board
level workforce and leadership development programme.
PPI impact assessment included
in all Board papers relating to service change and improvement
to meet Section 11 requirements.
A range of approaches for engaging
patients and the public across diverse communities.
Clear mechanisms for organisational
learning from user/public feedback"Patient Experience
Learning Groups".
Mechanisms for feedback and
responding to patients and the public.
Active and well resourced PALS
service.
Impact on changes to access
to services for those most in need.
User Expenses Policy and ring
fenced resources.
Good Practice Guidelines for
PPI.
Use/Public Engagement Steering
Group.
5.2 Currently each NHS organisation has a
Patient Advice and Liaison Service (PALS)
PALS has an important role in
organisations to:
deliver and maintain a customer
care/education/support function at the user/public interface;
Provide valuable organisational
intelligence on user/"customer"/public experiences,
preferences and needs to inform:
continuous service improvement;
and
understanding market share/market
management.
PCT's need to ensure that any new arrangements
for services meet national guidelines on complaints and PALS
Organisations need to strengthen and develop
the capacity of the PALS service ensuring the DH PALS Core Standards
are met:
PALS service is identifiable
and accessible to the community served by the Trust/provider.
PALS is seamless across health
and social care.
PALS is sensitive and provides
a confidential service that meets individual needs.
PALS has systems that make their
findings known as part of routine monitoring in order to facilitate
change.
PALS enables people to access
information about health and social care services/provisions and
issues.
PALS plays a key role in bringing
about culture change in the NHS and social care, placing patients
at the heart of service planning and delivery.
PALS will actively seek the
views of service users, carers and the public to ensure effective
services.
See Appendix PALS in focus.[60]
*
6. The Future of Public Engagement
Recent guidance and policy has sought to create
a system capable of delivering this vision and supporting the
engagement of the Third sector to have a stronger voice in commissioning,
needs assessment, policy development and delivery looking at the
Third Sector Commissioning Task Force and the Stronger Local Voice
policy recommendations aiming to:
Build the capacity of the Third
Sector to realise its full potential in the health and social
care system and to benefit from greater plurality in Commissioning.
Promote understanding among
Commissioners of the Third Sector's contribution to strategic
planning, needs assessment, health improvement, reducing health
inequalities, (specifically equality, diversity and social inclusion
related), service delivery and community and individual capacity
building/empowerment.
Collate and share effective
practice in partnership work between statutory agencies and the
Third Sector within the region including Local Strategic Partnerships,
Local Authorities and social care.
Facilitate and support systems
reform, which builds on this learning.
The newly published Local Government and
Public Involvement in Health Bill which details the reform
of the current arrangements for patient and public involvement
in the provision of health and social care services has also contributed
to a significant step change in the empowerment of citizens and
greater engagement of local people in shaping public policies
and services. Better joint working should provide the benefits
of:
Empowered citizens with an individual
and collective responsibility for health.
A better understanding of the
health needs of "marginalised" groups.
More responsive and inclusive
services, leading to equality of provision, adherence to Compact
principles.
Greater choice for service users.
Sustainable Third sector provision.
Opportunities for joint commissioning
optimised.
A strengthened leadership role for local authorities
to bring local services closer to communities, making them better
coordinated and offering better value for money. Local Area Agreements
(LAAs) and the accompanying duty to cooperate should further incentivise
local agencies to work with their communities in a joined up way
to improve services and the quality of life and work together
to reduce long standing problems such as health inequalities.
A new duty will require local authorities to
inform, consult and involve local people in running local services;
and councillors will be empowered to resolve issues of concern
to the communities they represent (if necessary by requiring consideration
by Overview and Scrutiny Committees).
There will be significant social capital from
the expected rise in engagement and empowerment of citizens and
communities by local government. This should benefit service delivery
and improved partnership working at the local level based upon
local needs, plans and implementation.
The Community Call for Action and the Overview
and Scrutiny and governance reforms will provide additional mechanisms
to enable a person or persons to require their local authority
to consider an issue which is causing concern to the community.
See Citizens Involved: Community Participation in Neighbourhood
Renewal (2004) For evidence of how engagement can improve
trust see ODPM, New Deal for Communities 2001-2005: An interim
evaluation. Research Report 17, (2005).
Patient and Public Forums will be replaced by
the introduction of local involvement community networks (LINKs)
which will be at the heart of the new arrangements to strengthen
the voice of local people. Each authority with social services
responsibilities will be appropriately funded to carry out a new
statutory duty to make arrangements providing for the establishment
of a LINk in its area. LINks are expected to build on the best
of the work of the patient forums, creating a strengthened system
of user involvement, which expands the opportunity for engagement.
But will one size LINk suit
all? Most communities have several constituent parts who may not
work well together, and where large sectors may dominate.
Will LINks be able to ensure
a community led "health impact assessment" process?
In summary, the new policies and guidance should
give local people more influence over the services and decisions
that affect their communities; provide effective and accountable
strategic leadership; operate in a performance frameworkfor
local authorities working alone or in partnershipwhich
supports citizen empowerment and secures better outcomes for all;
and leads local partnerships to provide better services for citizens.
Moreover, measures will facilitate improved engagement and empowerment
of users and communities and more responsive and efficient local
services.
This will bring a focus on:
New relationships, systems,
access routes and utilisation.
New providers eg Voluntary Sector.
The need for Identification
and targeting-key of groups of potential patients.
The need for organisations to
understand their "market share".
Engaging target groups of future
patients by "market segment" eg high risk groups, young
people, mental health, older people etc.
Engaging with future patients
through:
Alliances with retail and other
sectors.
Creative use of media eg Digital
TV, Text messaging.
Engaging the public in non-NHS
environments eg supermarkets, libraries etc.
Links to and feedback from Local
Strategic Partnerships, Voluntary and Community Sector Organisations
and Local Authorities.
Learning from public feedback.
Circumstances in which wider public consultation
(including under section 11 of the Health and Social Care Act
2001) should be carried out and the form it should take
1. Creating an NHS Fit for the Future
Like many Strategic Health Authorities across
the country, NHS South East Coast together with the local health
communities in Surrey and Sussex, is taking is fundamental look
at how and where NHS services are provided in the area. This programme
of service review for the NHS across Surrey and Sussex, (and,
subsequently Kent and Medway) has been called Creating an NHS
Fit for the Future and is expected to result in far-reaching
proposals for change. The programme is reviewing the way services
are provided in light of people's changing health needs in the
21st century to ensure that services: clinically sound, accessible
and sustainable for the foreseeable future.
Diagram based on presentation by Jenny de Ville,
Department of Health expert panel member
Surrey and Sussex comprises four local health
communities, Surrey, East Sussex, West Sussex and Brighton and
Hove. Primary Care Trusts in each of these areas have led on engagement
and local planning and work programs, with the SHA providing support
to ensure overall "fit" and coherence across the four
communities. As part of this process, it has been important to
engage with members of the public in each area, as well as clinicians,
managers and partner organisations to discuss the underlying principles
of the need for change and talk about what a sustainable service
model might look like.
2. Purpose
To ensure a locally owned and driven review
of services, that is supported by local people both within and
outside of the NHS. The Fit for the Future engagement work is
attempting to address an inherently complex challenge through
a complementary set of interventions:
Stakeholder discussions: Introducing
as wide a range of key players as possible into the discourse
and its substantive challenges.
Deliberative Events: Enabling local
citizens to appreciate and get to grips with the "trade-offs".
(For further information see appendix 3.)
Co-Design: Facilitating leading
"players" (patients/public; clinicians; managers) to
review and test the evidence for change and move towards collaborative
problem-solving: improvement through informed engagement.
This is underpinned by ongoing Section 11 work
by local health communities and is complemented by the ongoing
communications, media, and public relations work, especially with
local politicians, partner organisations and local campaigners.
3. Approach
The SHA has supported the local health communities
through various planning programmes to ensure that there are active
engagement strategies in operation by the PCTs and trusts throughout.
These strategies and action plans offered stakeholders and the
wider public a variety of opportunities to become involved in
discussions around the drivers for change and their impact, the
actual design of service change, and the subsequent proposals
for service options in a formal consultation process.
Where large scale change to key local services
for the general population is proposed, then there must be full
public consultation, preceded by a lengthy period of discussion,
awareness raising and involvement with local stakeholders which
will support the development of plans for change and eventual
consultation on options.
Through Fit for the Future we have learned
that this is the only way to build an understanding of the reasons
for change among stakeholders, and therefore, to engage people
properly in a constructive debate about the options with shared
responsibility. For details of the processes undertaken see appendix
3.
4. Developing an Understanding Leading to a more
Informed View and a Shift in the Public's Perception
Public engagement has been fundamental to each
stage of the Fit for the Future programme. Through engagement,
it is possible to ensure that any proposed changes to health services
will be responsive to the concerns and aspirations of patients,
carers and the general public. Throughout the programme, participants
have been asked to comment upon and help improve the communication
and engagement process itself. Aware of it's the challenging aspects
of the debate and the tensions of competing priorities; we consistently
endeavour to improve the engagement process itself so as to improve
the overall outcome.
Figure 1
PROCESS ARCHITECTURE: ENGAGEMENT IN CONTEXT
(PROF BOB SANG)
5. Communication and Engagement
Through the development of thorough communications
and engagement processes, the public's awareness of changes to
service provision is increasing as more detailed information will
be on hand, outlining what services are available. "Providing
patients with more information will help increase their confidence
in the system." (Member of public at deliberative event)
An independent report of several events stated: "The general
public need educating about which services they need and what
is available to them, people need to know which service to go
to for different kinds of treatment. Participants in both the
deliberative events acknowledged that the media coverage of these
changes so far has been very negative and we felt that (although
we were not sure how) this needs to change. If these changes are
going to be effective then they do rely on the public fully understanding
them."
Feedback from people in Surrey and Sussex includes
the following quotes and views expressed at some of the deliberative
events:
"Be careful to prepare the ground with local
providers before moving services from hospitals to other hospitals
or to the local GP service."
"There is a need to consult local representatives,
medical and non-medical."
"Ensure the public has the full particulars."
"Widen the scope of public consultation
and ensure that it is perceived as being listened to, rather than
a window dressing exercise."
"Make it as simple as possible, publicise
it as fully as possible."
"Ensure the public are given full facts
as well as the scenarios for change. It's hard to debate something
that is undecided. Be very careful that you are not accused of
"spinning" to reach the scenario that suits your agenda."
"Acute care and emergency care are not the
only priority. The money is to be taken into account but patient
priority is to get the best care. We need clear information not
PR talk."
"Allow for full consultation with all affected
user groups before any changes are implemented."
"Communicate the fact that this is a change
in the strategy of delivering care (an improvement) and not a
reduction in care; if this is indeed the case!"
6. Consultation
All of the Fit for the Future work so
far has been undertaken prior to the formal consultation process
which is due to start this spring. This early work provides a
firm basis for wider understanding despite the negative media
and public campaigns. It is clear that people can appreciate that
tough decisions need to be taken to ensure health services are
safe, viable and affordable, freeing NHS time and resources to
improve health prevention and health promotion and meet the ambitions
of the white paper Our Health Our Care Our Say for a broader
range of services based within the community and offered closer
to people's homes.
"Co-Design", "Deliberation",
"Stakeholder Engagement" are all means of enabling local
people and frontline staff to consider the reasons for reform
in a safe space that allows fear and aspiration to be acknowledged
and heard. In order to do this there are seven highly contingent
sets of data variables to be addressedand each is dynamic
and contentious:
Rhetorical | Reflecting policy and the Reform programme and political interests
|
Strategic | The "drivers" of change and their implications
|
Operational | The population ad service data
|
Financial | Historic and projected
|
Infrastructure | The estate ad related systems/resources
|
Local-Contextual | Critical additional factors: eg, transport, inequalities
|
And, crucially | |
Technical-Clinical | The evidence-base for safe and sustainable practice
|
Thus the assessment of the "trade-offs" between
Clinical Safety, Accessibility, and Affordability that now forms
the substance of most of the engagement work, will rely on the
quality, contestability, and relevance (including meaning to diverse
audiences) of the data used in the above process to affect a shift
in "critical mass" of understanding.
7. The Challenges Faced and Lessons Learned So Far From Creating
an NHS Fit For The Future are
7.1 Key Challenges
Early Involvement vs "Vagueness"
Whilst there are immense benefits to early engagement of
stakeholders, including patients and the public in the development
of proposals for change, this does create a period of uncertainty.
Early involvement means engaging people in a discussion about
the need for change and the challenges faced before there are
plans or options on the table. However, this leads to a perception
of the NHS being vague or worse withholding plans for discussion,
and creating a vacuum filled by rumours which can fuel campaigns
and media coverage ie a lack of understanding of what section
11 aims to achieve in terms of shared responsibility for designing
new models of care whereas the reality was that the plans were
slow to be finalised.
Stakeholder vs "Public Discussion"
Early discussion focussed on stakeholders and representatives
of patients and the public eg Patient and Public Involvement Forums,
Health Overview and Scrutiny Committees, Voluntary and Community
Sector. However, especially once media coverage creates anxiety
about future plans for hospital services, there is an expectation
from the public that effectively a "full public consultation"
will be running throughout the period of discussionit would
be impossible to resource or maintain this degree of public involvement
for a year or more. (See A1ppendix 4 for full scale of work undertaken
prior to consultation)
Balancing the messages
There is a complex balance between clinical safety and standards,
patient needs and accessibility and affordability. It is extremely
difficult to ensure these messages are heard and understood particularly
in a challenged financial climate, any change is viewed as financially
driven.
Clinical Leadership
Clinical leadership is absolutely key to the engagement process,
as stakeholders and the public have a high degree of trust in
clinicians. However, a hostile reaction to proposals for change
makes it very challenging for clinicians to provide public support,
particularly if colleagues are not supportive.
Aligning discussion with development of proposals for change
It is challenging to create a staged engagement process where
the views expressed are constantly feeding into the development
of plans for change in a meaningful way. The planning and engagement
processes often run parallel with different pieces of work feeding
into one another. Also the complexity of data can be a considerable
challenge both in terms of language and density.
Involvement vs Reputation
There is pressure on the NHS to, on the one hand, be very
open about challenges and reasons why services need to change,
and, on the other, to minimise negative coverage and maintain
a positive public reputation. This can create tensions in terms
of managing an effective engagement process.
Feedback loop
There is need for a constant feedback through various modes
to those involved in the planning process to feedback what has
been said, and how it will be incorporated into the plans. (see
Appendix 5 )
7.2 Lessons Learnt
There must be an active engagement of key players
and a constant liaison, ensuring that critics and campaigners
are invited to work with the NHS and share responsibility for
addressing the challenges public services face.
A lot of time needs to be invested with stakeholders
to develop understandingthis is time well spent, but it
is impossible to do this with the whole of the general public.
Deliberative events give a far more informed view than traditional
public meetings, but the public prefer the public meetings! And
those monitoring process may expect them?
Close working with Health Overview and Select
Committees from the earliest stage means greater clarity and congruence.
Ensure clear and well communicated processes throughout
so that people understand the different stages and the reasons
for involvement before plans have been developed.
Clarity of messages about changeshould
be simple, open and direct.
Openness and transparency is fundamental.
Identifying clinical spokes people and supporting
them to present clinical issues and drivers for change to the
public and stakeholders.
Analysing and responding to concernscreate
a constant feedback loop to demonstrate listening and the value
of people's involvement. Also enables adjustment of the approach
to involvement to meet needs and expectations.
8. What are the circumstances in which consultation may
not be required?
Where full scale public consultation seems inappropriate
but is currently sometimes expected, is in terms of the closure
or relocation of small numbers of beds or of a specialist service.
Small numbers of bed closures are often a part of the NHS adapting
to changing needs and practices and whilst there should be discussion
with key stakeholders around the reasons for such adjustments,
full scale public consultation on such issues does not usually
seem the best use of resources, or conducive to the NHS operating
most effectively. Any engagement should be conducted as part of
the requirements under section 11 guidance rather than full and
formal consultation under section 7 guidlines.
There are also difficulties where a change is proposed for
very strong clinical safety reasons. Consultation then turns into
a communications/information exercise where the public may rightly
feel the decision is already madebecause circumstances
are calling for urgent action.
This kind of situation can then damage genuine engagement
and consultation processes where there is a real choice to be
made and flexibility about the way forward which patients', partners
and the wider public can influence. Maybe there should be a different
name for an "informing" type "consultation"
where urgent changes need to be made to differentiate from more
interactive processes where there is mutuality in finding potential
solutions.
Candy Morris
Chief Executive, South East Coast Strategic Health Authority
10 January 2007
APPENDIX 1
CASE STUDYRENAL AND VASCULAR REVIEW
4. PATIENT AND
PUBLIC INVOLVEMENT
(PPI)
This process involved a structured method of seeking patients/public/carers
views. The process adopted was to visit and contact consultants
and specialist nurses who agreed to contact their patients, who
gave their consent to pass on their contact details. They were
then personally invited to join small discussion groups.
Discussion groups were set up in four locationsMaidstone,
Canterbury, Medway and Ashford. A total of 40 patients/carers
attended these groups. An independent facilitator, engaged from
the college of Health led these discussion groups. The purpose
of these groups was to:
Ask people what service they use.
What it is like to be a patient?
What is their experience of services in Kent and
Medway?
What is important to them in receiving a service?
What are the important aspects of receiving a
good service?
The emerging themes from these discussion groups were:
Waiting times for transport.
Quicker and more accurate diagnosis.
Reviewing times for outpatient appointments, eg
late pm.
Specialist nurses and outpatient clinics.
Peer support patients "buddy" system.
Dedicated central renal centre, including specialist
nurses in OPD.
More detailed information when first diagnosed
in understandable language.
Need for service in county before and after transplant
surgery.
Inadequate patient support services.
Developing an expert PPI group
Volunteers were requested from these groups who would be
involved in further re-design of services. They are experts from
the point that they are experiencing first hand what it is like
to live with chronic disease, eg renal failure. This personal
experience makes them experts. They are prepared to share this
experience to convey knowledge about living with this condition
or illness to others and be involved in developing PPI in this
particular review.
Patient expenses
A policy and process has been established to reimburse patients/carers
for travel expenses when attending discussion/involvement sessions
and the agreement of a one-off additional reimbursement payment
for specific workeg presentations at conferences etc.
Working conference
"Making it Happen" working conference on 19 May
2003 at the Hilton Hotel, Maidstone, was organised and attended
by 95 stakeholders. The purpose of this conference was to:
Bring together work from three of the review sub
groups, namely commissioners, Clinicians and patient/public/carers.
To share the achievements to date by identifying
opportunities for redesign and approving these specialist services.
To hear the views and experiences of patients/carers
who use these services.
The outcome of the conference helped clarify and produce
the basis for future proposals for wider public consultation and
scrutiny across the county's diverse community. The delegates
who attended the conference represented:
Two thirds NHS and local Authority Managers, NHS
Clinicians and front line staff.
One third patients/carers/public representatives.
Overview and Scrutiny Committee (OSC) Involvement
The Health and Social Care Act 2001 makes statutory provision
for local authorities with social services responsibilities to
extend their scrutiny and overview functions to cover the NHS.
The aims of the NHS overview and scrutiny are:
The focus is on health improvement, bringing together
the responsibility of local authorities to promote the social,
environmental and economic well-being and the power to scrutinise
local services provided and commissioned by the NHS.
To address issues of health inequalities between
different groups and working with NHS and other partners to develop
a dialogue to achieve health improvement.
NHS bodies have a duty to consult the local OSC
on any proposals under consideration for any substantial development
of the health service in the area.
Two meetings were held with Kent County Council (KCC) and
Medway OSC officers. The purpose of these were:
To inform those present of the process of the
review.
To inform and understand the process and engagement
of the OSC in both Kent and Medway.
To share the consultation document and process.
5. CONSULTATION DOCUMENT
This reflected the discussions from the full range of stakeholders
involved in this review. It identified and sought views on the
key factors which had been established as contributing to what
is considered to be best practice in providing a specialist service.
These factors will decide the criteria which will be used to help
PCTs and PPI assess the options of service models and arrive at
a decision for future development and implementation.
Stakeholders and patient/public/carers representatives were
involved in writing and agreeing the context and content of the
consultation document. This involvement included conference presentations,
input from the discussion group sessions and a half day workshop
on 9 June when 18 individuals attended to scrutinize and adjust
the draft document. Those 18 attending represented one third NHS
staff and two thirds patient/public representatives.
Finally, the consultation document was signed off by the
Review Project Team and four patient/public representatives after
further input and comments had been received from steering Group
members.
6. Subsequently those patients and carers involved in
the review have been part of the implementation team and were
recently present at the opening of the Medway Centre of excellence.
They were thoroughly heartened to see other patients receive the
treatment they require within the best facilities and with a responsive
service which they had helped set up.
APPENDIX 2
SURREY & SUSSEX SELF-ASSESSMENT FRAMEWORK FOR PATIENT
& PUBLIC INVOLVEMENT (PPI)
INTRODUCTION
This self-assessment framework aims to draw together the
expectations, requirements and good practice around PPI into one
place. By self-assessing against this framework, organisations
will be able to:
Assess progress in developing PPIidentifying
areas of strength and areas which require further development.
Identify risks in not meeting key requirements
such as the Section 11 duty to involve and consult.
Compare progress with other organisations and
identify sources of good practice elsewhere.
Provide evidence to inform the organisation's
declaration against the health & social care standards, to
inform the Strategic Health Authority (and if appropriate the
Department of Health), and to inform independent scrutiny organisations
such as Patient Forums and Overview & Scrutiny Committees.
KEY AUDIENCES
The lead executive & non-executive directors.
The PPI, clinical governance or other group overseeing
PPI within the organisation.
Operational lead(s) for PPI.
Strategic Health Authority.
This framework is based on key guidance documents and national
frameworks (listed below), and has drawn on frameworks used in
other Strategic Health Authorities. Its development has been overseen
by a small working group of PPI operational leads from NHS organisations
(who also piloted it), and has input from the wider network of
PPI leads and other audiences.
KEY DOCUMENTS
Strengthening AccountabilityPolicy and
Practice Guidance.
National Standards, Local ActionThe new
health and social care standards.
Choice, Responsiveness and Equity.
PALS National Core Standards.
NATPaCT Competency Framework, Section 7Community
Patient and Public Involvement.
Performance Improvement Framework for PPI (SHA
PPI leads/DH, 2003).
HOW TO
USE THIS
FRAMEWORK
This is a self-assessment framework and there will therefore
inevitably be an element of subjectivity. It is helpful for the
self-assessment to be undertaken by a small group (eg operational
lead, PPI Forum representative, lead NED, lead Director, staff
member) to bring different perspectives and to form a consensus.
It will certainly be necessary to consult with colleagues when
completing certain parts of the self-assessment. It is important
to be as honest as possible in order to get the maximum benefit
out of using the framework.
THE FRAMEWORK
STRUCTURE
The framework is made up of 24 competencies, within which
there are a series of objectives and actions which contribute
to achieving that competency. There is a line to complete for
each action as follows:
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
1 | Statement describing an overall objective
*(Xx)
| 1.1 | A specific action which contributes to achieving the objective and competency
| Your brief statement of where you are against this action. Eg fully achieved, requires xx to complete, not achievedplan in place etc
| Evidence which supports your position statement eg reference to an action plan, a system, process or policy.
| A | final
| rating |
*(Xx) Cross references against the relevant critera for assessing
the Healthcare Commission core standards in The annual health
check. Where appropriate the developmental standard is also identified
in this way. The primary core standard for PPI is C17 and cuts
across the entire framework, so has not been identified separately.
The final rating of red, amber, green should take into account
the position statement and the evidencean action cannot
be green if there is no evidence to support this. Definitions
of red, amber and green are:
RedNot achieved and limited progress made
GreenFully achieved with supporting evidence
AmberNot fully achieved, but good progress being made
COMPLETION DETAILS
| Lead responsible for completion: Name:---------------
Others involved in carrying out the assessment:
| ------------------------Role: ---------------------------------
|
1. | Name.--------------------------------------------------------
| Role:----------------------------------------------------------
|
2. | Name. --------------------------------------------------------
| Role: ----------------------------------------------------------
|
3. | Name. --------------------------------------------------------
| Role: ----------------------------------------------------------
|
4. | Name. --------------------------------------------------------
| Role: ----------------------------------------------------------
|
5. | Name. --------------------------------------------------------
| Role: ----------------------------------------------------------
|
| | |
How was the assessment carried out?
How has the assessment been communicated (who has it been shared
with and how?)
Section A: Patient & Public Involvement Strategy
& Action Plan
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
A1 | Carry out a baseline assessment of PPI activity across the organisation (ref: strengthening acc)
| 1.1 | A comprehensive baseline assessment has been carried out, identifying strengths, weaknesses and development needs.
| | | |
| |
| | |
| | | |
| |
A2 | Develop a clear PPI strategy and action plan, agreed by the Board (ref: strengthening acc)
| 2.1 | A PPI strategy and action plan have been produced with the involvement of key stakeholders and has been agreed by the Board.
| | | |
| |
| | 2.2
| A reporting mechanism is in place to monitor progress against the action plan.
| | | |
| |
| | 2.3
| The PPI strategy demonstrates links to the local planning and policy process (incl LDP) and there is evidence that patients and the public are involved in the organisations internal planning processes.
| | | |
| |
| | 2.4
| The PPI strategy and actions are publicised to staff and public.
| | | |
| |
| | |
| | | |
| |
A3 | Develop an infrastructure to support the PPI strategy
| 3.1 | There are designated NED, executive director and operational leads for PPI.
| | | |
| |
| | 3.2
| There is a designated group or committee that oversees PPI strategy and activity within the organisation.
| | | |
| |
| | 3.3
| Progress in achieving PPI is evaluated annually and reported internally and externally.
| | | |
| |
Section B: Supporting Patient & Public Involvement
Activity & Integration
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
B1 | Support staff to undertake PPI activity
| 1.1 | PPI is included in staff job descriptions and appraisal processes.
| | | |
| |
| | 1.2
| PPI is included in staff induction. Advice and training are available to support staff on PPI.
| | | |
| |
| | 1.3
| Examples of good practice are shared across the organisation
| | | |
| |
| | |
| | | |
| |
B2 | Support patient, public and voluntary sector representatives to participate in PPI activity
| 2.1 | There is clear information for patients and public on opportunities to get involved in improving services.
| | | |
| |
| | 2.2
| Patient/public representatives are offered training and support to help them participate fully.
| | | |
| |
| | 2.3
| There is an agreed policy on reimbursement of expenses that clarifies terms of payment for time if appropriate.
| | | |
| |
| | 2.4
| A wide range of methods are used to involve patients and public.
| | | |
| |
| | 2.5
| There are specific measures to involve harder to reach groups.
| | | |
| |
| | |
| | | |
| |
B3 | Learn from good practice and experience elsewhere
| 3.1 | Staff involved in PPI, PALS and related areas participate in local and SHA wide networks.
| | | |
| |
Section C: Systems for Patient Feedback
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
C1 | Improve the 5 key dimensions of the patient experience through; learning from patient survey results developing action plans, acting on any concerns to improve service delivery and the patient experience.
*(C14c) *(D8)
| 1.1
1.2
1.3
| A patient survey is carried out annually and the results of the survey are made public and shared with staff and PPI forum.
Areas previously identified for action have shown improvements.
An action plan is produced with involvement of staff and stakeholders and has been shared with Board, who also monitor progress.
| | | |
| |
| | |
| | | |
| |
C2 | Provide an accessible PALS service which can resolve patients' ques-tions and problems, provide information and receive feedback
(ref national core standards)
*(C13b) *(C14a)
| 2.1
2.2
2.3
2.4
| A fully operational PALS is in place, accessible and publicised across the community.
The PALS has been assessed against the national standards.
There is a development plan for PALS based on the national standards.
Staff are aware and trained in the role of PALS and their own role in overall PALS approach.
| | | |
| |
| | |
| | | |
| |
C3 | Provide a well-publicised, non-discriminatory complaints process.
*(C14b) *(C14a)
| 3.1 | There is a process for formal complaints and information is available to the public/patients.
| | | |
| |
C4 | Provide opportunities for feedback from patients, carers and others and manage this feedback systematically, analysing it across the 5 domains of patient experience.
*(C14a)
| 4.1
4.2
| There are clear ways for patients, carers and others to provide feedback.
Feedback from PALS, PPIF, complaints, surveys and other sources is drawn together and themes and issues identified.
| | | |
| |
Section D: Partnership Working
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
D1 | Demonstrate a strategic approach to planning, PPI and policy through partnership working
*(C6)
| 1.1
1.2
| There is evidence of strong partnership working with local authorities, voluntary and community sector and other NHS through LSPs, local compacts and networks to develop patient/carer involvement.
The organisation has been involved in the development of, and has signed up to its local compact(s).
| | | |
| |
| | |
| | | |
| |
D2 | Demonstrate positive working relationships with independent PPI structures
| 2.1
2.2
2.3
| There are agreed working arrangements with PPI Forum(s) and evidence of a good working relationship
Liaison arrangements have been agreed with HOSC(s) and evidence of a good working relationship.
There are procedures in place to consult with HOSCs on any proposal for potentially significant service variation. There is evidence of consultation with HOSCs.
| | | |
| |
| | |
| | | |
| |
D3 | Promote recognition of and support for carers needs, and make arrangements to involve carers.
| 3.1
3.2
| There are links with carers groups and networks. Carers are supported to be involved in all aspects of PPI.
The organisation contributes to a local carers strategy.
| | | |
| |
Section E: Patient Information
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
E1 | Provide a range of information to patients to including information to support choice and self-care (ref info for choice and info leaflet guidance on DH website)
*(D9a) *(D9b) *(C16)
| 1.1
1.2
1.3
1.4
1.5
1.6
| There is evidence of a range of information in place, including what to expect during treatment, aftercare, and from services and health promotion.
There are protocols in place for style, content, format and distribution.
Information is made available to support choice.
Information is available to support self-care and prevention.
Information is available in a range of formats and languages.
Patients/public and staff are involved in producing and reviewing information
| | | |
| |
E2 | Provide patients with a copy of letters sent between clinicians about their individual care (ref copying letters to patients info, guidance and toolkit)
| 2.1
2.2
2.3
| A policy for "copying letters to patients" has been produced and agreed.
There is an action plan for implementing the policy and progress/compliance is monitored.
The organisation is compliant with the policy.
| | | |
| |
| | |
| | | |
| |
E3 | PPI links closely with communications strategy
| 3.1
3.2
| The organisation has a proactive communications strategy with links to PPI.
Interpreting services are available to all patients.
| | | |
| |
Section F: Ensuring PPI has an impact
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
F1 | Ensure patient feedback influences service planning and development
*(D8) *(C14c)
| 1.1
1.2
1.3
| There is evidence that issues and trends identified from PALS, complaints and other sources of feedback have consistently been acted on.
There is evidence of action taken as a result of patient survey findings and that the survey findings have improved the patient experience and influenced PPI activity.
There is evidence of the organisation responding to reviews from PPIFs, HOSCs and other groups.
| | | |
| |
| | |
| | | |
| |
F2 | Ensure that the adequacy of PPI is challenged and assured at Board level
| 2.1 | All Board members are familiar with the key PPI requirements and are equipped with the right questions to ask.
| | | |
| |
| | 2.2
| There is a section on Board papers which details how PPI has informed the decision.
| | | |
| |
| | |
| | | |
| |
F3 | Measure performance from a patient/carer perspective
*(D8) *(C14c)
| 3.1 | Data collected about patient/carer experience is used to inform service planning and delivery.
| | | |
| |
| | |
| | | |
| |
F4 | Ensure staff can action patient feedback
| 4.1 | Staff have clear routes for communicating patient feedback and know what happens as a result.
| | | |
| |
Section G: PCTspecific section
| Objective
| | Action
| Position statement
| Evidence | Red
| Amber | Green
|
G1 | Ensure commissioning processes take into account the needs and preferences of the local community, and support choice and PPI
| 1.1
1.2
| There is patient/public involvement in commissioning decisions
Contracts and SLAs make reference to PPI and patient experience requirements.
| | | |
| |
| | |
| | | |
| |
G2 | Ensure there are opportunities for PPI in the services provided by independent contractors
| 2.1
2.2
2.3
| All GP practices have PPI processes eg a patient participation group.
Dental, ophthalmic and pharmaceutical practitioners are encouraged and expected to take a PPI approach.
There is an identified lead for PPI on the PEC.
| | | |
| |
G3 | Ensure that the whole local community has information about local health services
| 3.1
3.2
| "Your guide to local health services" is produced annually and distributed to every home. It is available in a variety of formats and languages.
"Your guide" contains details of PPI activity and how patients/carer/public feedback has led to service improvements.
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| |
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| |
G4 | Support self-management, self-care and prevention
*(D9a) *(D10)
| 4.1
4.2
4.3
| There are a range of activities in place to support SM, SC and prevention, either directly provided or commissioned
Patients are provided with the opportunity to contribute to the planning of their care.
Initiatives are run in conjunction with the voluntary sector to maximise self-management, self-care and prevention
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| |
SUMMARY AND ACTION PLANNING
| Section
| Key weaknesses |
Actions needed | How to take forward
| Red | Amber
| Green |
A | PPI strategy and action plan
| | | | enter
| number | here
|
| | |
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|
B | Supporting PPI activity and integration
| | | |
| | |
| | |
| | | |
|
C | Systems for patient feedback
| | | |
| | |
| | |
| | | |
|
D | Partnership working
| | | |
| | |
| | |
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|
E | Patient information
| | | |
| | |
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|
F | Ensuring PPI has an impact
| | | |
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| | | |
|
G | PCT-specific
| | | |
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APPENDIX 3
TIMELINE FOR
THE PLANNING
AND ENGAGEMENT
PROCESSES
From May 2005 until July 2006 there have been a succession
of planning initiatives in Surrey and Sussex: S4 Sustainable services,
Strategic Work Programme and "settings of care" which
were designed to provide a vision of what a sustainable healthcare
system might look like. This was informed by meetings with both
the HOSCs and the PPI Forums.
HOSC INVOLVEMENT
A reference panel of all four HOSC Chairs was established
by the SHA to facilitate regular liaison and involvement. In addition,
further sessions were arranged with individual HOSCs to cover
both Commissioning a Patient-Led NHS consultation and updates
on the strategic work programme.
PPI FORUM INVOLVEMENT
A reference panel of PPI Forum members was established to
facilitate high level PPI input to the issues being taken forward
through the strategic work programme. A flyer was sent to all
100+ Patient and Public Involvement Forum members across Surrey
and Sussex via their Forum Support Organisations asking interested
members to send in their details. 13 members agreed to join the
panel, of which between five and 10 attended each meeting.
A large event was held for all 100+ PPI Forum members across
Surrey and Sussex with a keynote presentation from Simon Williams
updating PPI Forums about the strategic work programmes, followed
by questions and discussion. CPPIH and FSO worked in partnership
and answered questions informing them of what's going on. This
enabled them to test out McKinsey's findings providing insight
into potential issues that the wider patient and publics might
have. The event itself also provided forum members with personal
contacts responsible for the Fit for the Future programme.
At the April meeting of the reference panel, members agreed
to disband the panel as they would now be focusing on continuing
their involvement at a local health community level. To continue
PPIF representation at the strategic level, two members of the
panel were nominated to join the Surrey and Sussex wide Programme
Board as patient representatives, and two joined the communication
and engagement steering group. This ensures community leadership
is influencing the planning and engagement processes throughout
the programme.
REGULAR BRIEFINGS
TO STAKEHOLDERS
MPs and local authorities were informed and engaged in the
ongoing Strategic Work Programme through regular briefing meetings
with the SHA Chief Executive and Chair. In addition, specific
meetings were organised with Directors of Social Services, and
the SHA CE took the opportunity to inform colleagues of the programme
at scheduled meetings of GOSE and other LA partnerships. This
has been an ongoing feature of the work led by PCT CE and programme
leads who have continued to meet and make regular reports on progress
and planning to stakeholders throughout the Fit for the Future
programme.
"FIRST STEPS
FOR IMPROVING
SERVICES IN
SURREY AND
SUSSEX"
The above document was produced by the SHA in March 2006.
It summarised the findings of the S4 review and how these were
developing into the Strategic Work Programme. The document was
distributed to key stakeholders (MPs, HOSCs, local authorities,
PPI Forums, clinical networks and NHS managers and clinicians)
and their feedback was invited. Regular written feedback to the
public and the wider stakeholders has also been a feature of the
review detailing published documents from this process. (See attached
newsletter)
DISCUSSION DOCUMENT
In May 2006 a discussion document titled "Creating an
NHS Fit for the Future" was published by the Surrey and Sussex
NHS. This outlined the drivers for changing health services, the
proposed direction of travel at a high level and the identified
priority areas for each local health community. It invited feedback
on the proposed vision for health services, with a freepost address
and response form for comments.
This document was distributed widely to stakeholders:
MPs | HOSCs |
Local authorities | PPI Forums, FSOs and CPPIH
|
Patient and carer groups | Voluntary organisations
|
Local strategic partnerships | Libraries
|
It was also published on the newly launched Fit for the Future
website, with links from the websites of individual NHS organisations.
An on-line feedback form was available. [61]
A total of 6,226 people responded to the discussion, 3,651
signed a petition or campaign letter to protest against the perceived
closure or downgrading of a local hospital and 2,575 wrote in
with a more detailed response to the issues raised in the discussion
document. Of these responses, the majority (81%) were about concerns
at the possible closure of St Richard's Hospital, and most were
sent by members of the public (87%).
Each local health community designed a programme of discussion
activities to engage local stakeholders and patient/carer representatives
in debate about the issues raised by the discussion document.
Each person who had phoned, emailed or written in commenting on
the discussion document was responded to by either SHA or PCT
staff and subsequently sent an update via a Newspaper printed
September 2006.
ONGOING ENGAGEMENT
BY THE
LOCAL HEALTH
COMMUNITIES
East Sussex LHC
Three major stakeholder events were held to discuss the issues
outlined in "Creating an NHS Fit for the Future".
An Out Reach Programme meant that the two PCT's worked hard
to attend over 70 local meetings of community/voluntary groups,
local authorities, local strategic partnerships and NHS organisations/staff
groups to ensure they knew what progress had been made and had
an opportunity to inform the thinking. This included meetings
of local PPI Forums and the East Sussex HOSC and meetings with
local MPs.
West Sussex LHC
Two major stakeholder events were held to discuss the issues
outlined in "Creating an NHS Fit for the Future", plus
a smaller event linked to a regular meeting of the West Sussex
Public Partnership Forum.
In addition, the local health community team attended a wide
range (around 30) local voluntary/community groups, local authority
meetings and local strategic partnerships. This included meetings
of PPI Forums and the West Sussex HOSC and meetings with local
MPs.
Surrey LHC
Four major stakeholder events were organised to discuss the
issues raised in "Creating an NHS Fit for the Future".
In addition the local team attended a wide range (around
30) of local voluntary/community groups, local authority meetings
and local strategic partnerships. These included meetings with
PPIFs, the Surrey HOSC and local MPs.
Brighton and Hove LHC
Brighton and Hove LHC focused on using existing community
engagement mechanisms to discuss "Fit for the Future"
issues with local stakeholders. These mechanisms are well developed
following previous consultation on "Best Care, Best Place".
The local team attended a range of local community/voluntary groups
and local authority meetings, including meetings with PPI Forums
and the Brighton and Hove HOSC. They also set up small focus groups
as a means for discussing any issues raised by the programme for
local people.
SHA LEVEL ENGAGEMENT
Although stakeholder involvement was led locally, the SHA
continued to liaise with key stakeholders such as MPs and HOSCs.
In order to provide further independent and expert guidance
to the involvement process, the SHA also established a "Patient
and Public Involvement (PPI) Expert Panel". This consisted
of representatives from national organisations and people with
recognised expertise in the field of service reconfiguration,
and representatives from local HOSCs and PPIFs were also invited
to join. The membership from national organisations is as follows:
Prof Bob Sang (Chair) | PPI advisor to Fit for the Future
|
Tim Gilling | Centre for Public Scrutiny
|
Jenny Deville | DH, author of "Strengthening Accountability" and PPI lead, South East London SHA
|
Pippa Hague | DH PPI team and PPI lead, East of England SHA
|
Chris Howgrave-Graham | Advisor to DH Reconfiguring Hospitals programme
|
Martin Houghton | Independent Reconfiguration Panel
|
The purpose of the panel was to provide an expert sounding
board for engagement plans and access to national best practice
and policy on engagement involvement consultation and its possible
repercussions. Programme leads also attended the Future Health
Network to learn from their peers and best practice in large scale
service reconfigurations in Bristol and Manchester etc.
FEEDBACK FROM
DISCUSSION PHASE
All the feedback and correspondence received during the initial
discussion phase was logged centrally by the SHA and passed to
independent analysts TwoCan Associates who have produced a report
summarising the key themes and issues raised by stakeholders.
FURTHER DISCUSSION
(AUGUSTPRESENT
AND ONGOING)
This stage moved the discussion on from drivers for change
and a high level vision into the specifics of what this would
mean in terms of service change in each local health community.
During this stage stakeholders are being engaged in discussion
about the potential scenarios for the configuration of acute care
as well as consideration of what community based services would
be needed to support this.
Co-designAugust to January 2007
During August each local health community held a "co-design"
workshop facilitated by the PPI advisor to Fit for the Future,
Prof Bob Sang. These workshops brought together small groups (c20)
key stakeholders such as PPIFs, voluntary groups, patient representatives
(including "campaigners") with clinicians and managers
to look in more detail at the potential change scenarios emerging
from work on local sustainability plans. The ground rules for
co-design require everyone to listen respectfully, and to contest
the evidence from the perspective of improvement and a person-centred,
service-focused rather than building- focused, value base.
Thus the challenge facing the local health communities can
be described as an "effectiveness improvement cycle".
Co-Design is not new. It has deep roots in the work of the
Tavistock Institute (Lewin, Emery, et al), and a strong evidence
base, linked to Action Research and Action Learning (Revans, Bessant,
McGIll, etc). It is a method for addressing tough "trade-offs".
Locally, the Kent and Medway Specialist Services Review and the
Central Sussex Partnership Programme (CSPP) both achieved a constructive,
consensual resolution of initially contentious service change
proposals. The four health communities have had regular iterations
of the co-design events to take people's collective thinking forward
through the need for change, the potential areas of what within
each community, and latterly what those scenarios might look like
in terms of service changes and proposals which require a wider
consultation.
Deliberative eventsSeptember
As part of this engagement process four deliberative events
were held, one in each Local Health Community area. Vision Twentyone[62],
a company specialising in consultation and public involvement
was commissioned to recruit, design, manage and facilitate these
events. A representative sample of members of the public from
each area, who had not previously played and part in the discussions
were recruited to participate in one day workshops where they
listened to presentations from the perspective of clinicians,
managers and patients. Having heard the case for change they had
the opportunity to deliberate on the issues in small groups.
The aims of the events were as follows:
To invite a local sample of individuals to participate
in a discussion about how sustainable healthcare services could
be provided for their community.
To give participants an opportunity to talk about
issues that affect their lives and to tell the NHS in Surrey and
Sussex how they think things can be changed for the better.
To create an "opentwo way dialogue"'
explaining the constraints of resources, clinical standards and
modern medical practice which will need to be taken into account
when decisions about these changes are made.
Improving understanding and raising awareness about the need
for change
Having heard the presentations (and worked through deliberative
exercises in small groups) the majority of participants felt that
they understood the need for change and were in favour of a community
focused model of health services with specialist centres for critical
care remaining at fewer hospital sites.
One participant noted: "From what we have heard through
the presentations, if the services promised to be delivered in
doctors' surgeries and Walk-in Centres are actually implemented
the benefits will be great."
When asked participants were asked "why" they took
part in the event, reasons given were because: they wanted to
find out what might happen to local hospitals. Another participant
noted that following the telephone survey, they were interested
in seeing or hearing "both sides". The perceived downgrade
of services and issues around cleanliness are also points that
encouraged people to take part. They wanted to take part in the
debate and contribute to the discussion around the future of the
NHS. Ultimately they were interested in having their say. Above
all: "the health service is vital, even more so as one grows
older."
There continues to be a gap in understanding between those
who have worked with the health service to improve services, and
those who learn about the NHS through media coverage and the rumour
mill generated by NHS staff.
60
* Not printed here. Back
61
A readers panel informed the content of the website and all materials
produced to ensure accessibility. Back
62
The use of independent contractors has been used to ensure a robust
quality assurance is present throughout, and reassure participants
that no bias can affect the outcome of any part of the discussions
or subsequent plans. Back
|