Don't just talk - do something.

Have you ever talked about your GP surgery over dinner, sitting in a café, standing in the checkout at the supermarket….?

Well you are not alone!

A Million people a day use their GP surgery and most of those will have something to say about the experience.

Most of those experiences are good.

However sometimes us patients have ideas about how to make the experience of talking with a GP or practice nurse better.

There can be problems with the phone service, making appointments isn’t always easy, seeing your own GP can mean waiting weeks, no privacy at the reception desk, access can be difficult for those with disabilities and as for car parking…!

So instead of talking about things on your own – join your Practice Patient Participation Group (PPG) and do something about them.

A patient participation group is a bunch of volunteers who want to make a difference.  They work with the practice to gather information from patients and to make suggestions about improvements.

They look at the surgery and ask:

What works well?

What works less well?

Are there services that are not provided but would benefit patients?

They also run an annual patient survey, hopefully the questions are set by the patients not the surgery.

Sadly General Practice is going to have to change. Being part of your PPG is one way you can help to make sure we keep the best bits of General Practice

Your voice on its own is very quiet.

But the voice of the many people in the PPG is much louder and will be listened to.

Please join your Practice Patient Participation Group.

Ask at reception or look on the practice website.  Maybe there is a social media page?

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. 

How can the public hold Clinical Commissioning Groups to account

I think that 'holding to account' means that the public must be confident that the Clinical Commissioning Groups (CCGs) are answerable to the public and patients for the decisions they make on our behalf.

The sorts of decisions they will be making (maybe they have already made them) are:

• What healthcare do we need.
• How much.
• The quality of the care
• Where the care will be delivered and by whom.
• How long will it take to get treated.

There will be over 200 CCGs.  Our is a small one with only 190,00 people and a budget of about £200M.  Others will be much bigger and responsible for very large sums of public money. So it is crucial that they use this money for the benefit of their local population and get value for money.

So how can we hold these organisations to account.  It will not be easy as individuals to do so.  Organisations of this sort can hide behind a number of barriers. They use the Freedom of Information Act to delay answering questions.  They can also use the idea of 'Commercial Confidentiality' to avoid giving answers about the value of contracts, especially with private healthcare providers.  They also use jargon to confuse us.  Lastly one of the ways to ask them questions is at board meetings held in public and that isn't easy for many people. It isn't much fun standing up in from the board and holding them to account.

However there are a number of ways that the public can make sure they spend our money wisely and on healthcare that will benefit us.

Ask questions at meetings

CCG boards will have to hold their meetings in public and publish the board papers online.  Go to meetings and ask questions. CCGs will also hold other so called 'engagement' meetings so please go along and ask awkward question. 

Join your Practice Participation Group (Patient Reference Group)

Each GP surgery should have a group of patients, perhaps as an virtual group, who support the practice in many ways. They can ask questions of the GPs who in turn can ask questions of the CCG.  Our CCG intends to have a Patients Forum with one person from each practice participation group on it. Exact details are current unknown. The patients will need to set the agenda not the CCG.

Service User Groups

If you have a long term condition join the service user group/support group or set one up.  They may be able to ask questions about specific services as they are often considered as 'experts'.  These groups are often used when services are being redesigned or changed. 

Local Healthwatch

These groups will be taking over the role of the Local Involvement Networks on April 1st. They will act as the patients champion  and should be seeking the views of patients and the public about the health and social care services. They will be monitoring the quality of services and holding the CCGs to account if the services are not benefiting patients. These groups will be as new as the CCGs and will take time to become effective. Anyone can join a Local Healthwatch and support their activities.

GPs

Our CCG intends to have an 'accountability forum'.  Each practice will have a GP on the forum and their role is to hold the CCG to account on behalf of the GPs and the practices. Even more reason to get involved in your practice participation group so you can influence the GPs.

Local Health and Wellbeing Boards

This is a joint Council & CCG body that is responsible for strategic thinking and priority setting for health and social care. A lay person from the Local Healthwatch will be a member. CCGs should be answerable to the board to show it is matching commissioning to the health needs of the population. How it will hold the CCGs to account remains to be seen but it could be quite powerful.  

Health Overview and Scrutiny Committees

This is a Council committee that monitors the commissioning and delivery of services and can hold the CCG to account.  The meetings are in public and you can go along and ask questions.

CCG Governance procedures

CCG are required to hold meetings in public, publish their papers online and to publish the methods they use to make decisions.  We should make sure that they actually do use those methods when making decisions about our healthcare. There will be much talk of the use of 'evidence' and we need to make sure they use all the evidence and analyse it in a consistent manner. 

Lay people on the CCG board

Each CCG is required to have two lay people on the board and one of those must act as 'the patient and public involvement' champion.  Find out who it is and make sure they act on our behalf.

NHS Commissioning Board

The new NHS reform act makes sure that the CCGs will be accountable for their performance to this national organisation.  But there is nothing in the act to make the CCGs accountable to us.

Monitor

The CCGs will be accountable to this national organisation for their financial performance.

Conclusion

Those of you who have read my previous blogs about patient involvement might notice some similarity to this one. I feel this is inevitable since the two processes of involvement and accountability are two sides of the same coin.  Both rely on good communication and trust. The same limited number of organisations are going to be active in the involvement process as well as the accountability process. 

Meaningful and effective involvement of patients, at an early stage of decision making, and in a sustained manner throughout the process will enhance the trust that the public have in the CCGs.  The accountability process will follow naturally from the involvement of patients and the public in decision making. 

There seem to be very few ways in which individuals can hold their local CCG to account. So it looks like you will need to join one or more of the organisations mentioned above if you want to make sure the CCG does what it is meant to do and 'make no decision about me, without me'.

The trouble with joining an organisation is that you hope that the person representing you is able to stand up to the CCG board.  Will the CCG take more notice of that person than the opinion of an individual?

Lets hope that the evolving CCGs will be different from the old PCTs. and that they will act in an honest and transparent manner so we can be assured that they are working on our behalf. 

  

How to improve healthcare in your area

How to Improve Healthcare in Your Area.

Patient and Public Involvement in Healthcare

I find that patients are, on the whole, only too happy to discuss their experiences of using the health service. In fact often it is hard to stop them talking and I cannot take notes fast enough!

Yet they find it hard, as individuals, to get their opinions listened to by Hospitals, PCTs and Social Care providers and commissioners.

Perhaps part of the problem is the bureaucracy and apparent inflexibility of these organisations. They like to do things in formal ways, by holding consultations and engagement meetings. Most patients prefer a face to face, informal conversation.

Patients also want quick feedback.

Then there is the language!

Public and Patient Involvement (PPI) has its own jargon, like many of things that happen in the NHS.  There is ‘engagement’, ‘consultation’ and ‘involvement’. They seem to mean different things to different people. In fact to most patients they mean little. They are words that managers use and are found in all the strategy documents and reports published by hospitals and the government.

Patients just want someone to listen to them and then to take some action so that services are provided or improved. One of the things that patients feel is important is to have some feedback from the organisation about how it is using the information it receives from patients.

This is what the government has said (see bullet point 6) about giving patients a louder voice through the Health and Social Care Act 2012:http://www.dh.gov.uk/health/files/2012/06/B3.-Factsheet-Greater-voice-for-patients-300512.pdf

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Involving Individual Patients

Patients, at an individual level, have always been involved in managing their own health.  This took place, either through self-management of their illness or during the consultation with a health professional. Between them the patient and doctor or nurse will work out what is best for the patient.

There are times, however, when the patient would still say “What do you think, Doc?”  But in every consultation there should be some form of joint decision making about what should be done to improve the patient’s health and wellbeing.

There are other ways that patients, as individuals, can influence how healthcare services are delivered.

Choice.

We all, as patients, have the right to choose where we receive our hospital treatment. The hard part is finding out which hospital provides the best treatment for our condition and for us as a person. But by making a choice we are influencing those who make the bigger decisions for all patients. So ask your GP about the quality of the service you need.

Patient Advice and Liaison Service (PALS).

If a patient or carer has concerns about something then one way of letting the organisation know is through the PALs officer.  This service has been around for a while now and the PALs officers are there to provide information about services but also to sort out minor concerns and problems that patient’s experience.

The PALs officer is able to pass on the concerns to senior management who should sort it out or provide explanations.

Regular reports are made to the hospital board on the number and types of issues that come to the PALs department.  The idea is that this provides information on services that may need to be improved in some way.

Writing to MP and local press.

This is always a good way of getting the attention of the Chief Executive.

Ask questions at Hospital Board meetings.

This is not easy for some people and I suggest that you write down your question and ask the chairman to read it out.

Ask questions at your local Council Overview and Scrutiny Committee.

Again some people might find it easier to ask the chairman to read out your question.

Complaints.

People are often hesitant in making formal complaints. They are concerned that if they cause a fuss something might be written in their notes about being a ‘trouble maker’.

However every complaint has to be investigated and a report is seen by the Chief Executive. A sub-committee of the board will also see the investigation and should make sure that actions are put in place to ensure that no harm comes to future patients. Regular reports are made to the board in public on the causes of complaints and the actions taken to stop similar things happening again.

Sadly, sometimes the only way to make sure that services are improved is by making complaints. 

The NHS needs to make it easier for people to make complaints. There are organisations, such as ICAS (see below) that support patients, their carers and relatives, in making formal complaints about the care they have received.

The Independent Complaints Advocacy Service (ICAS). ICAS provides advocacy support to people who wish to make a complaint about the service - or lack of it - that they have received from the NHS.

Finally patients and carers can also influence the way their healthcare is provided by joining one of the many groups that exist in the community and becoming part of a network.  Networks of people tend to have a louder voice than an individual.

There are lots of organisations and groups in the community that can help patients and members of the public to influence the authorities. The hard part is to find them and then to find the time to be active.  Often local councils will have lists of such organisations.

Join your local GP surgery Patient Participation Group.

If you have a long term medical condition you could join the local user group (or set one up). These groups are often used by the authorities to provide ideas for improvements in specific services such as stroke, diabetes, mental health, disabilities and other conditions.

There are local & national charities and other voluntary sector groups who support patients and carers and who can start campaigns to improve care services.

Foundation hospitals will have members who elect a board of Governors who can influence the executive board of the hospital.

Hospitals and PCT (and hopefully the new Clinical commissioning Groups) have patient experience groups or forums.

Online groups.
There are plenty of online groups that can both provide support for people with long term conditions and others like Patients Opinion (https://www.patientopinion.org.uk/ ) who provide a way of raising your concersn in a user friendly way.  Hospitals do respond to these online comments so hopefully they also act on them.

There is the Local Involvement Network (LINk), an independent local volunteer led responsible for collecting the views of the patient and passing them onto the authorities.  They also have the right to inspect NHS and social care funded organisations providing care. The LINk will evolve into Local Healthwatch in April 2013.

Local Healthwatch will have a greater involvement in this sort of activity and will be recruiting members to undertake some of the work. Look out for information in your area.

Other voluntary sector organisations take an interest in health and social care issues.  The Women’s Institute in Buckinghamshire recently ran a campaign to improve stroke services. http://www.bucksfwi.org.uk/index.php/wi-campaigns/bucks-activities.html

Influencing the Clinical Commissioning Groups

The government has placed great importance on the need for the new Clinical Commissioning Groups (CCGs) to undertake “Meaningful engagement with patients, carers and their communities.” as part of their authorisation process.  They are also required to “…to involve the public on any changes that affect patient services.”

This means that they should be asking all people about their experiences of the health care they have received and also asking how they can be improved. Ideally patients and the public should also be involved in designing the changes to services as in this example:

http://www.improvement.nhs.uk/audiology/presentations/national_audiology_conference_july2010/Workshop2_presentation.pdf

It will be interesting to see how CCGs engage and involve individual patients in decisions about patient services. In an ideal world GPs will have time in a consultation to discuss with patients and carers the issues and priorities that face the CCG.  Then they should have time to collect together all the comments made during the working day and pass those onto the CCG. The CCG then will look at all the comments from all the GPs, analyse them to help their decision making.

In my experience I fear that scenario is unlikely!

So ask your GP and your local Clinical Commissioning Group how they will involve the patients and the public in any changes that affect patient services.

Lay Person's guide to Commissioning Healthcare

A Lay Persons Guide to Buying Healthcare

The Government's recent reforms of the NHS in England have changed many things.  These changes are intended to improve the quality of care provided by the NHS and ‘to offer doctors and nurses the opportunity to play a major role in improving local health and wellbeing’.

One of those changes is that healthcare will be bought or ‘commissioned’ for all those who live in England by new organisations called Clinical Commissioning Groups (CCGs).

All GP practices in England must belong to a CCG.  There will be 212 CCGs in England.

The CCGs will buy:

Elective (planned) Hospital Care (outpatients and inpatients),

Urgent and Emergency Services (A & E),

Community care and rehabilitation services,

Mental Health Services,

Learning Disability Services,

The Government provides a certain amount of money that the CCG will use to buy our healthcare. The CCG will decide how that money is spent.

The CCG will decide how much of each service to buy and where it will buy it from. So it has to choose which hospitals will provide our health care. They will be required to use any provider who is qualified to provide health services. This could be from NHS hospitals or it could be from private companies.

Commissioning is more than just simply buying healthcare.  It is also about discovering what are the needs of the population, identifying the services required to meet those needs, deciding how services should be provided (pathways) and setting quality standards.

The CCG will then agree a contract with the service provider on an annual basis (April to March).  Some contracts, especially those with private providers, will last for longer than a year, perhaps up to 5 years.  Negotiations on contracts will usually start in the summer and are expected to be signed by the end of March in each year.

The price for each outpatient appointment and each treatment & operation is set by central Government.

Having bought the care the CCG will need to make sure that it gets what it paid for, both in the amount of care (the number of outpatients and inpatients, the number of tests etc.) and also the quality of care that is provided for patients.

The CCG also has to make sure that the quality of care improves each year.

The Government expects that each year the CCG must break even financially.

Some services will be commissioned by a national organisation called the NHS Commissioning Board.  These include GP services, Pharmacies, Dentists and specialist services.

CCGs will be run by a board which has GPs as members, as well as a nurse and a hospital consultant.  There are also two lay representatives and a number of other board members who will look after the finances and other activities.

Most of the managing of the contracts and the administration will be carried out by another organisation called the Commissioning Support Unit/Service.

The CCG will be held to account by its member practices and also by the National Commissioning Board.

The CCG is required to involve patients and the public in decisions about how it commissions our healthcare.  I assume that it will do so through the Patient participation Groups but also through public meetings, surveys. The CCG may also involve patients through service users groups and voluntary organisations. One of the roles of the lay representatives on the board is to act as champions for patient and public involvement (Health and Social Care Act 2012 Section 14u).

So if you want to influence how health care is delivered in your area I suggest you join your Practice Participation Group.