Evidence submitted by Dr Albert Day, Harrogate
and District NHS Foundation Trust (PPI 156)
EXECUTIVE SUMMARY
1. Effective PPI gives patients and the
public an increased understanding and awareness of local health
decision making, thereby gaining local ownership of strategy and
service change. For clinicians and non-clinical managers alike,
PPI is a means of transformational leadership. Developing a constructive
relationship and strong partnership with the local health community
through effective communication is essential.
2. Models of effective PPI within Harrogate
and District NHS Foundation Trust are explored, emphasising the
value of the Board of Governors and the multi-facetted Quality
of Patient Experience group. I will contend LINks should retain
and build on the best of the Patients Forum and its forerunner
Community Health Council namely local knowledge with independence.
There is some potential for duplication as between LINKs and the
Board of Governors.
INTRODUCTION TO
DR ALBERT
DAY
3. Dr Day is qualified in medicine and medical
law. He was a General Practitioner and vocational trainer in Harrogate
for 20 years and occupational health physician to the Harrogate
group of hospitals. He was a research assistant and hospital practitioner
in rheumatology.
4. Dr Day moved from clinical medicine to
a career in legal medicine in 1987. He was Head of Medical Services
at Medical Protection Society. He acted as adviser to the ethics
committee of the College of Occupational Therapists. He is a Council
member of the section of Forensic and Legal Medicine of the Royal
Society of Medicine, a founding Fellow of the forensic and legal
faculty of the Royal College of Physicians and a Fellow of the
Royal College of General Practitioners. He served as a Magistrate
in Harrogate for 16 years.
5. Dr Day was appointed a Non-executive
Director of Harrogate Health Care NHS Trust in 1993, and Chairman
in 2001 thus taking a central role in the transition to Foundation
Trust status. Dr Day takes a keen interest in risk management
and governance matters. He chairs both the Board of Directors
and the Board of Governors of Harrogate and District NHS Foundation
Trust.
What is the purpose of patient and public involvement?
6. A glimpse into the history of health
and social care in local communities will inevitably confirm the
depth and strength of ownership and pride that was, and is, present
in the minds of the majority as regards "their" hospital.
In planning the National Health Service, as Hansard records, Parliament
was mindful of the need to use and develop local services within
the framework of a national service. In Harrogate for example
the archives of the General Hospital and the Royal Bath Hospital
are replete with evidence of genuine concern for the welfare of
the population and that the hospital should thrive as a community
facility. There are fascinating minutes of the early managers,
then called governors and of the standards they required for example
of the Matron and others.
7. When Parliament legislated to introduce
NHS Foundation Trusts, one of the attractions for me personally
and for my organisation in preparing its application was local
accountability, an enhanced opportunity to draw on involvement
from the local community to shape its health service. Harrogate
and District NHS Foundation Trust (HDFT) is totally committed
to delivering a high quality acute secondary care service that
reflects the needs of local patients and their carers. The patient
experience is our core focus.
8. I believe one element of the success
of this organisation is our continuing focus on effective patient
and public involvement. HDFT can claim huge support and interest
from the public, indeed an exemplary record of PPI.
A MEMBERSHIP ORGANISATION
9. We are a membership organisation. HDFT
has almost 15,000 members—about 10% of those whom we serve
have chosen to join. Membership clearly matters to them. The return
in our most recent elections to our Board of Governors, in September
2006, showed that 46% of our members voted. The Foundation Trust
enjoys regular and disparate support from more than 800 volunteers.
The Board of Governors comprises 15 elected and six nominated
governors. Elected governors (11) are from public constituencies
and the four staff constituencies. Public constituencies are coterminous
with those of local government and ensure that all areas are represented.
The work of the Board of Governors that I consider crucial in
our PPI strategy is described below; it includes activity to balance
the geographical and age profile of the membership.
What form of public and patient involvement is
desirable, practical and offers good value for money?
10. At HDFT we are proud of our strategy
for encouraging an increasing number of patients and the public
to become involved in the development of their local hospital.
We encourage patients and public involvement through both formal
and informal mechanisms such as patient feedback on the wards
or in outpatient clinics, comments from our membership and our
Governors, comments and questions raised through our public Board
of Governor meetings, the PALS service, patient focus groups,
patient questionnaires and surveys, audits, readers panels and
the formal complaints route.
PPI strategy
11. What strategy has the Board of Directors
to ensure that patient and public involvement is real, and valued?
Quite simply the Board requires all internal plans to have input
from service users or advisory groups. Our Foundation Office maintains
data from questionnaires collected from our membership on their
areas of special interest and ways in which individuals have said
they are ready to offer advice. Patient special interest groups,
expert patients, and complainants are all added to the mix. Service
delivery and performance is routinely reported to the monthly
Board of Directors; each quarter a report from the Quality of
Patient Experience Group includes examples of how comments from
service users have been incorporated in developing the service.
That group includes members of the Foundation Trust working in
a lay capacity as well as Governors.
12. Effective PPI gives patients and the
public an increased understanding and awareness of local health
decision making, thereby gaining local ownership of strategy and
service change. For clinicians and non-clinical managers alike,
PPI is a means of transformational leadership. Developing a constructive
relationship and strong partnership with the local health community
through effective communication is essential. At HDFT, PPI is
not about ticking boxes, but is embedded in the culture of the
organisation.
13. Face to face contact is undoubtedly
the most productive means of engaging health professionals with
the public and patients. It offers a real opportunity for ownership
and understanding of potentially complex issues.
14. The Foundation Trust offers and encourages
a wide range of opportunities:
— Become involved as a lay representative
on a range of health committees or advisory groups.
— Become involved on our patient
reader panel—reviewing literature to ensure it is fit for
purpose.
— Become involved in volunteering
including tailored opportunities which may lead to vocational
choices.
— Become a member of the Foundation
Trust, receiving a quarterly letter from the Chairman.
— "Foundation News"
magazine to all Trust members Introduces PPI initiatives.
— Attend our interactive Medicine
for Members sessions.
— Attend the Board of Governors
Meetings.
— Attend our annual hospital Open
Event and AGM.
— Stand as a Governor and work
on task and finish projects.
— Attend our quarterly Governor
surgeries.
— Take part in patient focus groups
and audit of patient experience initiatives.
— Get involved in specialty groups
on chronic diseases or disabilities.
— Get involved in patient interviews/stories.
A range of additional PPI mechanisms at HDFT
include:
— Questionnaires and patient satisfaction
surveys relating to a range of services.
— HDFT inbox—where patients
and the public can leave comments, ask questions. Make suggestions
etc.
Value for money
15. In headline terms, PPI is free of charge.
In fact it carries its own overhead, requires servicing and management
time. Outputs may have financial consequences. Effective PPI is
undoubtedly superb value for money—but loose planning, tokenism
and failure to use the outputs would erode trust from patients
and the public quickly. In short there must be some point to every
activity. Are there examples of good VFM? In my Trust I would
cite our Quality of Patient Experience Group (QPEG) and the Board
of Governors as excellent models. Each takes from the best elements
of the former Community Health Council that many of us found an
effective body and develops them further. The Board of Governors
has a democratic mandate; it is truly representative. It is economic:
The cost of the Board of Governors is principally the cost of
elections. The repayment is handsome in terms of energy, engagement
and scrutiny as well as the effective discharge of the various
statutory duties. The QPEG comprises professional NHS staff, non
executive directors, governor, patients' forum, voluntary sector
leaders and a service user. Its focus is on delivering the PPI
strategy in a way that is meaningful for patients and the public,
underpinned by real community engagement, particularly through
representation from the voluntary and not-for-profit sectors locally.
The Board of Directors uses input from QPEG as part of the annual
planning cycle.
PPI and the board of governors
16. I am clear that the Board of Governors
has a number of roles, PPI being one of them. Accordingly governors
are engaged widely in designing, implementing and analysing PPI
schemes. To give some examples: Our Membership Development group
is tasked this year with work to attract more members in the younger
age range. In collaboration with a group on publications it has
re-worked the reading material, then passed it to a members' reading
panel for a critique. Governors are equipped to attend and speak
at relevant meetings such as youth clubs, mother and toddler groups.
Governors are thus entrusted with the roles of ambassador and
recruiting sergeant.
17. One major PPI activity each year is
our Annual Open Event. In 2006 for example we had in excess of
eight hundred members of the public visiting the event. Governors
are part of the planning team, there are three objectives: The
day is to be educational, interactive and interesting with a take
home health message from each of the 48 displays and tours. It
is an opportunity for questions to be put to front line staff,
to see what makes NHS care so comprehensive. Staff tell me it
is fun and I see on their faces that PPI is a positive experience.
18. A hugely popular Governor initiative
is our "Medicine for Members" series that is designed
around a list of topics suggested by members. Recent examples
are prevention and control of hospital infection; pain management;
elderly people's care; hospital catering; emergency medicine.
Every session is chaired by a governor who leads a lively debate.
LINKs
19. The increasing number of foundation
trusts, each with its Board of Governors/Council of Members offers
an effective and ever-greater democratic mechanism whereby the
public and patients have a real stake in their local health service.
Involvement and a say in the wider network of local services including
voluntary services across a specific geographical area is demonstrably
strengthened through the foundation trust model.
20. The Patients' Forum has at its heart
total independence; LINKs should in my view maintain that, as
well as local knowledge. LINKs performs a different role from
that of the Board of Governors. Governors receive regular detailed
information from the Board of Directors, with data and presentations
continuously reinforcing their ability to discuss matters with
the membership from a position of factual knowledge. For example
all press releases are sent to Governors before release, with
a briefing note as necessary. The Chairman's monthly Governors'
briefing is complemented by a copy of all Chief Executive staff
briefings.
21. Governors set their agenda and are proactive,
assisted by joint meetings of the Boards of Directors and Governors
on strategic issues. The objective of my communication strategy
is to ensure timely accurate local knowledge, the most powerful
public relations tool of all. Questions and/or concerns from members
that come to Governors are handled by channeling them through
the Foundation trust office. A swift response to both governor
and member may be followed by inclusion in a general briefing
at the month end.
22. Governors are local people. Not only
do stakeholder governors bring their own personal qualities to
the Board but their inclusion ensures two things: input to the
debate from different external perspectives and feedback to the
nominated body to which they belong. The strengthening of a local
health community from collaborative dialogue with commissioners
is obvious. How much better when Governors are part of that and
have the knowledge required. To that extent I believe Governors
fulfill the role that LINKs has in commissioner organisations.
If foundation trusts increase their number of nominated governors
to include LINKs, an extra public governor must be added to maintain
its majority; a decision for each FT. It seems obvious that a
LINKs person would attend the public Board of Governors meetings
(as our patients forum representative does at present) and work
in our QPEG.
Conclusion
23. PPI is not an addition to the work of
this Trust, it is a core function. I have set out our philosophy
of inclusiveness; drawing on the experience and energy of patients,
carers, volunteers and complainants to enrich the patient journey
of tomorrow. LINKs could add to our pool of feedback and dialogue
by working alongside the Board of Governors and directly into
specific PPI groups. The question of whether there is a different
role for LINKs in a PCT, more particularly one that combines a
provider and commissioner role remains.
Dr Albert T Day
Chairman, Harrogate and District NHS Foundation Trust
January 2007
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