Patient Information: Setting up a new service

1. Patient Information: Setting up a new service Pitfalls & Pluses • Paul Stevenson

2. Our Service

3. Signposting • We do not produce new material. • Signpost patients to appropriate existing high quality services and information. • Advice staff who are producing specific internal patient information leaflets and products.

4. Quality Assured Information • Certified source : Information Standard • Assess using tool such as DISCERN (www.discern.org.uk) • Discuss with specific healthcare professionals

5. How do we deliver the service • Web Site • Telephone • Email • In Person • Work with wider community • Work with internal staff

6. Web Site

7. We link to a lot of existing material

8. USP - Localisation

9. Access Routes • Web Site is getting approximately 2,000 hits per month. • Difficulty in measuring what that actually means, or the impact . • Far more email enquiries than telephone or in person enquiries. (approx 80% by email) • Direct enquiry levels are still lower than we anticipated: approx 8 per month.

10. Why Offer Face to Face and Telephone Enquiries • We can spend longer with patients. Clinicians and GPs often do not have sufficient time to discuss in depth. • Often not the patient but relative or carer who wants the information. • Often enquiry is prior to contact with a healthcare professional.

11. Book Stock • Fast Facts Series • BMA : Understanding/ Family Doctor series • Medical Dictionary/Encyclopaedia • Good basic visual physiology and anatomy text

12. Setting Up The Service – Reflections • Objectives and Aims “We need a patient information Service” • Difficult to get exact measurable objectives from Executives. • Cost savings through reducing re-admissions. • Supporting long-term condition pathway.

13. Limitations we knew about in advance • BudgetA few thousand pounds. • Limited scope for what service can do. • Location Within current healthcare library • Limited patient footfall or ‘drop in’ opportunities • StaffingOne full time member of staff • Limited outreach and community involvement work • Patient Information StrategyI wrote one • Lacked clear specific objectives or outcomes • IT NHS block on social media and advanced web functions.

14. Enquiries – What we Expected • General enquiries about specific conditions & treatments • The kind of thing that’s on NHS Choices:

15. Enquiries – What we Actually Get • More orientated to local service provision: “I’m claustrophobic, is your MRI scanner enclosed or open?”

16. Layers of Enquiry • Patient has bladder weakness • Asked for information on “exercise at home” as unable to go far or do vigorous exercise without incontinence issues. • Actually wanted information about dealing with incontinence

17. Active Listening • Sometimes people just want to be listened too…

18. Set Boundaries Explicitly document what is expected of the service. Will you give information that differs from local practice? • i.e. Give details of a drug that is prohibitively expensive. • i.e. Give details of a surgical technique that is not used in the local hospital • i.e. Give details of off-label drug use such as Avastin for AMD • Code of Conduct / Professional Standards • Is it OK to accept gifts of thanks ; or start friendships with patients ? • What support should staff expect to be in place for them? www.rcpsych.ac.uk/pdf/General%20-201.45%20Staff%20%20Patient%20Boundaries%20%20Relationships_Ashen%20Hill%20East%20Sussex.pdf

19. Setting Boundaries • Enquiry – woman wanted details of local private options for abortion. • Was her 20th abortion , used as method of birth control. How do you best answer this enquiry? • Do you supply the details requested • Give information on alternative methods of birth control • Is this a safeguarding adults issue – is there possibly an abusive scenario here? Do your staff know there responsibility for safeguarding adults/children?

20. Setting Boundaries • Enquiry –man wants details of European countries that offer euthanasia. How do you best answer this enquiry? • Do you give the information requested ? • Do you give information on palliative care and end of life planning ? • Do you refuse to answer the enquiry stating referral to more expert healthcare professionals is needed ? • Counselling • End of life /Palliative care team

21. Set Boundaries Explicitly document what is expected of the service. • Information –vs- advice • What depth • Will you clarify the meaning in statistical data? • Will you supply journal article/research level information? • At what point do you ‘refer’ to other services , what is the referral process?

22. Good Governance • Record patient enquiries • Useful for service evaluation • Evidence in any legal proceedings • NHSLA • Standard operational Procedures (SOP) & Guidelines • Protects & supports staff delivering the service • Indicates the level of service expected • Gives patients consistency of service

23. What worked • Email enquiries • Specific Focus on local information and support • Patient Information prescriptions & Integration with care-pathways • Starting small and gradually growing

24. What we would do differently • Establish clear objectives & outcomes • Identify physical location that is prominent and easily accessible to patients. • Have SOP and guidelines in place prior to service starting. • Ensure staff delivering service are confident and have opportunities for training .

25. Further Information • Contact me if you have any questions or want to visit • Paul.Stevenson@anhst.nhs.uk