Healthwatch Bucks wanted to find out about the experiences of people treated in Accident and Emergency (A&E) after a self-harm injury. We wanted to see if the NICE guidelines are followed. We worked with Buckinghamshire Mind, who carried out the interviews with service users.
As a result of the project we made a number of recommendations aimed at supporting the implementation of NICE guidelines. This was responded to with a joint action plan put together by our local CCG and Healthcare Trusts - which implemented a number of recommendations including those around privacy and consent.
Aims and objectives
Healthwatch Bucks wanted to find out about the experiences of people treated in Accident and Emergency (A&E) after a self-harm injury. We wanted to see if the recommendations in NICE guideline CG16 are followed in practice. We worked with Buckinghamshire Mind, who carried out the interviews. We asked service users:
- Whether they were treated with respect.
- What waiting for treatment was like.
- If they understood treatment options and had a choice.
- If they had pain relief offered and if treatment was ever refused.
- Whether they got a choice of staff and could be accompanied by someone.
- About confidentiality.
We also got feedback on other services used by our interviewees.
Reasons for implementing your project
Healthwatch Bucks is an independent not for profit organisation. Our role is to make sure that what Buckinghamshire residents have to say about makes a positive difference to local health and social care services. Our remit covers the whole of health and social care. Our catchment areas is the whole of Buckinghamshire (except Milton Keynes) and our organisation consists of 7 staff (5 full time equivalents) and over 25 volunteers,
Mental Health and Wellbeing is a priority area for Healthwatch Bucks. A Bucks resident talked to us about their concerns with their treatment in A&E after a self-harm injury. We wanted to find out more. We knew that this would be a challenging area to get feedback about. This project allowed people to talk about their experiences who might not use our normal ways of collecting feedback.
We put together a set of questions for use as part of an in-depth interview. It was hard to find people to talk to about such a sensitive and personal topic. In the end, Buckinghamshire Mind interviewed eight people. They told people who to contact if they needed help after the interview and provided emotional support at the time of interviewing.
How did you implement the project
We used the NICE guidelines to create a structured questionnaire to work through in interviews with service users. The challenges were around:
- making sure the questions were phrased in a way that reflected the NICE guidelines and also made sense to service users
- recruiting service users in such a difficult and personal area to be part of the project.
To support this, we worked with Bucks Mind who supported us in recruitment, we also engaged with our local mental health trust who promoted the project. Finally, in order to increase the number of interviewees we extended the project timelines to allow additional time for recruitment.
The project did meet its aim of understanding the views of a small but important group of service users. The main results are set out in our published project report which has been sent separately to the shared learning co-ordinator.
In response to our recommendations the following organisations: Buckinghamshire Healthcare NHS Trust, Buckinghamshire Clinical Commissioning Group, Oxford Health NHS Foundation Trust (the local provider of mental health services), have put together a comprehensive action plan - sent separately to the shared learning co-ordinator. This includes a number of steps which will align operational practice more closely with the relevant NICE guidelines, including a separate room to be made available in A&E for the discussion of sensitive matters; and the reinforcement of arrangements around consent.
Key learning points
I think the interesting points here are:
- You don't need to be doing a massive research project (or be a massive organisation with lots of funding) to make good use of the NICE guidelines;
- NICE guidelines are not just for medical professionals and clinicians, we as a lay organisation have found them invaluable and have made good use of them
- You can talk to patients about the application of NICE guidelines - in all sorts of areas - even highly sensitive ones
- The NICE guidelines provide an invaluable framework for structuring thinking and one that is widely accepted and has high levels of credibility across the health system - which is invaluable when coming from a lay organisation.
I hope that even though this project is relatively small scale, it provides a good illustration of the diversity of ways in with NICE guidelines can be used to drive improvement at all levels in the system - starting with a single user voice.