How to Improve Healthcare in Your Area.
Patient and Public Involvement in Healthcare
I find that patients are, on the whole, only too happy to discuss their
experiences of using the health service. In fact often it is hard to stop them
talking and I cannot take notes fast enough!
Yet they find it hard, as individuals, to get their opinions listened to by
Hospitals, PCTs and Social Care providers and commissioners.
Perhaps part of the problem is the bureaucracy and apparent inflexibility of
these organisations. They like to do things in formal ways, by holding
consultations and engagement meetings. Most patients prefer a face to face,
informal conversation.
Patients also want quick feedback.
Then there is the language!
Public and Patient Involvement (PPI) has its own jargon, like many of things
that happen in the NHS. There is ‘engagement’, ‘consultation’ and
‘involvement’. They seem to mean different things to different people. In fact
to most patients they mean little. They are words that managers use and are
found in all the strategy documents and reports published by hospitals and the
government.
Patients just want someone to listen to them and then to take some action so
that services are provided or improved. One of the things that patients feel is
important is to have some feedback from the organisation about how it is
using the information it receives from patients.
This is what the government has said (see bullet point 6) about giving patients
a louder voice through the Health and Social Care Act 2012:
http://www.dh.gov.uk/health/files/2012/06/B3.-Factsheet-Greater-voice-forpatients-300512.pdf
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Involving Individual Patients
Patients, at an individual level, have always been involved in managing their
own health. This took place, either through self-management of their illness
or during the consultation with a health professional. Between them the
patient and doctor or nurse will work out what is best for the patient.
There are times, however, when the patient would still say “What do you think,
Doc?” But in every consultation there should be some form of joint decision
making about what should be done to improve the patient’s health and
wellbeing.
There are other ways that patients, as individuals, can influence how
healthcare services are delivered.
Choice.
We all, as patients, have the right to choose where we receive our hospital
treatment. The hard part is finding out which hospital provides the best
treatment for our condition and for us as a person. But by making a choice we
are influencing those who make the bigger decisions for all patients. So ask
your GP about the quality of the service you need.
Patient Advice and Liaison Service (PALS).
If a patient or carer has concerns about something then one way of letting the
organisation know is through the PALs officer. This service has been around
for a while now and the PALs officers are there to provide information about
services but also to sort out minor concerns and problems that patient’s
experience.
The PALs officer is able to pass on the concerns to senior management who
should sort it out or provide explanations.
Regular reports are made to the hospital board on the number and types of
issues that come to the PALs department. The idea is that this provides
information on services that may need to be improved in some way.
Writing to MP and local press.
This is always a good way of getting the attention of the Chief Executive.
Ask questions at Hospital Board meetings.
This is not easy for some people and I suggest that you write down your
question and ask the chairman to read it out.
Ask questions at your local Council Overview and Scrutiny Committee.
Again some people might find it easier to ask the chairman to read out your
question.
Complaints.
People are often hesitant in making formal complaints. They are concerned
that if they cause a fuss something might be written in their notes about being
a ‘trouble maker’.
However every complaint has to be investigated and a report is seen by the
Chief Executive. A sub-committee of the board will also see the investigation
and should make sure that actions are put in place to ensure that no harm
comes to future patients. Regular reports are made to the board in public on
the causes of complaints and the actions taken to stop similar things
happening again.
Sadly, sometimes the only way to make sure that services are improved is by
making complaints.
The NHS needs to make it easier for people to make complaints. There are
organisations, such as ICAS (see below) that support patients, their carers
and relatives, in making formal complaints about the care they have received.
The Independent Complaints Advocacy Service (ICAS). ICAS provides
advocacy support to people who wish to make a complaint about the service or lack of it - that they have received from the NHS.
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Finally patients and carers can also influence the way their healthcare is
provided by joining one of the many groups that exist in the community and
becoming part of a network. Networks of people tend to have a louder voice
than an individual.
There are lots of groups in the community that can help patients and
members of the public to influence the authorities. The hard part is to find
them and then to find the time to be active. There are local & national charities
and other voluntary sector groups who support patients and carers and who
can start campaigns to improve care services. Often local councils will have
lists of such organisations.
Join your local GP surgery Patient Participation Group.
If you have a long term medical condition you could join the local user group
(or set one up). These groups are often used by the authorities to provide
ideas for improvements in specific services such as stroke, diabetes, mental
health, disabilities and other conditions.
Foundation hospitals will have members who elect a board of Governors who
can influence the executive board of the hospital.
Hospitals and PCT (and hopefully the new Clinical commissioning Groups)
have patient experience groups or forums.
Online groups.
There are plenty of online groups that can both provide support for people
with long term conditions and others like Patients Opinion
(https://www.patientopinion.org.uk/ ) who provide a way of raising your
concerns in a user friendly way. Hospitals do respond to these online
comments so hopefully they also act on them.
Local Involvement Networks (LINk) are independent local volunteer led
organisations responsible for collecting the views of the patient and passing
them onto the authorities. They also have the right to inspect NHS and social
care funded organisations providing care. The LINk will evolve into Local
Healthwatch in April 2013.
Local Healthwatch will have a greater involvement in this sort of activity and
will be recruiting members to undertake some of the work. Look out for
information in your area.
Other voluntary sector organisations take an interest in health and social care
issues. The Women’s Institute in Buckinghamshire recently ran a campaign
to improve stroke services.http://www.bucksfwi.org.uk/index.php/wicampaigns/bucks-activities.html
Influencing the Clinical Commissioning Groups
The government has placed great importance on the need for the new Clinical
Commissioning Groups (CCGs) to undertake“Meaningful engagement with
patients, carers and their communities.” as part of their authorisation process.
They are also required to “…to involve the public on any changes that affect
patient services.”
This means that they should be asking all people about their experiences of
the health care they have received and also asking how they can be
improved. Ideally patients and the public should also be involved in designing
the changes to services as in this example:
http://www.improvement.nhs.uk/audiology/presentations/national_audiology_c
onference_july2010/Workshop2_presentation.pdf
It will be interesting to see how CCGs engage and involve individual patients
in decisions about patient services. In an ideal world GPs will have time in a
consultation to discuss with patients and carers the issues and priorities that
face the CCG. Then they should have time to collect together all the
comments made during the working day and pass those onto the CCG. The
CCG then will look at all the comments from all the GPs, analyse them to help
their decision making.
In my experience I fear that scenario is unlikely!
So ask your GP and your local Clinical Commissioning Group how they
will involve the patients and the public in any changes that affect patient
services.
Bill Russell