Patient & Public Involvement Definition and Objectives - Essay Example

Introduction Patients and public have moral and ethical rights that played a meaningful role in developing healthcare policies. Therefore, involving patients and public in healthcare will be the key in improving the quality of healthcare services. The National Health Services (NHS) Plan recognised the UK Government's clear intention that patients should be the main focus of NHS services. It sees public and patient involvement as a centre to service planning and provision, and a major catalyst for service improvement. The Health and Social Care Act 2001 (section 11) policies are developed to put an obligation on strategic health authorities, primary care trusts and NHS trusts, and makes arrangements to involve and consult patients and the public. One manifestation of these policies is the appointment of Patient Information Strategy Project Manager (PISPM) at the North Devon Primary Care Trust (PCT). North Devon PCT developed a strategy to involve the public and provide multiple services to enhance the understanding of patient needs within the PCT. They also aim to improve the knowledge based from the patients and general publics' opinion. PISPM post's performances have strengths and weaknesses but they also play an important role in leading this strategy. By improving North Devon Information Strategy, value will be added in developing a greater public involvement in North Devon PCT. Patient & Public Involvement Definition Patient & Public involvement and other allied terms are used to covey a variety of meanings. Public involvement refers to the involvement of individual patients, together with health professionals, in making decisions about their own health care (Florin & Dixon 2004). According to the Department of Health, patient and public involvement is not just about structures, it is a cultural change. It is about empowering patients and the public to have a role in health care society. Working, listening and acting upon the views of patients and the public will be the main focus of the members of NHS. Patient & Public Involvement Objectives The involvement of patients, carers and public in health decision-making is the purpose of modernisation of NHS. The NHS ensures that patients are engaged in health policy decision-making to help assure that policies are reflected on patient and caregiver needs, preferences and capabilities. Through these practices, the way to address the needs of the growing number of people with chronic conditions will now be appropriate and effective. Hennessy (2002) pointed out that involving individual encourages and empowers them. The sense of ownership improves health outcomes and patient experiences. On the other hand, the Trusts will also benefit from this involvement. It will provide a more responsive service, which meets the local needs. Involvement in NHS activities encourages staff to consider alternative ways of meeting the care needs and look at providing services from a different perspective which is that of the patients' perspective. Florin & Dixon (2004) indicated that involving the public may help ensure health policy decisions better reflect the values of the community. It will make services more responsive to the individuals and communities who uses them and that more responsive services will lead to improved health. Patient & Public Involvement Policies Policies to encourage public involvement in the NHS are not new. Previous governments have used various policies in an attempt to encourage democratic and informal decisions in the NHS. A review of policies from 1948 to 1997 showed that public involvement in the NHS decreased over this period (Harrison, Milewa and Dowswell 2002). In contrast, Klein & New (1996) reviewed the period from 1990 and concluded that there had been a moderate increase in democracy in the NHS. Since the Labor government came to power in 1997, a new raft of policies has been introduced with the stated aim of increased public or patient involvement. The NHS Plan, published in July 2000, aimed to give the population a health service designed to fit the 21st century patients. It stated that 'The NHS of the 21st century must be responsive to the needs of different groups and individuals within society, and challenge discrimination on the grounds of age, gender, ethnicity, religion, disability and sexuality. The NHS will treat patients as individuals, with respect for their dignity. Patients and citizens will have a greater role in the NHS, and the provision of services will be centred on patients' needs' (Department of Health 2000). New statutory duties were assigned to NHS organisations such as NHS trusts, primary care trusts and strategic health authorities by the "Health and Social Care Act 2001", to make arrangements to involve and consult patients and the public in, planning services they are responsible for; developing and considering proposals for changes in the way those services are provided, and decisions to be made that affect how those services operate. Section 11 places a wider responsibility to involve and consult patients and the public, not just when a major change is proposed, but in the ongoing planning of services, not just when considering a proposal but in developing that proposal; and indecisions that may affect the operation of services. The primary care trusts and NHS trusts obligations are the following; Carry out a baseline assessment of current work arrangements to involve and consult patients and the public. Develop a strategy and planning process to involve patients and the public. Bring together the feedback from the Patient Advice, Liaison Service, Patients' forums, overview and scrutiny committees, complaints and annual patients' survey (Department of Health 2001) This duty has been a legal requirement since January 2003. In February of that year the Department of Health published the policy and practice guidance which is "Strengthening Accountability". These guidelines will help the NHS to carry out the new duty. 'Involving and consulting' has a particular meaning in the context of Section 11. It means discussing ideas, plans, experiences, the services needed to be changed, what they want from services, how to make the best use of resources and other concerns with the patients and the public. It is more about changing attitudes within the NHS and the way the NHS works rather than laying down rules for procedures' (Department of Health 2003). In Autumn of 2003 the Department of Health launched "Choice, Equity and Responsiveness", a national consultation to give staff, patients and the public an opportunity to tell the Government what choices they would like to be able to make about their health and health services. The document, "Building on the Best", summarizes the responses from the "Choice, Equity and Responsiveness" consultation. There are several themes that appear frequently. A theme included in the document is about patients 'Our health needs are personal, and we would like services to be shaped around our needs, instead of us being expected to fit the system.' What the NHS would have to do is to listen to what patients and the public are telling them, follow the right procedures and then act (Department of Health 2003). Patient and Public Involvement in Health: The Evidence for Policy Implementation was published in May 2004 as a summary of the findings from 12 research projects. The findings of the report contributed in an important way to the growing body of evidence that demonstrates the benefits of patient and public involvement (Department of Health 2004). The NHS Improvement Plan: Putting People at the Heart of Public Services was launched in June 2004. It sets out the priorities for the NHS between 2004 and 2008. It also supports the Government's continuing commitment to a 10-year process of reform first set out in the NHS Plan in July 2000. It includes the following statements. 'The next stage in the NHS's journey is to ensure that a drive for responsiveness, convenient and personalized services takes root across the whole NHS and for all patients.' As money, control and responsibility are handed over to local health services, the communities that they serve will be given greater influence over the way that local resources are spent and the way that local services are run.' 'A new spirit of innovation has emerged, centered on improving the personal experience of patients as individuals, and this is now taking root in the NHS.' 'The NHS is set to thrive by meeting the needs of patients and the public' (Department of Health 2004). Public Service Agreement (PSA) is the current 2003 to 2006 target for improving the patients' health care experience. 'Enhance accountability to patients and the public and secure sustained national improvements in patient experience as measured by independently validated surveys' (Department of Health 2003). For 2005 to 2008 the PSA target is as follows. 'Secure sustained national improvements in NHS patient experience by 2008, as measured by independently validated surveys, ensuring that individuals are fully involved in decisions about their healthcare, including choice of provider' (Department of Health 2004). Since the publication of the NHS Plan, there have been some significant developments that have empowered patients and the public to get involved in having a say in the way the health service works and which enable people to have a greater role in their own health. Patient Advisory and Liaison Services to be set up in every NHS trust to provide information and on site-help for patients. An Independent Complaints Advocacy Service provided locally, operating to national standards. Patients forums to be set up in every NHS trust to "bring the patient's perspective" to management decisions. Forums will be able to elect a member to sit on the trust board as a non -executive director. A "voice" to be set up in each strategic health authority area-a professional group acting as a local resource to help communities. The Commission for Patient and Public Involvement in Health is to set standards, provide training, and monitor new arrangements. The Commission for Patient and Public Involvement in Health is responsible for appointing, supporting and providing advice and guidance to PPI forums. It will be abolished as part of the Department of Health's review of arms length bodies. Local authority overview and scrutiny committees, made up of elected councilors, now have powers to scrutinise the NHS. The committees can review any aspect of NHS care locally and call NHS managers to account for their actions and will have the power to refer any potential change to the Secretary of State for Health for a final decision. North Devon Patient & Public Involvement Policy The North Devon PCT is the largest of the four PCTs in North and East Devon Health and Social Care Community. The Trust currently has a 2 Star Performance Rating. The Department of Health awards up to 3 stars based on a range of indicators including access to services, speed and effectiveness of treatment, quality of environment and financial competence. The trust should developed a strategy that aims to ensure that user involvement based in what is placed in the governments' policies. The purpose to all these aspects of trust activities, including planning and delivering of services is to be able to effectively meet the health care needs of the local community. (Attached PPI strategy). Many North Devon healthcare professionals have been involving and consulting patients for years, for example by undertaking patient questionnaires or surveys and working with support groups. But after the governments' policies were implemented, the degree of involvement was extended. Patients and public should be involved and consulted in decision making on how services are run and developed before the trust set up a service or make a change. Patients and public can be involved in helping to shape local health services in North Devon in many ways; 1. Patients can apply to be a member of the Patients Forums. 2. Patients can become a member of the North Devon Primary Care Trust's steering groups that are responsible for planning and monitoring health services 3. Patients can join local "Friends of" group. 4. Patients can join the Expert Patient Programme (EPP). These courses are designed to help patients with long term chronic conditions, such as diabetes or heart diseases improve their quality of life. And 5, Take part in NHS patient surveys as their views really count. North Devon Primary Care Trust and North Devon Healthcare Trust, in partnership with Macmillan Cancer Relief, have a goal to develop a strategy which aims to improve understanding about what information needs are desirable for the people of North Devon in relation to health, health care and supportive services. In addition, identifying how it is best to provide access to this information to people and then move on to implementing a programme to deliver the project is also one of the organisations goals. Health organisations in North Devon are committed to this work and want to be ambitious in this area on behalf of local people. This 3-year programme is funded by Macmillan Cancer Relief to ensure that information about cancer and palliative care and support for people with cancer is available to empower, support and reassure patients and carers. However, the strategy will cover information relating to all health care conditions. They need a qualified post to help in accomplishing this strategy in achieving the plans being stated. The Role of Patient Information Strategy Project Manager Patient Information Strategy Project Manager is a position which is appointed in North Devon PCT to fulfill their strategy objectives. This position will be based at the Primary Care Trust Headquarters in South Molton and will require traveling to partner organizations including North Devon District Hospital, Social Services, North Devon Hospice, Macmillan Cancer Relief, voluntary organizations and patient and public representatives. The post is funded by the Macmillan Cancer Relief as part of its important work to support cancer and palliative care services. Macmillan cancer relief will follow shortly in two years of strategy implementation. The required skills for this post are qualification and training such as degree level study and relevant information & management, excellent communication skills with public, patient and all related services, specific knowledge skills such as project management training/experience, analytical skills, interpersonal and influencing skills, change management skills and team working. It desirable that the person assigned for this position has knowledge in cancer and supportive care, public health and NHS Information Strategy. Experience and knowledge in working with users/carers and wider health service is important to be able to assist and be involved in knowing information requirements. IT literate, ability to work in multi agency/multi professional groups and has evidence of strategic work experience is also important. The following are the duties and responsibilities that a Patient Information Strategy Project Manager has to perform. First is scoping and developing a public/user health information strategy for health, cancer and palliative care services across the healthcare community in North Devon in line with NICE Supportive and Palliative Care Guidance. Second, scope and develop a model for a health and cancer information service in accord with the needs and requirements of potential users and develop a proposal for a center reflecting this model. Third, coordinate with patients, public, health care professionals, service managers and other staff using. If needed, the Macmillan resources' guides are available. Fourth, use existing project work on the PCT's Information Strategy and on cancer Information. Fifth, produce a service specification for the information service including Information requirements, methods of making information available and the nature of the technology and staffing and any location requirements. Furthermore, the Patient Information Strategy Project Manager links directly with social care and other non-health information sources to scope their information availability to be used by health/cancer information users. He/She should report to relevant management groups, the project steering Group and the relevant Local Implementation Group (LIG) and take the lead in collation of current information available for patients looking at quality, clarity and availability, GP surgeries, Internet, NDDH etc. Finally, he/she should outline public/user information, strategy implementation and project plan to facilitate the strategy to go forward, setting initial timetables, draft implementation resources required etc. The following will be the major working relationships and identified Communication channels: Patients, Carers, PALS Service, Cancer Services - Clinical, Nurse Specialists, NDDH Cancer Director, PEC Cancer Lead, Macmillan Cancer Relief, PCT Information Strategy Lead, Public Health Directorate, Library and Information Services, Initial services, North Devon, Choose and Book Lead, PCT and NDDH Managers and Cancer Network and its specific information group. The person assigned as Patient Information Strategy Project Manager should cover an entire patient cancer journey and the wide range of other health information needs. The Projects Strengths The strengths of this project will be attained by accomplishing the NHS policy which is "Meeting public and patients' needs". Listed below are the projects strong points: By fulfilling and making use of the system the quality of care by making information will improve, thus, the service will be faster and easily available to patient. By creating a proposal should operation of service and liaise with patients, public and others related services to develop information strategy to meet the user needs will be improved. The person assigned will be responsible in developing Health and Cancer Information Strategy and accomplish what is coming in NHS Plan (July 2000). Cancer patients services will be given high priority (policy). Any important information that people requires in making decisions and choices about their health or the health of those close to them is readily available. Access to consumer health information will be timely, relevant, linguistically and culturally appropriate. Information is accessible and delivered in a relevant format. The entire patient cancer journey and the wide range of other health information needs will already be covered. Those duties accomplish the upcoming NHS plan which is 'the next stage in the NHS's journey'. It is ensured that a drive for responsive, convenient and personalised services takes root across the whole of the NHS and for all patients. There will be a lot of choices for patients about how, when and where they are treated. It will mean much closer personal attention and support in the community and at home millions of people who have lifetime illnesses such as diabetes, heart disease, or asthma. The Projects Weaknesses The Patient Information Strategy Project Manager is the person who has the overall responsibility for the successful planning and execution of any project like problem solving and judgment. Therefore, the person in-charged should acquire or develop skills such as strong analytical skills, arriving to the root causes of a problem, manipulating data and research evidence, applying sound information gathering and analytical skills to policy problems, lateral thinking that can provide creative solutions to problems and seeks views on policy development and implementation There are also some weak points in the Patient Information Strategy Manager responsibilities: Performing more duties in involving public and patients all throughout the ongoing planning of services. He/She should emphasize the developing of a strategy for involving patients and the public in improving the health care in the Trust. He/she should listen to the patients and publics not only to their information needs but to their opinions and patients experience about the Trust services and the strategy. He/she should have more knowledge in fulfilling the policy guidance in "strengthing accountability" involving patients and the public, NHS plan "putting people at the heart of public services" and all governments' policies that are developed to put a new strategy in giving people an involvement in decision-making in the health services. Patients' views, about their experiences of the North Devon PCT, whether it is positive or negative should be main part in developing the Trust information strategy. Conclusion The benefits of patient and public involvement mean better outcomes of health care. It connotes a better NHS organisations environment, a more modern philosophy on the part of the NHS organizations, increase patient satisfaction, more responsive and cost-effective health care services, and an intensification of public confidence in the services provided by the Trust. By developing strategies, North Devon PCT ensured that users' involvement is the center of all aspects of all Trust activities. As a result of involving the patient and the public in planning and delivery of services, the Trust can now effectively meet the health care needs of the local community. Macmillan Information Project Manager plays an important role in establishing information strategy which aims to identify the information needs for patients and public. Patient and public involvement has been highlighted as one of the Trust key strategic objectives that should be put into practice. They need to ensure that there is a planning process for patient and public involvement that bring together the feedback from the Patient Advice and Liaison service, patients' forums, overview and scrutiny committees, complaints and annual patient's survey. There are three important elements needed in improving patient involvement policy. First is to acknowledge the importance of the involvement of patients and patients' organization in all decision-making. By practicing this, it will give an impact to the patients' lives. Second is to review existing healthcare mechanisms for patient involvement by following the standard guidelines such as NHS plan, talking to patients and the patients' organizations. And third is to revise patient involvement initiatives to follow patient involvement guidelines (IAPO 2005). Dixon (2000) mentioned that the future approaches to improving performance should start from the perspective of patients and not from the perspectives of politicians, managers or professionals, or any other powerful figures of the community. These principles of involving patients as individuals and citizens are important not just from the point of view of openness and accountability. Working effectively in partnership has a major potential benefits for health and health care. The government wants to see patient partnership become integral to the work of every part of the NHS, health authorities, NHS trusts, primary care groups and trusts, general practices and also within the NHS Executive centrally. Responding positively to this ambition and involving patients as equal partners are undoubtedly the key challenges in facing the professions and indeed the NHS as a whole as we move into the new millennium. References Department of Health, 2000. Shifting Gears: Towards a 21st century NHS.< http://www.dh.gov.uk/Consultations/ResponsesToConsultations/ResponsesToConsultationsDocumentSummary/fs/enCONTENT_ID=4082792&chk=GXJtJW >, [accessed 27.03.06]. Department of Health, 2001. The duty to involve and consult - Section 11 of the Health and Social Care Act.< http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/PatientAndPublicInvolvement/InvolvingPatientsPublicHealthcare/InvolvingPatientsPublicHealthcareArticle/fs/enCONTENT_ID=4093411&chk=yKK%2BXg >, [accessed 27.03.06]. Department of Health, 2003. Strengthening accountability - involving patients and the public: policy guidance: section 11 of the health and social care act 2001.< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/enCONTENT_ID=4008005&chk=rVmyFE >, [accessed 29.03.06]. Department of Health, 2004. 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Addenbrooker's NHS trust Harrison, S., Milewa, T. & Dowswell, G..2002 Patient & public involvment in NHS primarycare. Manchester: unviersity of Manchester department of Applied social science. Klein R., & New, B., 1996. Two cheers for democracy. London: King's Fund, 1996. Department of H Read More