Memorandum from Southwark Patients Forum
for Primary Care
Q1: Can public services learn from the way that
either non public sector organisations or oversee Government make
use of user experience in service delivery and design?
A: It is not necessary to refer to external sources
to identify an appropriate model. An effective framework is present
in the UK system of Patient and Public
Involvement Forums provided that:
— sufficient resources are made available
to communicate to users that there is an effective route that
enables them to have a voice in decision making and implementation;
— those resources are used to gain
awareness... and promote understanding of the Forum role... and,
in the absence of any directly elected system, ensures that the
appointed organisation is given legitimacy;
— there is commitment to user involvement
by the Service Commissioners... in the case of Health, the Primary
Care Trusts;
— this commitment requires to extend
to when ideas for policy, change or improvement are first mooted—and
when all options are open: not when decisions have been taken
at which time Consultation became defensive of those decisions;
— the work of the user appointees is
embedded in the day to day operations of the Service and, where
relevant, Provider and resourced to provide adequate support so
that independence is maintained;
— that back-up powers are given that
provide for:
— a duty to answer questions/supply
requested information to a fixed time scale;
— a right of entry for inspection of
Services or premises (including Service Providers from the Voluntary
and Private Sector); and
— Southwark Patients' Forum has developed
such an involvement model which is set out below.
THE OPERATING
SYSTEM OF
THE SOUTHWARK
PATIENTS FORUM
IMPLEMENTED WITH
THE FULLEST
COOPERATION OF
THE SOUTHWARK
PRIMARY CARE
TRUST
The objective of the operating system, worked
out during 2006, embeds the work of the Forum into the day to
day activities of the NHS Trust at both strategic decision making
level and policy implementation.
There are five components:
— Meetings with the Executive Directors
of the NHS Trust which take place six times per year in advance
of Trust Board Meetings.
Agenda are two way and allow of discussion of
Board Papers... before they are submitted to the Board (in this
way, the Forum is treated pari passu with Non Executive
Directors).
— Direct access to Trust Managers below
Director level in order to explore policy implementation.
— A Lead Members' Brief System with
the objective of extending both the breadth and depth of the Forums
involvement in the work of the NHS Trust.
This has been agreed upon by all Members of
the Forum who take personal responsibility for achievement within
their Briefs and are expected to be proactive.
The remit of the Forum has been shared among
the Forum members according to their interests and area of expertise.
Members have freedom to act with a full authority
and backing of the Forum within their brief.
Members report back to the Forum at meetings
in the form of written reports which are discussed and endorsed.
Any changes to Lead Member's Briefs are discussed
and agreed at Forum meetings.
The NHS Trust, at Executive Director and Management
levels, are kept informed of these Briefs.
— Forum members being full members
of Operating and Improvement Groups such as Urgent Care, District
Nursing and GP Referral (in which the Forum Member sits with GPs
considering Demand Management, which is significant in impacting
upon Patient interest).
— Continuation of presence at Public
Trust Board Meetings with a "seat at the table" and
the right to speak and ask questions, pari passu with Non
Executive Directors.
At the present time. The Patients Forum and
the NHS Trust are jointly seeking media communication of this
partnership working, using resources of the Trust, in an effort
to interest the public at large and so enhance the legitimacy
of the Patients' Forums' involvement.
MINIMUM STANDARDS
FOR PUBLIC
SERVICES
Q2: Is it possible to set minimum standards
for Public Service ? If so, how is it done?
A: Yes. The minimum standard is that at which
the Commissioners (advised by the user input) stipulates that
value for money is not achieved... and/or the benefit to the user
of the service is not worth having. From this point, a ladder
of gold plating can be established according to affordability
and in relation to other priorities, in which standards are being
determined similarly.
Q3: What role do measures of customer satisfaction
have in assessing Public Services? How should user views be monitored?
How can user surveys and feed back mechanisms be assessed?
A: If Public Services are to be delivered
within a market in which the user has both choice and information,
customer satisfaction measured by the exercise of choice (sales)
and attitude studies (focus groups and survey) because the favourable,
outcomes desired by Commissioners and providers, are (no difference
to those in the privates Sector. The Commissioners are rewarded
by that satisfaction... and should have personal incentives to
gain that satisfaction cost effectively (as in the private sector)
without this, the market model fails.
The inherent difficulties are that the user
exercises choice without reference to price or cost in individual
decisions... but has belief as to whether taxation is too high
for what is provided. Hence there was acceptance of direct tax
increases to fund the NHS.
Users views can be monitored by involvement
in the decisions (Forums), interactive web sites and the same
standard of survey for which there is ample experience in the
private sector.
Q4: Learning from complaints: what constitutes
best practice?
A: Analysis of complaints is the most potent
management tool in determining customer satisfaction. The present
systems in Health serve to constrain Complaints (PALS but maybe
an unintended consequence) and tend to be too defensive. Users
need clear answers, a route of appeal and above all honesty and
transparency supported by independent judgements on outcomes that
can penalise lack of transparency, and bureaucracy (ombudsman)
. The impact of insurance considerations in dealing with serious
complaints should be taken aboard as this can be a contributor
or to lack transparency.
All complaints be consolidated and not allowed
to be dispersed, as they are in the NHS—to PALS never emerging
as a complaint, within GP or hospital systems but never coming
together, or within a PCT system.
A consolidated report of the complaints relating
to the delivery of Commissioned services, should be used as a
management tool to inform need for change and/or service delivery
improvement (including change of provider where this is needed).
Q6: Should users be more directly involved—if
so how can this be directly achieved?
A: In the experience of Southwark Patients
Forum, in the NHS, it is. See Southwark Patients Forum model in
the final section of the answer to Q1.
Q7: Are there certain types of decisions which
are more suited to consultation?
A: There will be decisions of a highly technical
nature in which understanding the information itself will be difficult
for lay people since the language and/or the study is within only
the expertise of professional. However, any decision can be related
to its impact on users and it is this that requires to be the
focus of consultation.
A good model for reference is that used by NICE
in assessing drugs in terms of both clinical effectiveness and
at the same time value for money.
Q8: Do official consultations typically manage
to capture the views of the right people? What kind of consultation
are most effective in engaging with appropriate people?
A: Generally NO: those consulted (by survey
and who respond) and attend meetings will not truly represent
the less articulate, the lest educated and likely for lifestyle
reasons, the most deprived. Therefore, consultation needs to adopt
the popular touch and follow the format of TV programmes and use
TV presenter and local media to front the exchanges. As long ago
as 1971, this technique was used in Harrow, London with great
success to allow voters to hear from. Council leaders, with questioning
by an independent media panel, at a time of rising rates.
Q9: How valuable are Advisory Panels in the
design and delivery of Pubic Services?
A: Please revert to the model given in the
answer to Q1. Embedment in the decision making process is an improvement
on any advisory panel.
Q10: How does the user relate to wider issues
of democratic accountability?
A: In most instances service users and electors
are the same people.
Q11: How should measures of public satisfaction
take account of complaints about policy rather than administration?
A: It will probably never be possible to separate
these factors completely in some individual complaints. However,
where service delivery is possible within either National Policy
(or local policy where the LA or Health Authority has discretion
in respect of policy) the complaint will be about implementation—that
is, administration. Nevertheless, the user will never be satisfied
by a reply that explains the absence of the desired performance
is because of "policy".
Q12: Are there situations where the views
and experiences of service users are irrelevant?
A: No.
January 2007
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