A review of Bradford District Care Foundation Trust’s (BDCFT) Patient and Public Involvement (PPI) Strategy revealed the need for stronger leadership at senior levels of the organisation to drive forward PPI, and enable a more coherent, mainstreamed approach to community engagement - rather than volunteering, expert patients, membership etc all being seen as separate activities which were somewhat peripheral to the main business of the organisation.
BDCFT has now developed a strategy led by the Deputy CEO to implement the review recommendations and make community engagement central to everything it does. This is in line with recommendation 1.1 of the NICE guideline NG44 on Community engagement: improving health and wellbeing and reducing health inequalities, which sets out the overarching principles of good practice and emphasises the importance of joint working between local communities, community and voluntary sector organisations and statutory services.
Aims & Objectives
Our aim in reviewing BDCFT’s involvement work was to assess how effective this was currently in order to plan how to take it forward in the future so that it is in line with NICE guidance. The guidance recommends local communities, community and voluntary sector organisations and statutory services working together to plan, design, develop, deliver and evaluate health and wellbeing initiatives.
In April 2011 Bradford District Care Trust merged with Bradford and Airedale Community Health Services and expanded its provision of Mental Health and Learning Disability Services to also include Health Visiting, School Nursing, District Nursing and other community services to the population of Bradford, Airedale, Wharfedale and Craven.
Following the merger the Patient Experience Team and Equality Lead undertook an internal review around what worked well, what needed to improve what could be done differently this resulted in the equality element moving under the HR directorate, and the decision to commission an external review into the PPI element.
This review of PP was intended to enable the Trust to meet its aims of ‘working in partnership across diverse communities’ and ‘achieving excellence in service user experience’. It was anticipated that some job descriptions and reporting mechanisms would need to change as the result of the review but these were not seen as major barriers.
The methods used to conduct the review were:
• A review of documentation (in particular the Trust’s PPI Strategy ‘Involving You’).
• Interviews with key managers and officers employed by the trust
• Workshops for service users and their carers Since then BDCFT has acted on the recommendations from the review with the Deputy Chief Executive leading a two year programme of work focused on three key areas identified in the review: improving the experience of involvement, agreeing a set of metrics to capture that experience, and building relationships with key partners.
Examples of actions taken include:
• Rolling out an expanded version of the ‘family and friends’ survey.
• Appointing a member of staff to focus on improving and gathering metrics re PPI across the Trust.
• Setting up ‘listening panels’ with real time patient involvement.
• Volunteering policy has been reviewed and a member of staff has had her role enhanced from managing one volunteer programme to developing volunteering in a more coordinated way across the Trust with the possibility of including accreditation in the future.
All activity relating to community engagement is reported to the You and Your Care Strategic Reference Group chaired by the Deputy CEO which in turn reports to the Trust Board. It takes time to change organisational culture and senior leadership plus some resource commitment is needed.
The external review cost just over £7K, and there are costs in time for staff at various levels to participate in the new infrastructure for PPI, but this has now become part of organisational culture, progress has been encouraging and a new approach to monitoring and metrics is enabling this to be measured.
A database has been developed to record and coordinate involvement activity across the organisation. Over 100 service users, patients and carers are now registered on the database. Details are centrally collated ensuring everyone has an opportunity to use their skills in the most appropriate way. Services can access this resource when they want to engage and involve people in specific activities.
Results and evaluation
The main results have been:
• Development of the Involvement and Engagement Strategy in partnership with staff, service users, carers and involvement leads.
• Reward and recognition of service users and carers who give their time and expertise is now recognised as good practice. Significant changes to payment for time have been implemented. This includes payment of the Living Wage for those 25 years old and over.
• The Trust-Wide Involvement Group has been reviewed and Involvement Leads have been identified across 60 services. They are responsible for engaging service users and carers to work alongside them on involvement in local areas. Attendance at TWIG has significantly increased (30+ at meetings) with high levels of motivation and enthusiasm for the work involved, and improved engagement of service users.
• A scoping exercise, meeting with Involvement Leads from each service area, is underway to understand involvement practice across services.
• The NHS Trust Development Authority Patient Experience Development Framework has been used to benchmark practice within the organisation.
• Localities have set up ‘People’s Panels’ to engage service users and carers in developing services.
• Based on feedback from service users and carers, a Task and Finish Group has been set up to improve service user and carer representation on recruitment panels.
• The Introduction to Involvement Network has been transformed and has developed a training package to support service users and carers who wish to be involved in Trust activities.
• The Carers in Action group has changed its format with the aim of increasing its membership and providing support for carers. They have been involved in co designing a Carers Hub which opened in March 2016
• Volunteering, health champions and health trainers now all come under one manager, enabling better coordination of activities.
A ‘comments campervan’ has recently travelled across the district to engage over 100 service users, carers and members of the public. 17 sites were visited throughout the project, over 100 people got on board and more than 5 hours of footage was captured. Key themes include: communication, staff attitudes and access to services and appointments. Young people especially expressed the need for good communication in creative and interactive ways. Directorates are using the footage to inform induction, share learning and put action plans in place to address the issues raised.
Key learning points
Leadership has been key, as has a culture change in which the Trust moves towards a position where all staff see PPI as part of how they work, rather than something that a few specific (generally junior) staff do. Times are challenging across the NHS as financial pressures combine with ever mounting demand, and maintaining and developing PPI needs high level commitment.
Engagement with young people continues to be a challenge and there is work ongoing to look at how best to engage using a variety of social media tools. Services specifically for young people need to develop unique ways of involving them and capturing their feedback, both at local level and working with partner agencies. An engagement event with children and young people has been held to develop a children’s strategy.
The argument needs to be made continually that mainstreaming PPI is not just a different way of operating, but a better one which helps ensure services are provided in ways that work best for patients and their carers and which are enhanced by the contribution of users, carers and the public
The review was undertaken by Health Together at Leeds Beckett University and funded by BDCFT. Health Together worked with a local voluntary organisation to include service users.