Putting people First

1. Putting people First Lance Gardner MBE Development Manager: Citizen Involvement The NHS Leadership Centre

2. Involving the public & patients in healthcare • Why:should we want to involve patients? • When: should we involve them? • How: do we involve them effectively? • Where: is the right environment to do this? • What: are the best methods to achieve this?

3. “Frontline staff within the NHS must embrace change on an unprecedented scale if we are not to lose the publics’ commitment to the NHS”Alan Milburn, Secretary of State for Health, January 2002.

4. “there is no such thing as an in-appropriate request –only an in-appropriate response”

5. The Commission for Patient & Public Involvement in Health • Advise the S.o.S. on arrangements for public involvement and consultation on health • Assist patients forums, facilitate their activities • Assist providers of independent advocacy • Set standards for patients forums and ICAS • Report any concerns about services/professionals to relevant bodies • Must exercise its functions according to areas of PCT’s

6. Patients Forums • To be in established each NHS Trust • Monitor & review services • Obtain the views of patients & carers • Provide advice, make reports and recommendations • Provide information to the public • Inspect premises without prior notice

7. Other aspects of Bill pertaining to Public Involvement • CHC’s abolished [?when] • ACHCEW abolished • All public involvement personnel employed by Commission • The Commission is not ‘an agent of the Crown’ • Local Voices based in PCT’s but employed by Commission

9. NHS Hierarchy ICU Theatre WARDS Out-patients Primary care

10. Public Partnership community Primary Care/OPD in - patient Theatre ICU

11. Putting People first Citizens Visitors Guests Patients

12. “World Health Organisations Declarations of Intent are based on the foundation that it is a basic human right for an individual to self determine their health and health care.”[Declaration of Geneva, et al]

13. What’s in it for the Public? • Knowledge • Confidence • Self-esteem • Sense of importance • Sense of ownership • ?Better health

14. “There now needs to be a shift in emphasis from one of consumerism to one of participatory democracy. The modern relationship between the NHS and patients cannot be purely based on patients as consumers. Instead it must be based on patients as citizens. This should be seen as providing an opportunity for the NHS – and those working in it - and not a threat.” [Excerpt from S.o.S. IPPR address June 2001]

15. What’s in it for the Staff? • Education • Support • Validation • Trust • Respect • Job satisfaction • ?safety

16. From Passive recipients to Active Participants

17. What Every Trust Can Do • Mapping current activity • Developing a patient involvement strategy • Creating a strategy for volunteers • ‘walking the floor’ • patients on interview panels. • Effective PAL’s

18. Conclusions • Value your relationships – they are priceless • You may find support from unlikely places • Management & leadership are not the same • Natural teams often work better than carefully selected ones • Your natural allies are your patients not your peers • Public innovation needs to evolve in its own time

19. Bombay Hospital Mission Statement “A patient is the most important person in our Hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our Hospital, he is part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so.” Mahatma Gandhi

21. When in doubt,seek forgiveness not pernmission

22. Civic Entrepreneurs • Networkers • Risk takers • Difficult to manage • Poor managers • Difficult personal history • Very stubborn • Have a particular value structure • Talk too much!

23. Civic Entrepeneurs “Civic entrepeneurs understand that they need to develop the cabability, skills and knowledge of the people around them and generate greater capacity… that this is the amount of effective resources available to achieve their objectives”. Charles Leadbeater

24. “We learn more from failure than we do from success”

25. What is in it for the NHS? • Confidence • Trust • Less dependence • Votes • support • Ownership

26. A new kind of Care • Called a care centre • Community care not practice list centred • More social networks than health ones • A governing body • The ‘Partnership’ with the black economy

27. Commissioning for Wellbeing 3 comparative studies • West Manchester PCT • Langworthy/Seedley - Salford • Daruzzaman Care Centre - Salford

28. What does it look like? • School governor model • Delegated budgets - PMS - PCT -City Council • New accountability frameworks

29. D.C.C. Board • 8 patients • 2 team members • 1 PCT member • 2 Councillors • Co-opted members • A Lay Chair

30. What’s in it for the Trusts • Greater understanding • Reassurance • Support • Assistance with targets • Political protection • A Mandate

31. There are 3 potential levels of interaction: Level 1 Undiscussable undiscussability“Problems, what problems?……….with me, with us, with our process”Level 2Discussing UndiscussabilityThere are problems –I/we are struggling to say what I am/we are thinking and feeling”Level 3Everything is Discussable“We clarify and resolve problems……..together![Bob Sang Sept 2001]