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Patient Experience
Priority 5: Service User and Carer experience
The Director of Nursing commissioned Leeds Beckett University to undertake a review of patient experience.
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Overview of current status
Underpinning the review are statutory and non-statutory measures and includes engagement with other agencies like Care Opinion, Healthwatch, research / guidelines (publications) and good practice from other healthcare organisations.
The review has included
• More than 30 interviews of senior and middle level managers
• Engagement with service users
• Case study interviews with staff in areas where good examples of patient feedback activities were identified • Engagement with staff including frontline staff at Divisional Quality Forums and
Governance groups
• Interviewing Executive members, Chair,
CCG staff, Governance staff, Informatics and Divisional and Clinical Directors
The review is in the final phase with reviewers completing planned engagement with staff identified at the Acute Quality Forum on Wednesday 7th October 2020. The final report is anticipated at the end of October 2020.
Preliminary Findings
• Managers and staff have different views of what is happening around patient experience, although there are good examples of patient experience activities
• Patient involvement has a good reputation
• Patient experience is not integrated with patient involvement
• The Trust recognises the value of patient and carer experience but there is a lack of clarity about integrating experience
• A clear model or framework is needed to collect and analyse patient experience information
Recommendations to include;
• Integration of experience and involvement
• Triangulation of patient, carer and staff feedback
• Executive champion to provide leadership and consistency
• Emphasis on data capture and analysis
• Invest in people with lived experience
The Side by Side Network
The Network was started in the Spring 2016 by Beverley Chipp and Cerdic Hall, co-producing with a group of founder members who are still with the Practice Based Advisory Committee, which is representative of the wider network.
The purpose of the group:
• To be a voice for mental health service users of the Trust and increase coproduction with professionals within the Trust.
• To distribute information to our network on relevant subjects
• To feed into the Practice-Based Advisory
Committee and provide a pool of lived experience
• To reach beyond the “usual suspects” of service user involvement and be the voice of those who do not have a regular connection with the Trust but who have a mental health diagnosis. The Network aims to bring in people who might not be able to get to meetings, or who live in Kingston which is an impractical distance from St Pancras.
• The Network is service user-led, and in meetings it works by consensus.
Goals and achievements
• The Network has a good relationship with the Community Division and staff from
Primary Care Mental Health teams in both boroughs attend meetings.
• There are connections with many outside organisations.
• The Network would like to increase membership, and to monitor diversity in membership. A questionnaire on bullying has been developed, which will be rolled out to explore the extent of the issue, rather than to take up individual cases, after it was raised as a problem.
• The Network would like to develop closer relationships with the research teams at the
Trust
The Network does not meet regularly in person but is email-based. Members of the Network report into the Practice-Based Advisory Committee, which meets monthly.
Examples of activities over the last year
• Members have collaborated with staff to draft literature designed for service users leaflet about services, surveys, letters and information sheets
• Advice on writing role descriptions for user involvement with staff and distributed opportunities to the Network mailing list, including service user involvement and research involvements with other organisations
• The research opportunities from other organisations have been good, and many offered training in such things as interviewing or thematic analysis and upskilled the bank of service users.
• COVID-19 changes; After it became clear that remote meetings were costing several service users a significant amount in data costs, (not everyone has broadband at home and connect using a PAYG smartphone), the Network proposed an increase in reward and recognition rate of £5 per meeting allowance for data costs, which was granted by the Trust Service User
Alliance meeting in July 2020.
• Health and equalities for inpatients; The
Network became aware that service users
who were vegan on the wards were poorly-served by limited menu options. Through the Pancras User Forum, this was raised with the Contract Manager who arranged for the range of vegan meals to be increased. This improved the diet of not only vegans, but expanded the range of options suitable for many minorities who do not eat beef or pork, or who have halal or kosher diets.
• Lockdown made us realise that the extent of digital exclusion was far greater and more diverse than we had known. Technical and digital support for service users who were struggling to stay in contact with both service user groups and meetings with staff has been a constant activity since April 2020.
• The introduction of MS Teams by the Trust created a more unequal platform for Network involvement as without an NHS email address Network members attend only as guests, and are not able to see the channels and files shared, sometimes not able to raise a hand and have a more limited range of the Teams features, compared to staff. This is a new structural inequality in terms of co-production.
• The Network contributed to the Digital Consultation Working Group survey on digital consultations and star of the year nominations.
EXPANDING THE PEER WORKFORCE
Priority 6:
Excellent service - really helped me focus on my needs - I couldn’t ask for a better coach
The aim of the Peer Coaching Service is to support the development of each client’s sense of health and wellbeing and their ability to self-manage their long-term conditions by working in partnership across service and organisational systems to deliver personalised and inclusive care and support by:
• Empowering and motivating people to be able to take more control in choosing their support by providing coaching, facilitation and information
• Respectfully exploring goals and challenges for clients experiencing or at risk of experiencing a combination of mental and physical health issues
• Providing a non-judgemental and safe space for clients to develop and operationalize their recovery plans and improve their wellbeing
• Utilising a diverse range of examples of recovery, as illustrated by the lived and working experience of the team
The Peer Coaching Service aims to promote and sustain organisational and systemic improvement to service delivery through:
• Working towards the development of an asset-based, peer-led culture by promoting high-quality peer working through collaborative training, education and development with other peer working providers and groups
• Developing a peer coaching cadre for transition into employment in positions throughout the trust as they arise.
• To assist the development of standards of practice related to peer working recruitment, retention and service provision.
Service History
The Choice and Control Peer Coaching Service (CCPCS) has undergone rapid expansion and development during the three years of its operation. It has collaborated with the Trust, CCG, third sector and councils to develop its methods and reach other partners to improve the quality of its training and support infrastructure.
Key Points
• The CCPCS has developed its work through delivering high volumes of contact with relevant clients.
• The CCPCS is well-placed to work with key populations in a manner that meets multiple strategic agendas simultaneously
• CCPS has developed a high-quality coaching approach, facilitatory style and flexible approach that is engaging clients well and impacting on their wellbeing
• The CCPCS has been a leader in the development of local Peer Working initiatives including a Peer Involvement
Network and training programme.
Choice and Control Peer Coaching Service 2019/2020
Referral reporting
Referrals Monthly average Clients seen
236 19 203 Client contacts 1,100 Average sessions for completers 8 Clients currently open 127 SMI clients 11%
Primary care remains the key location for the work of the team, with the largest referrer being General Practitioners with 46% of all referrals coming from this group. Organisationally, GPs were the largest referrer with nurses from physical and mental health specialities referring regularly along with local social prescribing navigators.
There is a high degree of satisfaction with the model. Clients appreciate the flexibility of location and timings of sessions. The activity of the team includes benefits support, linking with employment and volunteering opportunities, advocacy and promoting self-management of conditions. They also promoted physical activity, helped clients challenge loneliness and promoted social prescribing. Crisis planning and drawing together overall care plans was a feature of peer coaching activity.
I feel as if I have a future now. Several things I’m thinking of doing feel more possible
In terms of the impact, the high ranking of the service indicates an ability to link clients up with support, help them self-manage better, assist them to find the right supports, get connected socially and to do this while feeling emotionally supported.
My Peer Coach was very helpful. I feel a lot better now. She didn’t tell me what to do. She made me want to change things for myself. I look forwarded to her visit.
Collaborations
The Peer Involvement Network
The Choice and Control Team have provided leadership and input into the development of the Peer Involvement Network, a local forum of statutory and non-statutory organisations utilising peer workers that seeks to promote consistent quality of peer working, shared understandings and responses to challenges and more integration across systems.
Talk for Health Peer Coach Training Programme and Taster groups: Training collaboration with third sector organisation, 18 out of 24 Talk for Health participants have gone on to become Peer Coaches.
Won a small Catalyst Grant to deliver Talk for Health Taster groups to those of our clients who have completed sessions with Peer Coaches but remain socially-isolated. Peer Coaches continue to facilitate Talk for Health group sessions.
Primrose A programme in Camden: The Choice and Control Team has been commissioned to assist a trial of the GP-based Primrose A programme in three GP practices in Camden. The model combines Practice Nursing Coaching with Peer Coaching support for clients who are listed by GPs as having SMI and Peer Coaches have delivered more than 60 sessions to clients. Became a partner organisation with Help on Your Doorstep (HOYD). Ease of referrals has led to an increase in referrals from them. Increased use of HOYD for navigation service Primary Care Network in house Peer Coach role development: The team has worked with the North Islington PCN to develop and recruit to a Health and Wellbeing Peer Coach role that will work directly with those practices to meet the need of complex clients.
Successful expression of interest bid to work with HEE to deliver a trailblazer training programme; The team will be replicating its training as part of a wider Health Education England programme of expanding the training capacity of Trusts to consistently prepare Peer Workers.
Coproduction activity
• Two improvement days with ex-clients of the service were held during the year. A variety of service design suggestions have been operationalised in response to these including the Talk for Health cafes.
• Had our service leaflet rewritten with help from service clients.
• Created several short films of Peer Coach interviews that are available on the Trust’s
YouTube channel.
• We have been actively involved in QI initiatives in the Trust, and presented to STP
QI group on Coproduction, July 2019.
• Currently working with the QI team to develop an operational manual and programme of improvement activities.
Investment
• The Peer Coaching Team has received investment from the Trust to set up an office space. That space is being shared with the Nubian Users Forum, Islington
Community Mental Health Team, and
Recovery College.
• The Trust also increased its investment in the team leading to the development of trial
Band 5 Senior Peer Coaching roles.
• The team delivered over the commissioned expectation, providing over 1,000 home visits to more than 200 clients.
• Apart from its core work, the team has also been active this year with the following programmes: -
• Provided a key pillar of the Primrose Project, delivering Peer Coaching to SMI clients who were also receiving extra input from
GP Practices in Camden. This pilot ran in 3
Kentish Town GP Practices and is currently being evaluated.
• Completed welfare checks, triaging and referral to the Resilience Network initiative in Camden from selected GPs as part of a pilot that is now being rolled out across
Camden
• During COVID-19, Peer Coaches worked across localities to support teams to manage with less staff, to reach out to vulnerable clients and to link people with practical supports during lockdown.
