Patient Experience and Engagement Forum

19th March 2014, Conference Room 1, Education Centre, Homerton University Hospital

Present: Sheila Adam, Chief Nurse (Joint Chair) (SA) Daniel Waldron, Director of Transformation (Joint Chair) (DW) Rosemary Jawara, CCG PPI representative (RJ) Liz Hughes, Healthwatch representative (LH) Jude Williams, Governor (JW) Talaat Quershi, Governor (TQ) Stuart Maxwell, Governor (SM) Suri Freidman, Governor/ Orthodox Jewish advocate (SF) Lesley Rogers, Head of Healthcare compliance (LR) Sarah Webb, Head of Nursing, CSDO (SW) Joan Douglas, Head of Midwifery (JD) Sharon Roberts, Patient Experience lead ITU (SR) Stella Timms, Ward Sisters/ Charge Nurses/ representative (ST) Lynne de Castro Arenas, Ward Sisters/ Charge Nurses/ representative (LCA) Ruth Stocks, Ward Sisters/ Charge Nurses/ representative (RS) Marion Rabinowitz, Orthodox Jewish advocate (MR) Hilda Walsh, Head of Locomotor Service (HW) Angela Holm, Community Matron/ District Nurse (AH) Louise Egan, Head of Nursing/ IMRS (LE) Debbie James, Head of Outpatients (DJ)

1 Margaret Howat, Head of Patient Experience (MH) Karen Gordon, Head of Quality (KG) Adrian Laugee, Facilities information & Monitoring Manager (AL) Sally Shaw, Head of Advocacy and Children’s Therapy Services (SS) Fiona Breen, Service Manager, SWSH (FB) Iyabo Aderotimi, Reception staff lead (IA) Robin Pfaff, Chaplaincy Team Leader (RP) Kim Boakye, Patient Experience and Engagement Coordinator (Patient (KB) Information and PALS) Margaret Bingham-Crisp, Staff Experience Lead (MBC) Lucas Daly, Senior Project Manager, Picker Institute Europe (LD)

Minutes: Cindy Hall, Patient Experience Co-ordinator (CH)

1. Welcome

Sheila Adam welcomed the members of the forum and introduced the morning presentations and discussions on the National Inpatient Survey for 2013, presentation of results for the Homerton 2013. This session would be followed by the introduction of the Patient Experience and Engagement Strategy.

2. Apologies for absence

Tracy Fletcher, Dylan Jones, Vanessa Cook, Iain Patterson, Janice Kelly, Mark Purcell, Jaime Bishop and Lesley Haines provided apologies for the meeting.

3. Minutes from previous meeting and matters arising

There were no previous minutes discussed at this meeting.

4. Terms of Reference: Patient Experience and Engagement Forum – setting the framework Sheila Adam

There have been many important reports recently to review and digest recently both nationally and locally such as the Mid Staffordshire Public Enquiry, Keogh Mortality Review, the Healthwatch Hackney and the Inpatient Survey. So the question is ‘What are we going to do about it?’ Moving ahead in context with this requires a different approach

2 and a re-styled governance structure has been developed for the Trust. This will include an Improving patient Safety Committee chaired by SA, Improving Clinical Effectiveness Committee, chaired by Dr John Coakley, Improving Patient Experience chaired by SA and DW as well as the Improving Education and Leadership chaired by DW. These groups will report into the Quality & Patient Safety Board chaired by Tracy Fletcher and this board will report directly to the Board of Directors.

The Patient Experience Strategy needed to be reviewed and a new more inclusive approach taken to improving patient experience. This will consist of a quarterly patient experience stakeholder forum to guide the work on patient experience with a monthly delivery group to carry out that work. The stakeholder forum agenda will inform, drive and monitor key components of the patient experience agenda. In addition there will be use of other sources of feedback such as the inpatient surveys, Healthwatch reports and frequent feedback. Information from CQC visits will also be included. The most recent acute hospital inspection from the CQC provided initial feedback on the acute site visit that the Trust is responsive and well led.

5. National Inpatient Survey 2013: presentation of the Homerton results

LD presented the Homerton results. The methodology of the survey stays the same each year to allow for comparisons. The baseline number of patients required is 850 at age 16+; it is a postal survey with the use of a Freephone language line.

The response rate for the Homerton was 30% with the national average being 46%.The presentation looks only at the Homerton results compared to the other 76 Trusts who use Picker to administer the survey. In April the CQC will publish the results for all Trusts in England. The responses are adjusted and standardised which allows Trusts across England to compare what patients are saying. This allows for the fact be Homerton has a younger demographic that tend to respond less favourably and also accounts in part for the low response rate.

The survey asks question asked under eight category headings. Lower scores are better. Overall 63% of people rated care as 7+ out of 10 with 88% saying they always had enough privacy when being examined and treated.

In the first section Admission to Hospital there were no significant changes since the 2012 results.

In the Hospital and Ward section, the Trust was worse than average on eleven questions. The Trust was significantly worse on the question regarding ‘shared sleeping area with opposite sex’ with an average of 17% compared to other Trusts with an average of 8%.

In the Doctors section three questions are significantly worse than average. The patient perception being that Doctors didn’t always provide clear answers to questions. The Trust scored 40% compared to a national average of 30%, ‘that patients did not always have confidence and Trust’, 26% for the Trust and on the national average 19%. For Doctors talking in front of patients as if they weren’t there 32% for the Trust and 24% for the national average.

3 In the ‘Doctors by Speciality’ section the Trust average for the patient ‘not always having confidence and trust’ and ‘being talked in front of as if they weren’t there’ 26% and 32% respectively. The figures for General Medicine and General Surgery are at 27% and 36% respectively.

The Trust is significantly worse than average on four questions in the Nurses section. These relate to ‘did not always get clear answers to questions’ for the Trust 47% and the national average 31%; ‘did not always have confidence and trust’ Trust 39% national average 24%; that nurses ‘talked in front of patients as if they weren’t there’ Trust 30% and national average 19%. The question ‘Nurse sometimes, rarely or never enough on duty’ for the Trust 53% and the national average 41%.

For the area of Nurses by Speciality the Trust the question for nurses: ‘did not always have confidence and trust’ the Trust average was 39%, for General Medicine it was 35% and General Surgery 46%. The second question for this area was nurses:’ talked in front of patients as if they weren’t there’ the trust average was 30% with General Medicine 35% and General Surgery 25%.

Care and Treatments by speciality the Trust was significantly worse than average in seven questions. HW stated that the perception of patients of their pain levels regarding their levels of pain and the demographic is very subjective.

In the section Operations and Procedure the Trust was significantly worse than average on one question which was the ‘surgery risks and benefits not being fully explained’ with the Trust average at 25% and the national average at 17%. By speciality in this area General Medicine came out at 40% and General Surgery 35%.

From the 2012 survey the Trust was significantly worse in eight questions in the Leaving Hospital section. LD stated that the main reason stated for delay in leaving hospital is the wait for medicines. The figures can’t reflect other factors that impact on delays such as if there were more patients in the Trust or less staff available on the ward.

LD went on to express the importance of focusing on the questions that are key to the patients as identified by Picker. Communication with clinical staff, doctors and nurses: these are the essential changes to make.

LH asked if the survey is only available in English and does this affect the response rates? LD said that it was hard to accommodate other languages but there are language sheets and a language line available for patients that want to take part. Seventeen patients used the language line.

RJ mentioned that it was a very detailed presentation and therefore moving forward and allowing for the services to digest the information is essential. LD replied that additional feedback would be available as well as the report to take this forward. DW confirmed that the information will be accessible to staff. SA announced that the Care Quality Commission (CQC) will publish an adjusted version of the Picker results on 8th April 2014. DW affirmed that the Trust will pull together the themes from the Forum and move forward with them.

4 RJ asked about the information from last year’s figures against the national average in order to know about the issues and concerns in driving forward change. DW offered to meet up with RJ to support with this work. SM asked about linking in with Healthwatch comments and the statistical significance of the figures. LD replied that there is a 50% response rate and 5% either side of 45% - 55% so the number has been worked out as statistically significant at 850 for the number of patients to contact as the optimum number for the survey.

6. Patient Experience and Engagement Strategy – Daniel Waldron

Patient Experience over the next five years has the main aim to ensure that all patients have an excellent experience of all our services through providing person-centred care that takes into account each patient’s or service user’s needs concerns and preferences. There are two high level success measures with four main objectives that place, quality, culture, patient experience, the Trust values, information and patient choice at the heart of the strategy.

There are eight elements of Excellent Patient Experience (October 2011). These elements are: respect; coordination and integration; information; communication and education; physical comfort; emotional support; involvement of family and friends; transition and continuity; access to care. DW asked the Forum what they thought comes under the Framework for other communication?

SM believed it was important to include the role of carers, learning disabilities and dementia and how we involve them in terms of patients care and serving the community. DW responded that when the strategy talks of ‘patients’ it is an inclusive term for carers, families and friends and is explained in the full Strategy document. The new patient feedback system will collate information and data from the community areas as well as the acute site. There will be a clear improvement cycle with local benchmarking and best practice to learn from e.g. Guys and St Thomas Hospital though improvements do take time to embed into the culture.

7. Facilitated Workshop: Developing our patient experience strategy and actions Daniel Waldron and Lucas Daly

The feedback from the individual groups has been collated and fed back to Daniel Waldron to be integrated into the reviewed Patient Experience and Engagement Strategy.

8. Any other business

LH said that the final version of the Healthwatch report on the Homerton University Hospital will be circulated once completed.

9. Date and time of next meeting

10:00 – 12:00 18th June 2014 in classroom 4/5, Education Centre, Homerton University Hospital NHS Foundation Trust. Please send any apologies or queries to: Margaret Howat, Head of Patient Experience and Email: [email protected] Tel: 020 8510 7157

5 Summary of Actions points

AP Action(s) For Status 1 National Inpatient Survey 2013: presentation of the SA April Homerton results  The Inpatient survey results will be published on 8th April by the CQC (page 4)

2 National Inpatient Survey 2013: presentation of the DW May Homerton results  Will pull out the themes from the report to move forward with.(page 4)

3 National Inpatient Survey 2013: presentation of the DW Homerton results  DW to support RJ and work through information for the service.(page 4)

4 Patient Experience and Engagement Strategy DW

 Put in ‘patient care’ term and explanation on the front page of the Patient Experience Strategy. (page 4)