Listening to you
Patient Participation – the difference it makes
People come with different experiences, views and expectations and it is important that our commissioning plans reflect an understanding of these different perspectives.
For example, public meetings to discuss the redevelopment of hospital sites attract a few hundred participants, many of whom have different views on the plans presented.
Here are just some examples of where we have listened to the communities we serve.
Transforming adult community services
The specification for the new service was developed in partnership with people who used and provided services including patients, GPs, county council services and the voluntary sector. We ran an extensive procurement process to select the provider for the new service and patients were part of the evaluation and scoring process.
Developing plans for future hospital provision
Opening hours for Hemel Hempstead Urgent Treatment Centre and the future of West Herts Medical Centre
In May 2018 our board reached a decision on opening hours for the urgent treatment centre (UTC) and also on the future of West Herts Medical Centre following a public consultation which attracted around 600 responses.
The board decided that the UTC should continue to operate from 8am to 10pm, however in recognition of the high level of support for a 24 hour service the board agreed to explore the feasibility of extending the opening hours until midnight. In November 2018 following analysis of GP workforce and A&E activity the board decided that extending the hours to midnight would not be workable on staffing, financial or patient safety grounds and could not be justified in terms of demand or value for money.
The board also considered the future of West Herts Medical Centre (WHMC), following the public consultation where feedback identified that patients valued the location of the centre and the ease of access to appointment. The board worked to identify and come to an agreement with a local GP practice to run the centre as a branch surgery but ultimately were unable to secure a service that would be right for patients. In September the board agreed to close the practice and support patients to register elsewhere. To provide patients with continued GP access on the same the board agreed to pilot an expansion of the 'extended' access bookable appointments through the GP hub that opened there in July 2018.
This expanded service means that all patients in the area can book to see a GP on the WHMC site at certain times during the day, in addition to evenings and weekends.
Read the board report here
We formed a service user group who played an active role in developing our wheelchair service specification, we also held several patient and wider stakeholder events which helped to shape the needs of the commissioned service. A patient representative was involved in the procurement process, evaluating bids and bring the patient perspective to all discussions.
We have a very active patient representative as a member of our quarterly Diabetes clinical forum who also fed into the development of the specification for the new integrated service. He continues to be involved in various task and finish groups to champion service delivery and a patient centred approach.Our patient representative and a Healthwatch Herts representative also supported in assessing the proposal for the new service.
For more information on diabetes here
Since 2003 Meadowell surgery in Watford has provided GP services to patients in temporary accommodation, staying with friends or at risk of homelessness.
The lease on their building came to an end and a relocation was proposed to a nearby GP practice just 300 yards from the current site.
Herts Valleys CCG met with the practice patient group and the leadership teams to discuss the move and to get feedback on what this meant for both patients and staff.
One clear request from patients was to retain both the practice staff and a separate waiting room and this was implemented.
On the day of the move a care navigator was available to walk patients to the new site where they were greeted by existing Meadowell staff members.
Following the move a survey was undertaken with very positive results.
Patient Transport Service (PTS)
Following patient feedback and to improve services, we now have three patient representatives as active members to bring a patient perspective to our monthly PTS contract review meetings.
Healthwatch, Herts on behalf of Carers in Herts, met with Herts Valleys and East and North Herts CCGs to establish how communication and patient eligibility for an escort could be improved - a very positive and productive meeting took place with PTS providers agreeing to work directly with Carers in Herts to address any future concerns. It was also agreed to review the training needs of staff to avoid future issues arising.
We have also been working and meeting with the Lister Area Kidney Patients Association (LAKPA) to identify how transport efficiency and patient experience can be improved for patients attending renal dialysis appointments – an outcome of this is a patient leaflet produced clearly outlining how the transport service operates and the telephone numbers to contact.
Engagement with young people
Hertfordshire Children and Young People’s Emotional and Mental Wellbeing Board
Working together with East and North Herts CCG and Herts County Council, we were joined by 16 young people comprising of representatives from the Broxbourne Youth Council, Children in Care Council (CHiCC) and Young Commissioners. The key emerging themes included support in schools, early intervention and prevention and measuring outcomes. The following actions were agreed:
To support the development of Young People’s Mental Health Champions in schools
Guidance for schools to be produced that helps them review their approaches and offers best practice. To include a section written by young people
To explore opportunities for piloting drop in models in Hertfordshire
More detailed information is available here.
Research project into bowel cancer testing
We shared, through our patient network, details of a research project into bowel cancer testing which was being proposed by Dr Jon Landy, Consultant Gastroenterologist at West Herts Hospitals NHS Trust (WHHT).
Patients were asked to comment on:
1. If they supported the study and felt it was important and had the potential to enhance patient experience.
2. If there were aspects of the study they felt should be changed so that it was better from a patient viewpoint
3. To suggest any changes to the patient information sheet (PIS) that would make the information about the study more accessible to patients
As a result of the feedback received it was decided not to share the protocol with patients as it was considered too technical but that the patient information sheet was useful. Descriptions and explanations of polyps and colonoscopy with the full details regarding European data protection standards was added to the PIS.
The researchers were encouraged that the feedback suggested the study was reasonable regarding patients’ experience and that no further changes were necessary to the study procedures that were set out to minimise any discomfort or risk to participants.
To view the letter from WHHT here
Service re-design and procurement
Patients are involved in all our service re-design and procurement processes, very much as part of the project team, discussing and developing service specifications, reviewing bids and attending market events. The patient perspective is integrated alongside clinical and managerial views and included at all levels.
Reader and website panel
Our reader panel regularly review our patient focussed information, ensuring that they are in plain English and easy to understand. A draft leaflet (such as for dermatology or ear, nose and throat services) is reviewed by the panel and amendments, corrections and in some cases a re-write are suggested and implemented.
Our new website was launched in October 2018 – this has been completely restructured and redesigned to make it more user-friendly. A key criterion of the redesign, based on feedback gathered through a patient focus group and discussions at a patient engagement network meeting was to create an easy-to-use, useful and informative site, and we have had a very positive response from our audiences to date.
Feedback is a key means of us ensuring that the site meet people’s needs and we welcome comments and suggestions on any improvements. Again, based on feedback from the focus groups we developed a new feature of the website is the ‘Find local services’ section which enables west Herts residents to easily find services in their area.
Feedback is gathered from public meetings, events and sessions – this is so that people who attend can influence future planning. For our meetings discussing plans for redeveloping hospital sites, for example, many people considered that discussions were dominated by a specific patient perspective. For future meetings, a facilitated discussion approach was adopted, to ensure that everyone had the chance to have their say.
Patient Participation Group for People Affected by Cancer
We held a patient participation group for people affected by cancer on the 6 December 2018, at the Stanborough Centre in Watford. The report on the outcomes and actions as a result of the participation is here.
Service user and carer feedback from mental health inpatient and community service
This summary report which was reviewed by our commissioning executive contains information about service specifications together with issues and feedback raised by service users and carers together with improvement plans.
To view the report click here.
For further information contact firstname.lastname@example.org who is part of the Integrated Health and Care Commissioning Team, working across Herts County Council, Herts Valleys CCG and East and North Herts CCG.
Patient Engagement network
We discuss a range of topics at our patient engagement networks (previously development sessions). The project leader is invited to give a brief presentation, details of how people can influence the process and then feedback and actions are taken from the group. For more information about this network check out the patient groups and networks page.
Ongoing participation evaluation
We are developing a routine process for understanding and evaluating the difference participation makes. All our patient representatives will receive a survey following or during their participation. We have trialed this approach with 15 patients who have taken part in quality visits, procurement, hospital site planning, reader panel, medicine optimisation committee and networking events.
Our next steps will be to discuss the feedback with our Patient and Public Involvement (PPI) Committee and agree ways of improving the ratings and the outcomes. The trial responses are here.