Friday 27 September 2013

Conversations between patients and hospitals



Some hospitals and the newly created Clinical Commissioning groups are finding it difficult to engage in a meaningful and effective way with patients and the public. 

These are my thoughts on how they could hold a conversation with the public rather than 'engage' with them.

  • Go out to the people – don’t expect them to come to meetings.  It’s the same old faces, like me who go to public meetings.
  • Use language suitable for all
  • Keep it simple
  • Keep events small and short
  • Don’t give too much information at any one time
  • Leave time for reflection
  • Be prepared to repeat and revisit issues
  • Hold a conversation
  • Use patient leaders/champions
  • Feedback is essential. Explain how the input from patients has been used and has influenced change
  • Be informal, don’t lecture/broadcast.
  • Use staff, not managers/executives (?)
  • Be bold, take risks, do something different.
  • Social media is very powerful but it is a conversation. Those of us who use twitter get irritated if all we get are broadcasts and publicity messages. 


My questions at the AGM (Buckinghamshire Healthcare NHS Trust)

In the previous blog I gave my own highlights of the Buckinghamshire Healthcare NHS Trust AGM.

After the Chief Executive gave her presentation and the finance director gave his summary of the financial situation we heard from the leaders of the emergency surgery teams. They described how they had changed the service, what is called reconfiguration, and how the new service was producing better outcomes for patients & reducing mortality rates.  Good news.

At the end of the event there was time set aside for the public to ask questions.  I have no idea how many members of the public were present but I was virtually the only person who asked questions. 

Why is it that people don’t ask questions in formal board meetings?  I reckon most people know the answer to that one.

I asked a couple of questions:

The first was about the campaign to restore an A&E department to the High Wycombe Hospital site. A petition with 16,000 signatures has been organised.

There are 16,000 people in the south of the county who believe that there should be an A & E on the Wycombe Hospital site.

Can I ask that the Communications teams from the Clinical Commissioning Groups and the trust remind us, on a regular basis, about the good clinical, organisational and financial reasons why, in the present circumstances, there can only be one A & E in the county?

This is an on-going issue for those who live in High Wycombe.  The A&E department was closed in 2005 after a public consultation and replace with a minor injuries type of service.

As we know from other examples of such closures the local population is incredibly loyal to their local hospital. MPs too! So the story here is how to sell the difficult and complex reasons, hopefully evidence based, for such closures.

In my opinion the only way to tell the story is to keep it simple and be persistent.

However the audience was asked what else could be done to explain the reasons why there are only resources for one A&E department in the hospital.

My suggestion is that the leaders of the campaign should meet with senior clinicians and managers (and the commissioners) to have an informal, facilitated discussion and look at the evidence. 

As for how to improve the conversation between the hospital executives and the patients is something to explore in another blog.


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The second question I asked was about the way they manage complaints.

Can I ask that the board measures its performance on managing complaints by using the following as outcome measures?

a)    Is the complainant satisfied at the end of the process
b)     has the trust learnt from the complaints  
c)    has the trust acted on the learning.

Normally the first thing that the board reports is that they replied to people within the required time. This is important of course, but I reckon that most people would say the best test of a good complaints service is: was I happy with the result?

  I hope that the trust may consider that a different approach will improve the way people think about the way complaints are managed.

They expressed some interest in this approach and said that they are trying to do something like this.  They have been contacting people by telephone after the complaint has been closed, especially complex complaints. But they have not been recording this activity. It sounds as if they are looking to improve the experience of complaining.


They did say that they get many more accolades than complaints. This is good to hear. 

Wednesday 25 September 2013

Buckinghamshire Healthcare NHS Trust AGM 2012/13

I realise that I have not written anything for my blog for a long time.  It has been a good summer so I have been otherwise engaged on holiday and working on my allotment.

I have just come back from our local hospital trust AGM.   This is a trust under special measures and heavily involved in the Jimmy Savile inquiry. Yet all is not lost –there is good news as well.

There was not a single case of MRSA during the year 2012/2013.  They recorded their lowest number of C Diff infections ever. – down by 50%.

The Hyper-acute Stroke Unit is the best in the region according to the Royal College of Physicians.

The hospital and the spinal injuries centre were at the centre of the Paralympics opening ceremony. A statue of Sir Ludwig Guttmann has been installed in front of the Spinal Injuries Centre

Three members of staff received national awards during the year.

In the first quarter of 2013/2014 even the HSMR has dropped below 100, it is now 97!

As the Chief Executive, Anne Eden, said “It was the best of times and the worst of time”.

The hospital had over a million contacts with patients and 5770 babies were born.

There have been service development and a £5M capital investment in A&E is being undertaken.

As part of their response to the Keogh report they have started  an “Every Patient Counts” action plan designed to improve services.

But the future is challenging as the health and social care economy has been under stress for many years and will be even tougher in future years. The CCG which is a major contributor to the income of the hospital is looking at a shortfall in its budget next year. There are difficult decision to be made in this year’s commissioning round which starts now.

The cost of the staff in the hospital accounts for 59% of the total expenditure of the trust.

There was a presentation by the emergency surgery team on how they have been redesigning the way in which they manage things.  They admit 3800 patients a year of whom 500 are over 80 years of age.  They see three times that number altogether.

I found it a bit confusing when they talked about emergency surgery that does not need to be done that day and the fact that their patient could be reasonably well.  Some patients can even stay at home.   This is obviously a version of ‘emergency’ that is new to me.

It was amusing to hear surgeons talking about holistic care!

The CE presented some internal awards to staff who had “Gone the extra mile” for patients.   These were people nominated by their colleagues and patients and from the hundreds of nominations a small number were selected.  They were both clinical and non-clinical staff and it was a nice way to end the formal part of the event.  Congratulations to those who received an award.



There was a final event when the statue of ‘Poppa’ Ludwig Guttmann was formally donated to Stoke Mandeville Hospital by the charity that had raised the money for it and other projects. http://www.poppaguttmanncelebration.org/


At the end of the meeting there was time reserved for the audience to ask questions.  I will discuss what happened then in the next blog.