Patient involvement - necessity not 'nice to have'

With a growing body of evidence that effective patient and public involvement actively drives improvement in health care, chief executive Dr Tracey Batten sets out an ambitious plan to make it business as usual across all aspects of our work.

A regular user of one of our day services shared her first-hand experience of being a patient at our recent board meeting. Amongst testimony of kindness and clinical expertise were also examples of behaviour that caused her unnecessary anxiety and distress. This included a two-hour wait for a test, alone, in a wheelchair, and without any explanation or support for the delay.

Not one member of our board thought this experience was acceptable. And the specific service involved had responded immediately to her feedback. But we want to prevent these issues arising in the first place. As one of our board members put it, "how do we identify and act on the root causes of poor experience so that similar problems don't happen again in the future or aren't already happening in a different clinic or on a different site?" How do we achieve sustainable and system-wide change?

The patient story has become a regular item at our public board meetings. It has been very successful in raising issues for improvement at the most senior levels in the organisation. But another item at our recent board meeting provides the opportunity to achieve a step change in the way we respond to patients' needs and preferences.

That item was a strategy to increase and improve patient and public involvement by embedding it in all aspects of our work, at all levels in the organisation. From patients and local residents as representatives on project boards, to patients routinely 'co-designing' service improvements or working as volunteers to support service delivery, to ensuring patients' expertise is put to best effect in guiding their own care and supporting other patients.

The new approach will also make it easier for patients and local people to get involved as much or as little as they want, when they want, and to co-ordinate and better analyse all of the information and feedback we get.

The strategy builds on many existing examples of good practice in our Trust, such as the development of the connecting care for children service and the recent re-design and refurbishment of a one-stop cancer clinic at Charing Cross Hospital. Both examples had patient and carer input at every stage of development and continue to be guided through the strong relationships established between staff and service users.

Externally, there is much evidence that a systematic approach to patient and public involvement is a necessity, not a 'nice to have'. The absence of effective patient and public involvement mechanisms was cited as a factor in three of the biggest NHS reviews relating to failures in patient care of recent times, including the Francis inquiry into Mid Staffs NHS Foundation Trust. And it is unlikely to be coincidence that one of the NHS trusts rated most highly for patient experience - Northumbria Healthcare - has one of the best track records in patient and public involvement.

Our board is very supportive of our approach. It is being taken forward through a collaboration between our quality improvement, patient experience, governance and communications teams, together with Imperial College Healthcare Charity. A 'strategic lay forum' - made up of patient and local community representatives - is being established to develop the strategy further and to guide and oversee its implementation.

Our new website - also developed through extensive patient input- reflects our commitment to increasing involvement. The 'get involved' section provides an overview and a simple way to sign up as a member so that we can keep you informed about the Trust and update you on involvement opportunities as they arise. And, importantly, the new website is intended to make it easier for anyone to find -and to feedback on - information about our performance and plans. For involvement to work effectively, we know we need to do all we can to increase openness.

There's lots of work still to do - not least to support and train more staff in co-design approaches, develop our policies, for example on payment of expenses, and build the mechanisms to gather and share data appropriately. We won't get it all right, especially at the start, but we do know this is the only way we can ensure we provide, and continue to provide, the very best possible care.


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