Royal Devon and Exeter Healthcare NHS TrustMarch 2004

Service Development Strategy

Section 4:process of public engagement and consultaTion and development of application

We have ensured that our strategic vision for the next five years is derived from an understanding of local needs, not by an aspiration to become an NHS Foundation Trust. This section describes the process we have used to develop our five year vision, and from it, our view that NHS Foundation Trust status is right for the RD&E.

The process for developing our strategic vision for the next five years has been designed to ensure:

  • The strategy is balanced and thorough, considering the full range of issues facing the Trust at this time.
  • Specific and practical actions are identified.
  • The views of as wide a range of stakeholders as possible are taken into account.
  • Views of different groups of stakeholders are tested against each other and ‘triangulated’ in order to develop an integrated and shared understanding of the way forward for the Trust.
  • Stakeholders have been involved in developing the five-year vision from the start, in keeping with Keeping the NHS Local[1].
  • The Trust satisfies its obligations to formally consult on its strategic vision and plans to apply for NHS Foundation Trust status.

Due to the timescales for the NHS Foundation Trust application, the formal consultation process on our plans for NHS Foundation Trust status has run in parallel with the latter stages of the wider stakeholder engagement and consultation process used to develop or overall strategic vision. Responses from the formal consultation will feed into the final output of the wider consultation process.

4.1Developing the strategic vision

The overall process used to distil the vision for the next five years is illustrated in the figure below:


The process has explored what the future might look like from a number of different perspectives:

  • The “reality check”. Being clear about what must be achieved in five years’ time, in terms of minimum requirements and standards of service, and the overall vision for hospital services set out in the NHS Plan for 2008. These form the parameters and “fixed points” for the vision.
  • Identifying the key local issues which must be addressed in the next five years, and what possible solutions and future scenarios there might be.
  • Exploring the opportunities offered by system reform within the NHS. This includes structured thinking and debate around emerging changes to the NHS system (including new financial flows, patient choice, and NHS Foundation Trust status), and predictions of the impact on, and opportunities presented to, the local health community and the RD&E.
  • Modelling perfection. This perspective will paint a picture of the aspirations of the Trust and the local health community for services in five years’ time. Through a number of different exercises, a vision of perfection in the delivery and organisation of services is expressed which will provide the benchmark for measuring the success of the Strategic Plan. This ties in with the work already underway in the Trust under the ‘Pursuing Perfection’ (P2) initiative.

4.2Process of stakeholder engagement and consultation

4.2.1Engagement and consultation to develop the strategic vision

Stakeholders have been divided into three main groups:

  • Patients and the public.
  • Members of staff working at the RD&E.
  • Local organisations that work closely with the RD&E. These are:

The process that was used for stakeholder engagement and consultation is illustrated in the diagram below:

Figure 1: Process for collecting the views of different stakeholders

Separate approaches were used with the different groups of stakeholders to gather their views in the first half of the process:

  • Patients and the public: We used a number of approaches and initiatives to gather the views of patients and the public on the future of the RD&E, and what improvements they would like to see over the next five years. These included:

-distributing questionnaires to patients and visitors using the hospital during a particular week. This asked what people felt was most important to them in the services the RD&E provided, what they thought the RD&E did well, and where they felt improvements could be made

-discussions with a number of community groups and organisations.

-a series of articles in the local press inviting readers’ contributions.

  • Staff: The views of staff were gathered using a questionnaire, and through two structured workshops to which a wide range of staff were invited from throughout the Trust.
  • Partner organisations: Around 20 one to one interviews were carried out with Chief Executives, Directors and professional leads from our key local partner organisations. The information, views and ideas gathered from the interviews was then collated, tested and refined at a specific stakeholder event for partner organisations. Independent consultants were employed by the RD&E to make sure the views of partner organisations were treated objectively.

Once the separate views of the three groups of stakeholders had been fully explored, they were brought together at an event on 7 October 2003 attended by patients and members of the public, members of staff, and representatives from partner organisations. Different stakeholders shared their conclusions with each other, and worked together to agree a shared vision for the future.

4.2.2Engagement and consultation on the Service Development Strategy and proposals for NHS Foundation Trust status

The formal consultation on our proposal for NHS Foundation Trust status ran from 17 September to 25 November in parallel with the final stages of the process to clarify our overall vision. The consultation and engagement process on NHS Foundation Trust status has been conducted as follows:

  • A summary consultation document has been circulated widely within the local health community, and inviting views and comments on the proposal by letter, phone, email or completing a form at the back of the consultation document.
  • Fourteen public meetings have been held, and four staff meetings. The number of meetings reflects the dispersed population we serve principally located around a number of small towns. Meetings have been publicised in local newspapers, GP surgeries, schools, libraries, places of worship, and Citizen’s Advice Bureaux.
  • Members of the RD&E Trust Board have spoken on NHS Foundation Trust status at meetings in the voluntary sector and at parish councils. This process began well in advance of the public consultation, and will continue for the next few months, with 40 meetings requested to date.
  • Four drop-in road shows have been held in town centres on Saturdays during the consultation period. Members of the Trust Board have attended to discuss the Service Development Strategy and NHS Foundation Trust status with members of the public, and to promote the benefits of membership.
  • Membership applications and information about NHS Foundation status has been mailed to approximately sixty thousand patients.
  • Local media interest has been used to help inform the public. Several pieces have appeared in local newspapers, including a favourable commentary on the benefits of NHS Foundation Trust status. The Chief Executive has appeared on local and national radio on eight occasions, and the story has been covered on regional television news programmes on four occasions.
  • Approximately 20 staff meetings were held prior to the public consultation, starting in February. These were used to give general information about NHS Foundation Trust status, and the plans for application as they progressed. They have included information about the draft human resources strategy. These meetings have been a combination of either open to all staff, or initiated by individual groups of staff or departments. They will continue as staff request them in the next few months. Additional meetings are being held for consultant staff, to which local GPs have also been invited.
  • The joint staff consultative committee and the medical staff committee have received regular updates on the application process in the last few months.
  • Colleagues in primary care and local authorities have been involved in a series of meetings about NHS Foundation Trust status, the first being held prior to the submission of the preliminary application. The RD&E was one of the pilot sites for the two-day national team event, and colleagues in the local community benefited from this early exposure to the debates around system reform and the opportunities associated with NHS Foundation Trust status.
  • The governance arrangements as they are described in the public consultation document evolved as a result of one of these one-day stakeholder events.

A full description of the consultation process and the outcome of the consultation is available on request. The summary of responses described below relates to the process of public, staff and stakeholder involvement in relation to the work done on the Service Development Strategy.

4.3Summary of responses

Our vision for the next five years set out in Section 2, and our decision to apply for NHS Foundation Trust status, are based on the views that were gathered throughout the engagement and consultation process. Summaries of the views of the different groups of stakeholders are provided in Appendix 1.

4.3.1In overall terms, the views of stakeholders about the RD&E and our intention to apply for NHS Foundation Trust status have been very positive. Issues raised through the process to develop the strategic vision

Patients and members of the public

People completing the questionnaires, when asked what was most important to them, mentioned the following things most frequently.

  • Quality of care offered at the RD&E.
  • Communication between patients and the hospital or individual members of staff.
  • Not having to wait for treatment.
  • Car parking.
  • Cleanliness of facilities.
  • Friendliness and helpfulness of staff.
  • Adequate numbers of appropriately trained staff at all times, including at weekends and holiday times.

In a number of cases, these were also the things that people mentioned most frequently when thinking about what the RD&E did well, like the quality of care that is provided, and cleanliness. However, some of the other things that people thought were important were not often mentioned as things that the RD&E did well. These were quality of communication with staff, not being kept waiting, adequate staffing, and car parking. These things should therefore become the focus of the RD&E’s attention in the future.

Staff

Staff tended to focus, understandably, on staff related issues, taking the view that they could better respond to patients’ needs and the RD&E’s priorities if they were supported to do the best possible job. The main points and conclusions to emerge were:

  • Ability to travel to work:

-better car parking on site.

-better public transport to work.

  • Feeling that individuals, and work they do, are valued, and addressing pressures at work:

-staff reported difficulty in taking breaks, leaving work on time, or taking time back if they had worked late.

-Need for more opportunities to express views and ideas about improving working arrangements.

-greater availability of staff rooms in wards and departments.

  • Communication:

-suggested need for more ‘newsy, what’s going on’ staff communication, with information from staff about what is of interest to them, social as well as work related.

-need to understand better how colleagues in other related departments’ work, so there can be more give and take.

-better information technology.

  • Recognition of “behind the scenes” staff:

-concerns that staff who support clinical work are not always recognised in the same way as clinical staff, either by the organisation, or by the public.

-greater job security.

-feeling that they are not so well staffed as clinical areas, particularly at times when workload has increased.

Partner organisations

Views gathered from the RD&E’s partner organisations in the local health and social care community grouped into the following key themes:

  • Improving services:

-focussing on the essentials and “must dos” e.g. waiting times.

-delivering services in new ways: changing traditional models of care.

  • Working better with local partners:

-within North and East Devon.

-across the South West Peninsula.

-with local people.

  • Improving information:

-for patients about their care and treatment options.

-about activity and performance.

-to facilitate better referral practices and communication between healthcare teams.

There was consensus amongst local health and social care partners that NHS Foundation Trust status would offer the opportunities and benefits to enable these improvements. However, the RD&E should work to ensure that NHS Foundation Trust status benefits the whole health community, and the RD&E should remain fully part of the local health and social care community.

4.3.2Responses to consultation on NHS Foundation Trust status

Attendance at public consultation meetings has varied considerably, from two to 22. Issues raised at the meetings have related as much to service reform in the NHS in general as to NHS Foundation status itself.

  • Questions about the impact of the national tariff and patient choice have featured most.
  • There is also a good level of understanding of the role of the RD&E in the local community and as part of the North and East Devon health community, and a view that this should continue.
  • There is a positive attitude to opportunities offered through NHS Foundation Trust status, such as access to capital to improve services in a much more timely way than is currently the case.
  • The governance framework and membership strategy for the NHS Foundation Trust have been discussed to a much greater extent than the Service Development Strategy.

The number of written or e-mailed responses received by members of the public has been low, but the vast majority of those respondents have expressed support for the RD&E in its application for NHS Foundation status. Responses from statutory organisations are in the main positive with, inevitably, some remaining caution about the implementation of a major new policy.

Attendance at voluntary sector and parish council meetings has been consistently better than at the open consultation meetings. The issues discussed are broadly in line with those raised at the open meetings, again with a considerable degree of support for NHS Foundation Trust status.

There is generally a good attendance at staff meetings from all staff groups, with the majority of staff supporting the application for NHS Foundation status. This approach has meant that issues such as the number of staff governors has been debated and discussed from an early stage. Staff have expressed a clear view that the RD&E continues to develop partnerships within the healthcare community, and that the whole community enjoys the benefits of NHS Foundation Trust status.

A more detailed summary of the consultation process is included as part of the submission to the Independent Regulator.

[1]Keeping the NHS Local – A new direction of travel, Department of Health 2003