1. Involving Patients and the Public in Urgent Care Dr Nicholas Reeves Adviser to the Urgent & Emergency Care Team at the Department of Health

2. Today’s presentation Three areas that I want to explore today:  Why involve patients and the public in the NHS?  Take stock of where we are today in respect of patient and public involvement in urgent care  Explore what remains to be done

3. Defining Terms Before I do any of that, I think it would be helpful to clarify what it is that we are discussing today. At least three different elements in all of this, namely:  Auditing people’s experience of services  Consulting patients and the public  Involving patients and the public Each involves different approaches and, where the first two involve issues of representativeness, the third is about recruiting individuals to serve in defined (and properly supported) roles, who may or may not (in themselves) represent the wider community from which they come.

4. Why involve people? Declare an interest : I was an historian and university lecturer for nearly thirty years... and then:  Lay Member of a Primary Care Group Board and Associate Non-Executive on Health Authority  Founded National Association of Lay People in Primary Care  Lay Member of Carson Review and Review of Emergency Care  Member of OOH Review Implementation Team  Adviser to Urgent & Emergency Care Policy Team

5. Why involve people? “The patient’s voice does not sufficiently influence the provision of services. Local communities are poorly represented within NHS decision-making structures. Despite many local and national initiatives to alter the relationship between the NHS and the patient, the whole culture is more of the last century than of this. Giving patients new powers in the NHS is one of the keys to unlocking patient centred services.” NHS Plan, July 2000

6. Why involve people? The NHS Plan signalled a new determination to put patients at the very heart of the NHS and this new emphasis on patient and public involvement has been reiterated many times since, culminating in new legislation in 2006 and 2007* which imposed a legal requirement on all organisations providing NHS- funded services to demonstrate that they have involved service users and the public in planning, evaluation and developing those services. * National Health Service Act 2006 and Section 233 of the Local Government and Public Involvement in Health Act 2007

7. Why involve people? Over and above the legal obligations:  Patients are likely to be more satisfied and happier with services they have helped to design.  People are most likely to be persuaded that a particular service is good value for money where they have been involved in service design.  Local communities are much more likely to accept changes in service provision where people have been directly involved in their redesign.

8. Why involve people? And of course for commissioners, 3 of the 11 competencies described in World Class Commissioning relate to excellent public, patient and community engagement:  Competency 1: To be recognised as the local leader of the NHS  Competency 2: Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalities  Competency 3: Proactively seek and build continuous and meaningful engagement with the public and patients, to shape services and improve health

9. PPI in Urgent Care Carson Review of 2000 set out for the first time national Quality Standards for the provision of OOH services and these included the Standard:  “All providers must demonstrate that they are regularly monitoring patient satisfaction and taking appropriate action on the results of that monitoring.”  From November 2002 all providers of OOH services had to comply with the Quality Standards

10. PPI in Urgent Care As a result of the new GP contract, in 2004, the original Quality Standards were reviewed to:  Make the standards ‘fit for purpose’ within the new primary care environment after introduction of new GP contract  Take proper account of the new Standards for Better Health The result of that review was a shorter set of Quality Requirements, which took effect in January 2005

11. PPI in Urgent Care Quality Requirement 5 : “Providers must regularly audit a random sample of patients’ experiences of the service (for example 1% per quarter) and appropriate action must be taken on the results of those audits. Regular reports of these audits must be made available to the contracting PCT. Providers must co-operate fully with PCTs in ensuring that these audits include the experiences of patients whose episode of care involved more than one provider organisation.”

12. PPI in Urgent Care New emphasis on exploring the richness of patient experience (as opposed to narrow focus on patient satisfaction) led us to commission a new questionnaire:  Approached authors of two questionnaires used in daytime general practice  End result was the CFEP Improving Practice Questionnaire available from http://www.cfep.co.uk/http://www.cfep.co.uk/  Since then, the University of Sheffield has produced a new questionnaire enabling an audit of patient experience across a whole system

13. PPI in Urgent Care The commentary published at the same time as the Quality Requirements had emphasised:  The range of different techniques available to explore patient experience, and  The importance of securing effective public involvement But only very limited evidence that either of these were being achieved. Therefore, in 2007 we commissioned the NHS centre for Involvement to develop a new Guide to Patient and Public Involvement in Urgent Care

15. PPI in Urgent Care This new Guide:  Recognises that there are particular challenges in securing effective public involvement in urgent care (notably the absence of a settled group of service users)  Describes a range of techniques, approaches and strategies that will deliver both real understanding of the way in which patients experience the services they use and also enable people to be effectively involved in the design and delivery of those services.  Encapsulates in its Wheel of Involvement the central reality that this is a project that is never completed.

16. What remains to be done? Important part of today is to enable you to influence what we do next.  Does the Guide meet your needs? Would you like to see it significantly revised in future editions?  Are there additional example of excellent or innovative practice that you would like us to include in future editions?  What further help and support do you need to achieve effective patient and public involvement in urgent care? Two ways of communicating:  Post its  Q & A session at the end of the day with some of the Expert Panel who advised on the Guide

17. Personal Postscript Public involvement still seems to be the most challenging area, although some OOH services have appointed Non-Exec Directors. I’d like to commend a slightly different model which draws on my experience as a Lay Member of a PCG Board:  Properly recruited, supported and paid (like Non-Execs)  Become actively involved in the decision-making and leadership of the organisation they served, as opposed to the more detached role of the Non-Exec  Singularly well placed to challenge the existing configuration of services, ask difficult questions and act as effective agents for change