Patient & Public Involvement, Patient Information & Voluntary Services Annual Report 2008/9

Patient & Public Involvement

1. Introduction: Section 242

The fundamental importance of the views of patients and the public in developing healthcare services is widely acknowledged. Effective patient and public engagement results in better health care processes and improved quality of care.

The Local Government and Public Involvement in Health Act made a number of changes to the way the NHS is expected to involve and consult communities in the planning and development of services. Section 242 of the consolidated NHS Act 2006 applies across the NHS health community including Foundation Trusts. Section 242 confirms a ‘duty to involve’, requiring NHS organisations to make arrangements to involve and consult patients and the public in:

  • Planning the provision of services,
  • the development and consideration of proposals for changes in the way those services are provided, and
  • decisions tobe made by the NHS organisation affecting the operation of services.

At the University Hospitals Bristol, Section 242 has strengthened an existing commitment and considerable history of involving patients. It has resulted in co-ordinated activity across the local health community, including NHS Bristol and has raised the profile and importance of Patient & Public Involvement within the Trust.

2. Corporate and Divisional support for Patient & Public Involvement Activity

2.1The Trust has a small Patient & Public Involvement Team based at Trust Headquarters. The team consists of a part-time Public Involvement Project Lead (Tony Watkin) and a full-time Patient Involvement Facilitator (Paul Lewis, who joined the Trust in 2008/9 from Gloucester County Council): in broad terms, the former facilitates community engagement activities and the latter co-ordinates patient survey activity. These two posts are managed by the Assistant Director for Audit & Assurance (Chris Swonnell) who is also actively involved in the Patient & Public Involvement agenda. This team works alongside the Divisional Patient & Public Involvement Leads (the Heads of Nursing); the Strategic Development Team including other trust developments such as the decommissioning of the Bristol General Hospital; the Young Person’s Involvement Worker (Cathy Gane) in the Bristol Royal Hospital for Children, and the Trust’s Innovation Team who play a significant role in promoting patient and public involvement through ‘experience based design’. The Trust’s Executive Lead for the Patient & Public Involvement, Lindsey Scott, the Chief Nurse & Director of Governance, left the Trust in the Spring of 2009 after supporting and driving the involvement agenda for many years.

2.2The Trust’s Involving People Committee was formally stood down in late 2007 as part of the process leading up to the attainment of Foundation Trust status in 2008, and for much of 2008/9 the patient and public involvement agenda was progressed via the Trust’s arrangements for engaging with its Membership (which of course includes significant numbers of patients and the public). The Involving People Committee has recently be reconstituted (June 2009) to monitor the progress of the Patient & Public Involvement Plan for 2009/10 and to ensure effective co-ordination of involvement activities across the Trust.

2.3A new special interest sub-group of the Membership Council was formed in 2008/9 to maintain a strategic overview of Involvement matters. The sub-group met for the first time in February 2009 and has met on two further occasions since. It has been agreed that a Governor will also join the membership of the Involving People Committee.

2.4The University Hospitals Bristol NHS Foundation Trust is signed up to the Bristol Compact and its meetings are regularly attended by the Trust’s Voluntary Services Manager.

2.5A detailed Patient & Public Involvement Plan for 2009/10 has been approved by the Trust Executive Group.

3. Patient & Public Involvement Activity in 2008/9

The Trust has continued to engage and involve patients and the public in a range of activities including the planning of new services and reviewing the quality of existing services.

3.1 Patient Surveys

3.1.1 Patient surveys in the form of written or electronic questionnaires, and structured and semi-structured interviews, are quality assured by the Trust’s Questionnaire Interview & Survey Group. This committee reviewedover a hundred patient (and staff) survey proposals during 2008/9. These projects are listed at Appendix A.

3.1.2 The Trust participated in the 2008 National Inpatient Survey. The Trust scored particularly well against the following questions:

  • Do you think the hospital staff did everything they could to help control your pain?
  • (On leaving hospital) were you told how to take your medication in a way you could understand?
  • (On leaving hospital) were you given clear written or printed information about your medicines?

And poorly in relation to the following question:

  • Were you given a choice of admission dates?

Detailed findings of the report were presented to Trust Board in June 2009.

3.1.3The Trust also participated in the 2008 National Emergency Department Survey. The Trust was in the top 20 per cent nationally in terms of patients’ overall rating of the care they received while in the Emergency Department. The survey also showed a strong appreciation among patients for the way they were cared for by doctors and nurses while in the department. Identified areas for action included improving the environment of the department to make it more welcoming for patients, and continuing to review options to improve car parking.

3.2 Focus groups

Focus groups and unstructured interviews are personally quality assured by the Public Involvement Project Lead. A list of these activities in 2008/9 is provided at Appendix B

3.3 Ongoing involvement

In addition to one-off surveys and engagement exercises, the Trust maintains a record of ongoing patient and public involvement, e.g. lay input into key committees and steering groups. This list is reproduced at Appendix C.

3.4 McKinsey/Monitor Patient Experience Project

The Bristol Haematology & Oncology Centre participated in this project in the autumn of 2008 following an approach to the Chief Executive from Monitor (the University Hospitals Bristol was one of four Trusts who took part in a trial of this methodology). The project began with a ‘diagnostic’ phase which included patient surveys and focus groups. Information was fed in rapid time to McKinsey who analysed the data and provided feedback in the form of posters made up of images, graphs and quotes. These posters were shared with BHOC staff and also will Trust Board. Six key areas were identified for action, including short, medium and long term goals:

  • Information & Communication
  • Teamwork & Co-ordination
  • Scheduling & Wait times
  • Staff time
  • Facilities & Environment
  • Parking & Transport

By January 2009, the Bristol Haematology & Oncology Centre had:

  • Encouraged staff to attend customer care training, volunteered the BHOC as a ‘mystery shopper’ site
  • Put up white boards in departments to display information about waiting times
  • Launched ‘real-time’ staff recognition and patient feedback boards in all clinical areas
  • Set up a regular Patient Experience group to monitor the action plan

A roll-out of the project methodology to other identified areas of the Trust is part of the Patient & Public Involvement Plan for 2009/10.

3.5 “Have Your Say” / “You Said We Did”

The Trust has adopted “Have Your Say” as a brand to draw together patient feedback activities. Large (A0) posters have been positioned in the entrance/reception areas to all Trust hospitals[1] explaining the various ways that patients, carers and visitors can ‘have their say’, including accessing PALS & Complaints systems and becoming a Foundation Trust Member. These posters are accompanied by “You Said We Did” boards: these have initially been used to feed back key results and corresponding actions in relation to National Inpatient Surveys, and the intention is to develop Divisional ownership of the content of these boards during 2009/10.

3.6 Developing plans for ‘real-time’ patient feedback

The Secretary of State for Health announced at the 2008 Labour Party autumn conference that all NHS trusts would be required to gather ‘real-time’ feedback from patients about their experiences of using hospital services. The Trust has been running a generic ward-based satisfaction survey for the past couple of years - using the bedhead ‘tv’ screens and a paper-based survey in bedside folders - but with very limited success. The important learning from this experiment has been the need for ward staff ownership of the survey: that they understand it, value it, and see it as part of routine care. In early 2009, the Trust created a short-term project group to review options for developing a more robust system for capturing rapid feedback. A formal options appraisal is due to be presented to the Trust Executive Group in August 2009.

Patient Information

1. Introduction

Information provision is an essential part of the patient journey, and a fundamental element in the overall quality of the patient experience. Patients have a right and a need to know about their condition, treatment options, and the availability of services. All patients should have access to high quality information at the appropriate time and in an easily accessible format.

2. The Patient Information Service

The main business of the Patient Information Service is the production, editing and reinstatement of patient information leaflets. There are approximately 1100 ‘current’ leaflets in circulation, covering a full range of clinical activity within the Trust. At the end of 2008/9 there were a further 200-230 leaflets listed as obsolete or awaiting review. During 2008/9, 120 new leaflets were produced by the Patient Information Service, and amendments were made to 436 leaflets.

Mark Roughan, our Patient Information Manager, left the Trust in the autumn of 2008, and was succeeded by Graham Slee. Due to budget constraints, Graham was appointed in a part-time capacity. Throughout the year the Patient Information Service has continued to work hard to deal with a significant volume of requests for the production of new leaflets and editing existing ones. Patient Information Service procedures have undergone a comprehensive review in an attempt to improve efficiency, and a series of practical measures have been implemented and highlighted to service users via Newsbeat and on Connect.

The migration of the library of leaflets onto a more modern and stable software platform has continued throughout the year, as has the task for re-branding leaflets to reflect the Trust’s Foundation status (now two-thirds complete).

A process has also commenced to make high-usage patient information leaflets available in audio format via the Trust’s internet site. Patient information continues to be routinely available in Braille and large print formats upon request.

3. Translating & Interpreting

The Trust continues to employ a team of 70 in-house interpreters via the Trust Bank, covering 36 languages. Face-to-face interpreting is supported by Language Line telephone interpreting for emergency/unplanned situations, and out-of-hours.Arrangements for Translating & Interpreting are overseen by the Assistant Director for Audit & Assurance (Chris Swonnell), whilst the Trust Bank Co-ordinator (Julie Rose) manages and co-ordinates the day-to-day activities of the interpreters.

The Trust’s Translating & Interpreting Policy has been revised in 2008/9 following extensive discussions with the local British Sign Language Forum in particular. Systems have also been put in place to identify patient complaints and safety incidents where translating and interpreting have been a factor.

Voluntary Services

1. Introduction

2008/9 has seen increasing numbers of people applying to volunteer within the Trust. This has included:

  • people out of work considering a changeof career or keeping themselves busy
  • students wanting and needing volunteering opportunities to apply to university
  • prospective nurses or other health-care professionals
  • people who have recently retired and who offer us the benefit of their new found time and energy, plus all of the work related and people skills they have accumulated over the years.

When placing volunteers, staff and volunteers are made aware that the volunteers’ work must complement the work of paid staff and not be used or seen as a substitute, i.e. the work of the volunteer must not put any paid job at risk.

The Voluntary Services Department is run by the Voluntary Services Manager (Glennie Derrick, who works 26 hours per week). A significant development in 2008/9 has been the provision of a team of dedicated reception staff to man the Reception Desk in the BristolRoyalInfirmaryQueensBuilding. A team of five staff provide cover for reception between 8am and 8pm Monday to Friday, and at Weekends 10am to 4pm

2. Volunteers within University HospitalsBristol

Voluntary Services have 699 volunteers registered on their database ranging from the age of 17 to some volunteers in their 80s; there are currently a further 89 potential volunteers going through the recruitment process. Our Volunteers help in the following hospitals

  • Bristol Royal Infirmary
  • BristolRoyalHospital for Children
  • Bristol Haematology & Oncology Centre
  • St Michael’s Hospital
  • BristolEyeHospital
  • Bristol GeneralHospital

All our volunteers are encouraged to work very much as part of a team being supported by the ward or department where they volunteer. The areas that volunteers are working range from:

  • Volunteering in reception areas and offices
  • Supporting the Play specialists in the Playroom
  • Volunteering on the Wards
  • Volunteering within the Chaplaincy Team
  • Friends for Parents (BristolRoyalHospital for Children)
  • Volunteering with BristolHospital Broadcasting Service
  • Volunteering in some of our Information Centres
  • Voluntary Car Drivers
  • Volunteers come in to help send out large mail shots
  • Fundraising

As well as the Trust volunteers, there are currently approximately 275 volunteers who are registered with the following support groups and charities:

  • Women’s Royal Voluntary Services (WRVS) – retail outlets and Bristol Royal Infirmary Trolley Service
  • Radio Lollipop based in the BristolRoyalHospital for Children
  • Scouts volunteer on a Friday evening at the BristolRoyalHospital for Children
  • League of Friends, Bristol GeneralHospital - coffee shop manned by volunteers
  • Ronald MacDonald House
  • British Red Cross, Bristol Haematology & Oncology Centre

Although the individual groups recruit and interview volunteers, the Voluntary Services Department processes all Medical, Criminal Records Bureau checks and provides bi-monthly voluntary induction sessions.

3. Example of success story in 2008/9

During 2008/9, Voluntary Services has been placing volunteers at the Bristol GeneralHospital supporting the Patient Activity Coordinator in improving patients’ stay in hospital and encouraging them to partake in activities that would benefit their care. The volunteers have ‘built bridges’ with patients, motivating, encouraging and lifting their self esteem with every visit. Although this arrangement has now ended, we are delighted to say that four of the volunteers have since found paid employment with our Trust.

4. Looking ahead

The Voluntary Services Manager’s vision for volunteering is to see: More wards and departments using volunteers; volunteers mentoring other volunteers who may find it difficult to work or volunteer within our Trust; an improved profile for Volunteering within the Trust; and improved links with our support groups

Since April 2009 the Voluntary Services Manager has also been working closely with Human Resources staff to ensure that the volunteer recruitment process is in accordance with NHS Employment Guidelines. The Volunteers Policy is being updated as part of this process.

Chris Swonnell, Assistant Director for Audit & Assurance

Tony Watkin, Public Involvement Project Lead

Paul Lewis, Patient Involvement Facilitator

Graham Slee, Patient Information Co-ordinator

Glennie Derrick, Voluntary Services Manager

Julie Rose, Trust Bank Co-ordinator

July 2009

Appendix A

Patient and staff surveys reviewed by the Questionnaire Interview & Survey Group during 2008/9

Project Title / Lead
Nutritional supplements / Dr Richard James
Last minute cancellations / Cesar Abellar
Management of patients with Parkinson’s Disease / Helen Dee and Suzy Root
Effectiveness of Oral Appliances in Sleep Apnoea / Ellen McKeown
Respiritory Discharge Team Patient survey / Mark Hufton
360 degree Consultant feedback / Phil Hall
Airway Training on Intensive Care / Fiona Kelly
Youth Council Survey / Maria Fox
Communication between doctors and parents of children on paediatric intensive care / Dr Michelle White
An Evaluation of Symptom Control in Patients with Inflammatory Bowel Disease / Professor C. Probert
Paediatric Anaesthesia Patient Satisfaction / Elena Fernandez
Cystic Fibrosis Food Provision / Julie Alisiadi
The role of patient information leaflets in consent / Dr Hannah Smith
Inflammatory Bowel Disease Questionnaire / Aileen Fraser
National Outpatient Survey / Paul Lewis
Nutrition and Dietetic Service Outpatients / Helen Brown
NICE Guidance on Surgical Site infection (CG: 74) / Andrew Robb - Specialist Registrar
Patient Booking Survey / Michal Kus
Home Enteral Tube Feeding Patient Questionnaire / Julie Barker
Liaison Psychiatry / Tom Hulme
Lucentis Therapy Survey / Sudeshna Patra
Upper GI Cancer Survey / Teresa Levy
Chemotherapy at Home Evaluation / Jo Poulton
Orthodontic Patient Satisfaction / Beth Keenan
Review of Innovian (Paper free) system / Louise Jenkins
Smoking and oral health / Janine Doughty
Pharmacy Homecare Satisfaction Survey / Ross Walker
Cardioversion Service Evaluation / Suzanne Reason
Nasogastric Tube Audit / Annette Marshall
Ward based pilot survey / Paul Lewis
Restorative Dental Patient Experience / Lucy Marsden
Food Audit / Toni Williams
Orthodontic treatment and General Dental Practitioner attendance / Neil McCusker
Antibiotic prophylaxis audit / Dr Inam Heulfe
Satisfaction with Radiology Department / Sally King
Patient Information Team Customer Survey / Graham Slee
Care of patients with Diabetes / Angela Kell
Nurse attitudes to Information Technology / Andy Landon
Skin Cancer Evaluation / Teresa Levy
Digital Rectal Examination / Petros Tsafkrakidis
Flu’ Audit / Emma Heckford
Fetal Medicine Unit Patient Satisfaction / Fran Tester
Cardiac Adolescent Transition to Adult Services / Vanessa Garratt
Did Not Attend (Children's Outpatient Audit) / Katherine Penney
Sexual Health Centre Survey / Michael Clark
Satisfaction with Breast Screening Telephone results service / Caroline Fuller
Emergency Department, signposting survey / Michelle Read
Awareness of recommended caffeine intake during pregnancy / Katie Blundell
Awareness of Optimal Fetal Positioning techniques among midwives / Dipika Aggarwal
Breast Services Questionnaire / Greg Martin
Complimentary Therapies Evaluation / Caroline Fuller
Play Team Survey / Elaine Eastman
A new combination vaccine against 6 childhood diseases / Vicky Payne
The turnover of Band 2 Nursing Assistants / Heather Toyne
Preparing children psychologically/socially for Stem Cell Transplant and to be sibling donors / Eileen Davis
Exploring the need for a children's Pacemaker support group / Stella Stuart
Biofeedback Therapy Audit / Anne Mills
Internal Communications Interview / Ben Harris
Complaints Survey / Anne Reader
Barriers to effective absence management / Laura Sanftleben
The Pulse Reader Survey / Ben Harris
How effectively are NHS leaders responding to the challenge of climate change? / Ruth Thomas
Divarication Class Audit / Lizzie Bradshaw
National Adult Inpatient Survey / Paul Lewis
Cardiac Rehab Physiotherapy / Mark Hufton
Psychological Assessment Tool / Julie Alderson
MicroClave Device Evaluation / Susie Gilbert/ Wendy Saegenschnitter
Paediatric Disability Audit / Ben Marsh
Impact of Agency Staff.. / Louise Quincey
Are Appropriate Referrals made for 24hr Holter monitoring / Marie Meader
Same Day Surgery – Patient Questionnaire / Clare Evans
Emergency Department Relatives’ Room / Rebecca Hoskins
Audit of Radiofrequency Ablation of Varicose Veins / Nicola Lawrence
Abdominal surgery physiotherapy leaflet / Emma Marchant
Choose & Book Audit / Lucinda Frank
Wellbeing at work / Robin Philipp
Resin-retained bridges / Matthew Garrett
C Diff
One stop cardiology clinic / Mandie Townsend
Cystic Fibrosis / Samantha Shaw
BHOC @ Whitchurch / Rae Harrington
Childhood constipation / Wynne Smith
Discharge planning at Children’s Hospital / Chris Cleaver
PAS survey / Tracey Masters
Support for Jesse May Trust care team / Liz Lewington
Jesse May Trust - staff audit / Ruth Butcher
Specialist nurse survey / Anne Miller
Productive Ward / Becca Robinson
Patient Pathway – pancreatic cancer / Meg Finch-Jones
Human Resources sickness project / Monica Ogborne
Vascular audit / Maria Morgan
Incident reporting audit / Robert Organ
Voice of the child / Lisa Goldsworthy
Child/adolescent psychotherapy / Julie Alderson
Potential for support group / Stella Stuart
Patient shadowing cellulitis / Kathryn Hall
Streets of London / Nisha Sanghrajka
Paediatric cardiac service information / Karen Sheenan
Pain relief / Emma Neale
Open Access pilot survey / Mel Taylor
Pre-operative assessment clinic / Wendy Visser
Teeth brushing practices / Richard Mears
Attitudes of Intensive Therapy Unit staff to medical withdrawal / Jeremey Bewley
Dry socket / Julia Winstone
Violence against NHS staff / Laura Godtschalk
Patient Information pack for Bone Marrow Transplant Unit / Eileen Davies
Parent Information regarding vaccinations / Sandra Dymond
Survey of parents and carers of children and young people with cancer / Kate Pye/Teresa Levy
Cardiac Rehabilitation patient questionnaire / Fiona Barnard
CRS admissions survey / Melanie Jefferies
Dermatology focus group / Giles Dunhill
Staff survey - ‘Physio Direct’ / Susie Tyrell
Family Clinic / Florence Manyika
CLIC Sargent survivors survey
MRI extended hours questionnaire / Sally King
TIA One stop clinic / Sally Wilson
Anaesthesia communication / Sally Masey
Trauma & Orthopaedic clinic / Helen Julian
Patient information survey / Mark Roughan
Prostate biopsy / Katrina Hurley
Effectiveness of denture adhesive / Dan Ghent
‘Suggestionnaire‘ for chemotherpay / Rae Harrington
Mother-infant Dance therapy group evaluation / Lucy LIvingstone
Paediatric oncology staff survey / Lyn Brown
Antenatal Hand expression of colostrum / Sally Tedstone
Communication survey / Alison Wall
Use of diaries for ITU patients / Penny Crook

Appendix B