Patient Focus and Public Involvement

Annual Self Assessment Report 2007- 2008

23 May 2008

Part 1: Summary

1.1 PFPI Governance arrangements and how these work

The NHS Highland Board has overall responsibility for Patient Focus and Public Involvement. However, the term “Patient Focus and Public Involvement” includes a wide range of activities, across all services and functions, so that elements of Patient Focus and Public Involvement are reported and monitored formally through a range of performance and governance arrangements. These include the Clinical Governance Committee, and the Governance Committees attached to each of the operational units. These Committees are subcommittees of the NHS Board, and have formal responsibilities to ensure compliance with performance standards, including the duty to engage with local people on service planning and provision.

In addition, the NHS Board receives reports on a wide range of activities including Equality and Diversity, patient information, feedback and complaints, volunteering, advocacy, carers, and public partnership forum development. Papers submitted to the NHS Board in relation to service change, design or development must include information which reassures the Board that there is or has been appropriate patient and public involvement in the process.

1.2What progress has been made with the development of Public Partnership Forums and how are these influencing the delivery of services?

NHS Highland has two Public Partnership Forums. The Highland HealthVOICES Network - the Highland-wide Public Partnership Forum - has been up and running since April 2006, and now has members from across the area of NHS Highland. Argyll and Bute Community Health Partnership has a local Public Partnership Forum, and is developing locality-based forums to encourage involvement at local community level.

Each of the operational governance committees has at least one member of a public partnership forum as a full member. A new feedback report has been designed to try to quantify the effectiveness of these appointments and to highlight learning points for NHS Highland from the experience of the public members.

Since its early days, the ongoing development of the HealthVOICES Network has been monitored, guided and supported by a Steering Group which is led by public members. The HealthVOICES Steering Group is strengthening links with the Argyll and Bute Public Partnership Forum in order to share experiences, learning, and opportunities for further development.

A detailed evaluation of the HealthVOICES Public Partnership Forum was completed in June 2007. Members reported on their experiences of the Network, and its effectiveness. The feedback was generally very positive. From the analysis, the Steering Group agreed 18 recommendations for further action, all of which have been completed. A full report (dated June 2007), including recommendations, is available on the NHSHighland website.

The Argyll and Bute Community Health Partnershipendorsed the Terms of Reference of the local Public Partnership Forum in April 2007. Members contributed to developing a local Action Plan for 2007/2008, drawn up following the Argyll and Bute Public Engagement Workshop in February 2007.

The appointment of members of the Public Partnership Forums to all four Community Health Partnerships and RaigmoreHospitalgovernance committees is only one method of influencing service delivery. PPF members are involved in a wide range of activities – some wishing only to be kept informed about health matters right through to hands-on hard work alongside NHS staff, eg. on steering groups and working groups leading significant pieces of work on service review, improvementor redesign.

‘Working together 2008’ - the revised Working Agreement - is nearing completion. It builds on the Highland HealthVOICES Network 2005 Working Agreement, and incorporates experience and knowledge gained. While it lays out what must be common to both Public Partnership Forums it also reflects the different structures. It sets out an agreement about working together between NHS Highland, the Community Health Partnerships andRaigmoreHospital, and Public Partnership Forum members.

1.3What has worked well in progressing PFPI?

  • The wide range of activities involving patients, carers and other members of the public demonstrates a very broad commitment from the NHS Board, and from managers and staff across all parts of NHS Highland.
  • The NHS Highland Public Engagement Team provides direct support, guidance and facilitation to promote good practice in working with patients and communities, assisting front line staffto develop further their own knowledge, skills and confidence.
  • The staff induction programme sets out for new staff the values of NHS Highland, and introduces them to what patient focus and public involvement means for patients, and for staff.
  • The ability to link into a wide range of patient and carer groups, and other community-based organisations who are very willing to get involved.
  • The regular face-to-face Public Partnership Forummeetings in Argyll and Bute, which involve both the public and NHS Highland staff, aredeveloping a better understanding of the needs of local communities.

1.4Where further work is required

  • Develop a better understanding of the ongoing development needs of NHS Highland staff in order to target support, training, and other resources. An evaluation process is being developed, and will be based on the experiences of staff working with members of the public partnership forums. This will include feedback from staff about how their experiences of working with patients and the public has influenced working practices. It will also include exploring how the involvement has influenced the day-to-day delivery of services.
  • Develop better staff awareness of the importance of working with people likely to be excluded from mainstream involvement activities, and continue learning and implementing new approaches to promote broader inclusion.
  • Share the learning and ongoing development of the two public partnership forums.

1.5How public/patients have been supported to be involved and the difference it has made

  • Through direct support from NHS Highland staff to public partners, including group sessions to promote understanding of the specific tasks/project, build confidence amongst public partners in the project, and create mutual respect.
  • Two development sessions were arranged for the public partnership forum members in key positions. Members on the Community Health Partnership and Raigmore Committees, the Highland HealthVOICES Network Steering Group, and the Committee members from the voluntary sector had dedicated time to help them establish an effective network, to share learning and experiences, and to identify development actions for NHS Highland to take forward in partnership with the members.
  • The public partnership forum members in key positions were also offered an individual induction to the role and to NHS Highland.
  • Public Partnership Forum members on the governance committees of the Community Health Partnerships and Raigmore have one-to-one support from the General Manager and Chair of the operational unit.
  • Network News - the monthly newsletter of the Highland HealthVOICES Network informing members about local, national and regional initiatives -to which members are invited to participate. This is also published on the NHS Highland website.This method of sharing information is complemented in Argyll and Bute with face-to-face meetings and presentations between the Public Partnership Forum and NHS Highland staff.
  • Through the Patient and Public Involvement Expenses Payment policy which ensures that any personal financial costs of involvement with NHS Highland are reimbursed. The policy was updated in September 2007.
  • NHS Highland staff have been provided with updated guidance in the form of a checklist to help them clarify the type of involvement they are seeking,and outlining simple suggestions to help support patient and public partnership working. Public members involved on groups must be given a named,key support member of staff.
  • Guidelines have also been developed for members of the public working on groups or committees, giving ideas aimed at helping an inexperienced person joining a group for the first time.
  • There is no simple or consistent means of recording the impacts of involvement. Examples of a systematic approach include complaints and the associated learning or changes to practice, patient surveys and the associated action plans from feedback, and recording/reporting in relation to major service change projects.
  • Revised staff guidance in the NHS Highland draft Communication Engagement guidance document includes practical tools to promote evaluation of methods used.
  • To gauge the difference involvement makes, the system of selfassessment and feedback reporting is to be rolled out to all Highland HealthVOICES Networkmembers following piloting with the members on the Governance Committees.
  • Highland people have been encouraged and supported to participate in Scottish Government consultations, for example through raising awareness with known contacts (e.g. written information from NHS Highland), general awareness-raising through the NHS Highland website, distribution of targeted information to individuals and groups with known interest in the consultation topic. Also by arranging and facilitating direct involvement eg. local events (Better Health Better Care workshops, Citizens’ Panel for the Local Healthcare Bill, locality workshops for Towards a Mentally Flourishing Scotland, local events for Better Cancer Care).

Part 2: Case studies

2.1Patients’ Experiences and the Unscheduled Care Collaborative Programme

Patients and the wider public were actively recruited to get involved in this key area of workat the start of the project. It was recognised that there would besignificant changes to working practices and systems to achieve the waiting time target, and the aim was to ensure that these changes were well-informed by service users. Maimie Thompson, Unscheduled Care Programme Manager, advertised for public volunteers to participate. The engagement started in May 2006 with an informal discussion group, which became a Reference Group which met throughout the project. One aspect of the work involved a series of patient feedback surveys over the life of the project. A key learning point was that some patients needed support to complete surveys, so Patients’ Council members became actively involved helping people to participate.

Since the start of the project, patient waiting times have improved from 87% of patients being seen within four hours to 98%. Feedback from the patient surveys indicates that not only have the changes been implemented successfully, but thatthe overall quality of the care experience has improved. Now in its third and final year, the national programme’s report can be viewed at (NHS Highland-specific information on pp102-3). Maimie won the Top Manager award at November 2007’s Scottish Health Awards for her work on the project.

2.2Healthcare Associated Infection

Patients and public partners have a key role in cleanliness monitoring of healthcare premises throughactive participation in peer review audits. Public partners arekey members of the Peer Review Teams which inspect, assess and validate the state of cleanliness of healthcare premises across NHS Highland. This provides a degree of independent scrutiny within the National Monitoring system.

There are Public Peer Reviewers in each Community Health Partnership area, and these volunteerswork with the Quality & Training Manager, Facilities(who is the Independent Peer Reviewer for NHS Highland)and also with other staff on a programme of quarterly inspections and audit of all 25 NHS Highland Hospitals. This ensures a consistent approach as well as independent scrutiny of cleanliness performance. In addition to the inspections, public members are involved with the Peer Reviewer in identifying any follow-up actions required to rectify faults and in giving feedback to NHS Domestic Supervisory staff and to the respective Ward Managers. They also submit reports of their findings to their own groups and networks.

Public Peer Reviewers are also involved in promoting other actions to minimise healthcare associated infections: for example, through contributing to the Hand Hygiene programmes, and helping to raise awareness of good hand hygiene practice.

Work is in progress to recruit additional public members to several locations. Public members are provided with Public Peer Reviewers’ training, and direct support is provided by the Quality & Training Manager, Facilities.

2.3Patient Experiencesin Diabetes Services

Patients with diabetes have been involved in a number of changes to working systemsat the Diabetes Centre at RaigmoreHospital, aimed at making services more responsive to individual needs and circumstances. These include ‘patient-focussed booking’, and text messaging reminders for clinic appointments.

Information and ideas gathered through interviews and group work highlighted the need to adapt working systems, and to make the service more patient-focused. There was a significant number of patientsnot attending appointments, so thedirect involvement of patients was essential to understanding their needs, and what would work well for people. For example: where do people want to have their consultation?How do they wish to receive blood reports?Patients participated in one-to-one interviews, and in group work, supported by dedicated training, “Diabetes Voices” which aims to promote self-confidence and self-care.

Patients also participated in the development of written patient information about the services at the Diabetes Centre.

The patient-focussed booking system was introduced in January 2008. It is the first in Scotland which addresses the issue of routine return appointments, and not simply first referral appointments. The text remind service was also launched in January 2008. The service has the capacity to be expanded in the future to encompass e-mail reminders, if there is patient feedback suggesting this would be worthwhile.

2.4Supporting direct involvement - Area Drug and Therapeutics Committee

This NHS Highland Committee recognised the importance of having members of the public involved directly inthe main Committee and its seven subgroups (Formulary, Antimicrobial Management, Exceptional Medicines, Non Medical prescribing, Medicines Safety, Patient Group Directions, and Policies Procedures & Guidelines). These subgroups are involved in a wide range of activities, including some very technical issues, so finding ways of having meaningful patient and public involvement was a real challenge.

From December 2007 to February 2008, the Public Engagement Team worked with the Medicines Management Coordinator, Principal Pharmacist and the two existing public members on the main Committee. Plans were made for a half-day seminar, inviting people with an interest in medicines or pharmacy matters to join with a view to becoming then actively involved in the work of the committees. This was advertised widely though local media, and through known contacts and voluntary organisations.

At the seminar day, public members had discussion time for questions and answers, the aim being to promote broader understanding of the complexity and relationship between pieces of work, and to promote networking between the members. Benefits of this approach include peer support, deputising capacity, and ‘buddying’ between more and less experienced members. Public members were given written information about the role and remit of each subcommittee. Generic points from these have now been adapted into new guidelines, an example of sharing good practice across disciplines.

Concrete outcomes from the seminar include five people being recruited to the subgroups. Feedback from one of the participants summed up the experience of the pharmacists dealing with members of the public in“an exemplary manner, promoting a noted feeling of worth and encouraging future involvement”. An article detailing the positive outcomes of this event is planned for Team Update (staff and public magazine).

2.5 Summary Table

Action / Progress
1. Patients’ experiences and the Unscheduled Care Collaborative Programme / Public volunteers joined the Programme which aimed to achieve a maximum 4 hour waiting time for A&E patients. Patients and the wider public were actively involved to help make informed changes to services. Informal discussion group in May 2006 started the programme and recruited members. Patient waiting times have improved from 87% of patients being seen within four hours to 98%, and overall patient feedback on their experiences of care has improved. Programme is in its third and final year. Contact: Susan Eddie, General Manager, RaigmoreHospital. Tel: 01463 705152
2. Healthcare Associated Infection / Public partners are directly involved in monitoring hospital cleanliness as key members of Peer Review Teams. They are involved in identifying actions, and reporting back to staff and to patient and other interest groups. Public members are also helping to raise awareness of other campaigns to minimise healthcare associated infections, for example by promoting good practice in hand hygiene through their contacts in patient and other groups.