CASE STUDY
East Somerset NHS Trust
Patient and Public Involvement within East Somerset NHS Trust.

User Involvement has long been a priority for East Somerset NHS Trust. There has been long-standing user input in Cancer Services, day hospital services, continuous quality improvement projects, identified from patient surveys and maternity care.

The enthusiasm of staff and users working together has fuelled the move forward with Patient and Public Involvement becoming a ‘normal’ and accepted next step in improving services and service delivery throughout our organisation.

East Somerset NHS Trust has been involved in a number of initiatives regarding Patient and Public Involvement and the following points are an overview of the areas that have been and are continuing to be developed.

• PPI Conference. A joint conference, with presentations from staff and users/carers of the service, was held in September 2003, which celebrated the benefits of working together for service development. A further half-day conference is being planned for late 2004, which is envisaged will be facilitated by the East Somerset NHS Trust User Group and supported by the Trust.
  
• PPI Strategy. The current PPI Strategy (2003-2005) was developed in direct partnership with the Trust User Group. This has ensured the vision for joint working plays an integral part in changing the culture of the organisation and moving the strategy forward.
  
• East Somerset NHS Trust User Group. The User Group held their first meeting in November 2003 and a lay representative was elected as Chair. The group has a Trust representative who helps facilitate the process. Terms of Reference have been agreed and the group’s visible approach to joint working with the Trust is continually promoting the vision within the PPI Strategy.
  
• Patient Information Leaflets. All East Somerset NHS Trust Patient Information Leaflets are now available to order ‘on-line’ from the Internet. It is hoped this will help with access to information for our local population. An area encouraging responses from patients to make comments on any of the leaflets accessed through this method is also available. As part of the Trusts commitment to have patients and the public involved in clinical care, a member of the Trust’s User Group was asked to review a significant number of Patient Information Leaflets from Outpatient and Day Theatre areas. The comments and suggested changes have been returned to the appropriate departments for actioning.
  
• User Group Involvement at Strategic Level. The Trust approached the User Group for representation on various strategic level committees to ensure the voice of the patient/carer is heard at all levels of the organisation. The committees currently having User representation are:
  
  • Clinical Governance Executive Committee (3 users)
    
  • Complaints and Compliments Group (2 members)
    
  • Trust Board open meetings (Chair of User group)
    
• User Group Involvement at Service Delivery. Two members of the User Group are involved in a pilot project on Level 9 (2 Wards) within the Hospital. The project is based around promoting self-care for patients and carers and good communication between the patient and nurse with regard to the patient’s emotional welfare. Evidence of identifying problems and problem solving is being gathered for both the Users and staff involved in the project with the aim of evaluating the findings together.  It has been agreed that the Users will present the findings to the multidisciplinary team at a Trust Clinical Governance meeting, ensuring the sharing of good practice and that further development takes place throughout the whole organisation.
• Patient Environmental Action Group (PEAG). Following the resolution of a complaint, the complainant was offered a place on this group to allow an opportunity for user input for improving the patient’s environment. This has been very successful and culminated with the User being present on the recent PEAT inspection.
  
• Development and Education. The FISH video, promoting public involvement, has been used to support the development and education of both staff and users. This video has been shown opportunistically in environments where staff and users have been present, as well as in individual departments within the hospital as part of developing the change in organisational culture.
  
• NHS Foundation Trust Application. Users from the PEAG Group and the Level 9 Project have supported the Trust’s recent move toward NHS Foundation Trust Status by agreeing to be interviewed about their input into developing and improving services. The interviews have been used in the NHS Foundation Trust Consultation Document in an attempt to show members of the local community how they too can ‘have a say’ in their hospital and that they may also help develop and improve local services.
  
• NHS Foundation Trust Presentations. Members of the East Somerset NHS Trust User Group have supported the NHS Foundation Trust presentations by committing members to attend each public presentation. Many of the Users have participated in the presentations, thereby actively displaying the joint working that the Trust and the User Group are promoting.

PPI TOOLS
Policy into Practice
by Jessie Cunnett - Pals and Public Involvement Manager, Adur, Arun and Worthing PCT.

I didn’t know it at the time, but I came to the world of patient and public involvement some eight years ago after experiencing the NHS as a fit and healthy adult going through pregnancy and childbirth for the first time. I was shocked at the lack of respect I was afforded by health care providers. I was the last person in any communication loop, and my thoughts, feelings and opinions seemed to carry little weight or importance in relation to the care of myself and my then un-born baby.

Having been a rather too-often resting actor for some time, I had some spare energy and enthusiasm that I dedicated to finding out more about this strange relationship between health service providers and users. I became involved in a Maternity Services Liaison Committee. It was an effective avenue to affect some change and a good place to learn. I was interested in why health care providers didn’t seem to recognise the value of working in partnership (adult to adult) with service users, why was the value of a persons’ knowledge about themselves and their experiences not utilised?

All things PPI have come a long way in the last eight years, to the point where in the right circles it is almost fashionable! But perhaps the most poignant difference I can see is a growing recognition of the value of involving patients and the public in decisions about their own health and care.

In my current role as PALS and Public Involvement Manager for Adur Arun and Worthing Teaching PCT, keeping abreast of the fast evolving PPI agenda has been at the top of my list of priorities; even the most stalwart of PPI resisters can’t fail to notice that patients and the public are beginning to get their say. However, embracing the need to involve and consult is one thing, practically doing it, and showing that you are doing it is another thing entirely.

With the introduction of legislation many staff began to approach me for help and support in looking at how to involve their service users. What appeared to be the most common concern for staff teams was the question of, “where do we start?” With already busy and demanding schedules, many staff were concerned about how to manage PPI, and saw it as an extra burden. What they wanted was practical solutions and suggestions.  There was certainly no shortage of information, and to start off with I was sending people away with a few trees worth of pearls of wisdom. Instead of being helpful it had the opposite effect, I think people took one look at all the reading and ran a mile.

The Public Involvement Levels: Policy Into Practice Tool, was developed in order to make PPI something accessible, something that staff needn’t feel afraid of, and something that was achievable. Strengthening Accountability Practice Guidance 10 is really useful and used by staff. The Policy into Practice Tool is an extension of that guidance, to help people identify what type and level of involvement is appropriate. The tool is not scientific and needs to be used as a guide rather than a definitive solution.

I will shortly be moving on to work for the Commission for Patient and Public Involvement in Health, and am keen to introduce the tool as a way that Patient and Public Involvement Forums, can work together with PCTs and Trusts to identify a mutual understanding of meaningful and realistic patient and public involvement. I am confident that the NHS is welcoming the involvement of patients and the public and am optimistic that we are working towards an NHS which puts patients at it’s heart.

Public Involvement Levels – Policy into Practice
The best outcome can be achieved by using this tool in conjunction with Strengthening Accountability Practice Guidance 10.

In order to gauge what level of public involvement you should be looking at regarding a particular project or change, assess the impact on the service against the impact on service users Example 1 the relocation of PCT head office, the impact on service users is relatively low, but the impact on the service/organisation is high, if you draw a line between the two, the levels through which the line passes gives an indication of what levels of involvement should be considered. Example 2, the provision of a piece of equipment is being considered, the impact on the service is relatively low, but the impact on service users using the equipment is high. NB: This measure should only be used as a guide, and not a fool-proof measure of levels of involvement.