Patient Panel 2019-2022

Our Journey So Far..

As I write this, I can hardly believe that the NNUH Patient Panel has now been in operation for more than three years. In some ways it feels like only yesterday and yet in others like we have been around forever!

Introduction by Rosemary Moore - Chair of NNUH Patient Panel

In July 2018 I decided to take a step back from full-time employment and relax for a while, having worked as a practice manager in GP practices locally for 30 years. But it was less than a year later when I saw in the hospital’s Pulse magazine that the Chief Nurse, Prof Nancy Fontaine was looking for volunteers to set up a Patient Panel at NNUH. I thought this sounded like a great opportunity to both give something back to the NHS which I believe in so strongly, and to learn more about the secondary care sector.

After the recruitment process, I was delighted to be appointed Chair and founder member of the Patient Panel and began forming the Panel team in earnest. Sarah Higson, Associate Director of Patient Engagement and Experience was instrumental in helping to set up the Panel and is the main contact point between the Panel and the hospital. We built the panel gradually and we’re now a group of 14 members, hoping to grow to 20 in the future.

The Panel members come from a wide range of backgrounds throughout the public and private sectors. What we all have in common is a desire to make a difference by listening to patients, families, carers and staff and ensuring that their voices are heard and embedded in all service redesign and improvement.

All the panel members are volunteers and give their time freely which I find both impressive and humbling - it is a pleasure and an honour to be their Chair and I have every confidence that as a Panel we will continue to grow and develop in the years ahead. Our Panel members are now supporting improvement projects in many areas and helping to make a real difference. You can read about a selection of the Panel’s projects, all designed to improve the experience of care for our patients and carers, in the following pages.

A big thank you also to Professor Nancy Fontaine, Sarah Higson and her team for all their support and encouragement since our inception. We could not have achieved what we have done to date without their support and encouragement throughout.

Our Patient Panel was launched in August 2019 with the ambition of bringing in direct expertise from patients’ own experience as users of our hospital services to help us improve patient care.

The Patient Panel received a Silver Award in the annual NNUH Staff Awards in 2022. The Award was presented by Roy Clarke, NNUH Chief Finance Officer.

Lilian Hodgson

Colin Jones

Rosemary Moore

Roy Clarke

The Patient Panel is transforming our approach to patient involvement and helping us to improve our services.

We’ve started to build a partnership with patients. They help us by bringing their experience to the forefront and we in turn are open to listening to everything they have to tell us, from straight feedback to ideas and innovations to make our services and processes more patient-centred. We now have a team of people who work alongside our clinical colleagues, and together we are making strides in our ambition to hard-wire co-designing service improvements into the way we work and to embed the patient voice throughout our organisation.

We’ve come a long way in three years. Patient Panel members are embedded in the Trust and are working in partnership with us on many important workstreams. We are now looking to recruit the final few members of the panel to give us more and wider representation. This will help us reach out further to embed the patient voice in improving and designing our services, and to work with Patient Panels in our colleague hospitals in Norfolk and Waveney. We extend a big thank you to all the Patient Panel members for everything they have contributed and achieved at NNUH.

Sarah Higson, Associate Director of Patient Experience Prof Nancy Fontaine, Chief Nurse

An integral part of our improvement journey

Our improvement journey is fundamental to our future and the support we receive from the Patient Panel is an integral part of this journey. The Trust is very lucky to have the support of a group of such knowledgeable and committed selfless individuals who give their own time and work with us to help improve the patient experience. Their views and feedback helped us to write our new Corporate Strategy ‘Caring with PRIDE’ and will help us to deliver the Strategy’s commitments – particularly the first one, the commitment to our patients:

We look forward to many more fruitful months and years ahead of working with the Panel members helping us to improve, become more open and be closer to our community.

“Together, we will develop services so that everyone has the best experience of care and treatment.”

Tom Spink, Interim Chair

Sam Higginson, Chief Executive

How the Panel works..

Each member’s portfolio of involvement activities harnesses their lived experiences, professional knowledge and diverse backgrounds. Our members bring a wealth of this unique mixture which enriches their contribution, the Trust’s and their experience of being partners for improvement.

Members also have links with other patient and carer groups across Norfolk and Waveney, as well as regionally and nationally to share and grow together – supporting each other and professionals alongside to build a strong collective movement of people who are confident and capable of working collaboratively.

Governance chart

The Patient Panel reports into the Patient Engagement and Experience Group (PEEG) which shares updates with the Quality and Safety Committee (Q&S) and the Management Board and ultimately Trust Board. The Patient Panel Chair is a member of both PEEG and Q&S.

NNUH Trust Board

Hospital Management Board

Patient Engagement & Experience Group

Patient Panel Community Groups

Quality & Safety Committee

Carers

Forum

Clinical Support

Services Directorate

Patient Panel

Maternity Voices Group

Patient Panel Chair

Membership

Carers Forum

The Carers Forum is a group which includes unpaid Carers, service users and staff members from a variety of wards and departments in the hospital. It also includes representatives from charities and professional organisations which have links to Carers, for example, Norfolk and Waveney Integrated Care System, Norwich City Council, Carers Matter, Caring Together, Carers Voice and Family Voice.

The Forum meets every other month and is currently chaired by a member of the Patient Experience Team. We aim for future meetings to be co-chaired by Carer members of the group. The agendas for the meetings are all aimed at making changes which improve the experience of unpaid Carers and their Cared-For Person whilst using our hospital.

At NNUH when changes are made, or policies are created to support Carers, the Forum and the hospital work together to co-design this work and projects. This means service improvement can be designed so that it includes the voice of the group potentially being impacted upon, appreciating Carers’ needs and the pressures they face. Carers, and supporting organisations, bring their feedback to the group to foster open and transparent conversations. Teams from across the Trust are invited to present new services and changes to existing services at the Forum to ensure that the Carer community are aware and is a voice to feed back with ideas, concerns or indeed praise.

Projects we have been working on:

• Carer friendly tick - achieved accreditation to raise the profile and have since supported other acute hospitals to do so

• Carer’s policy - full policy written and ratified

• Carer’s survey - carried out survey and now working on actions to improve staff awareness of Carers, education, and acknowledgement of Carer

• Awareness training - collaborative approach with Caring Together

• New Carer identification posters

• Input into new discharge process ensuring that Carers are identified as an integral part of this process

Working across Norfolk and Waveney

In 2021 the Trust, alongside the other acute hospitals in Norfolk, hosted a Carers’ Conference - the Forum members were instrumental in designing the content and supporting at the event. The recommendations from that Conference were for a Norfolk and Waveney-wide Carers’ identification ‘passport’ or card which could be used in a range of health, care and other settings to alert staff to the role of the individual Carer – leading to greater support and help.

A follow-up conference was held in June 2022, led by Norfolk Carers’ charities in partnership with the Clinical Commissioning Group (CCG) and supported by NHS, social care and other system partners.

This conference built on the ideas from 2021 and it was agreed to launch a Carers’ Identity Passport and training package across Norfolk and Waveney in the Autumn of 2022.

Carers are so important with a fundamental role in caring and as a crucial liaison point for wards and clinics. Great efforts are now being made for all departments at the Trust to recognise and respond to Carers, including in emergency care.

The Carers Forum has gone from strength to strength and the group was delighted to see the support from Carers and colleagues across Norfolk and Waveney demonstrated through the joint conference in October 2021.

Barry Capon, NNUH Patient Panel and Carers Forum member

I have found the Forum a great place to freely exchange views and concerns held by Carers. Everyone in the Forum is dedicated to ensuring a stress-free as possible experience for Carers, and by osmosis, the patient, within the hospital.

Paul Stern, Family Voice Norfolk

The Carers Forum always feels like a very open, safe space with time for discussion and collaboration, allowing for the voice of the Carer to be front and foremost. The team work passionately to ensure that Carers are represented and heard in the ever-evolving services within the hospital, which impacts upon both the Carer and their loved ones.

Lucy Thomas, Macmillan Information Manager at NNUH

I find the Carers Forum to be a brilliant opportunity for professionals and Carers to come together. We use the Forum to discuss how best to support Carers, this includes working on promoting the use of the Carer’s passports and addressing the concerns and worries raised by the Carers themselves. It is a very supportive group of people and it helps professionals like myself to hear directly from Carers about how we can improve their experience at the hospital.

Jennifer Woolgrove, Dementia Care Specialist Nurse

Joint acute hospitals’ new consent policy

The James Paget University Hospital (JPUH), the Norfolk and Norwich University Hospitals (NNUH) and the Queen Elizabeth Hospital, King’s Lynn (QEH) have been working together on a shared patient consent policy.

It’s part of the three hospitals’ joint work to ensure consistency in patient care and make it easier for clinical staff who move between sites. Staff from across the three Trusts from different teams developed the new policy which aims to reduce serious incidents and complaints.

Patient representatives were also involved in the process to ensure the policy met their needs.

Dr Bernard Brett, Consultant and Deputy Director of Medicine at NNUH, who chaired the consent policy working group, said:

“It was a real privilege to lead a hard-working, professional team who have come together to deliver the policy which is very different from each organisation’s original version.

“This will provide consistency for patients and staff, reduce risk, improve safety and will reduce unnecessary duplication and therefore improve efficiency. Richard’s, and the other patient representatives’ involvement in developing the new consent policy meant that our discussions felt open and grounded and the insights they contributed made all the difference to the final policy.”

Richard Drew, Deputy Chair of the Patient Panel said:

“As the patient representative and having been involved since the inception of this successful unified Consent Policy I have always been made to feel a full participant in the process. It was engaging and allowed a lot of constructive discussions - a great way to review a policy and achieve clear outcomes”.

Complaints Service Redesign

In July 2021 the formal complaints function joined with the Patient Engagement and Experience Team to sit with PALS (Patient Advice Liaison Service) – forming a new, streamlined PALS and Complaints Team, part of our wider Patient Engagement and Experience department.

To support this move, the Patient Panel formed a sub-group to work in partnership with the new PALS and Complaints Manager and the team, to review the way complaints are managed at the Trust. The aim was to create ‘one front door’ for concerns and complaints and to review and improve the processes for liaising with people raising concerns. It was also important to create a way to peer assess or audit a selection of response letters to ensure they answer concerns clearly, compassionately

Eight Patient Panel members have worked with the new team to:

• Redesign the complaints leaflet and public-facing information to make it easy to understand and more accessible

• Review the process - helping to make it as simple as possible - and to support alignment with the new Parliamentary and Health Service Ombudsman guidelines

• Codesign a survey to enable the collection of feedback on the new process and experience of using the service – to inform further improvements

• Codesign a process for regular review of a number of cases redacted and anonymised to provide lay-person insight into the process and responsiveness as well as structure and content of letters from a non-professional perspective

Amrita Kulkarni, Head of Patient Experience

Sarah Higson, Associate Director for Patient Engagement and Experience

Patient Panel member, Lilian Hodgson, reflects on her experience in the Complaints Sub-Group.

Being admitted as an inpatient into hospital can be one of life’s most stressful encounters for an individual and their loved ones.

As a Patient Panel member I felt compelled to become directly involved from the patient’s standpoint; to help improve the method for dealing with Complaints in a way that re-establishes confidence in the patient especially in the event of their and/or their loved ones future admissions into hospital.

Complaints can arise from a mistake, misunderstanding or miscommunication. It is the personnel in the hospital’s Complaints team who mediate in an objective, factual, honest, respectful and considerate manner.

They check detail on both sides, identify the root cause, and provide explanation, clarification and reassurance in a reply to the complainant in plain and comprehensive language. This is aimed at helping the patient to feel confident in their health and not feel apprehensive or anxious about any future admissions into hospital.

It is pleasing and encouraging to be a member of the Complaints Sub-Group as our contributions and concerns are listened to and valued by the hospital team.

We are working together in unison to ensure that every patient has a beneficial and positive experience whilst in hospital.

Sarah Jane Lynam, PALS and Complaints Manager said:

“Working with the Patient Panel to improve the complaints process has been invaluable because some members have had cause to go through the process personally so bring real, lived experiences to bear as well as their general insights as ‘customers’ of the NHS –they have both challenged and supported us as critical friends which has all helped to improve our process.”

Supporting Cromer and District Hospital

Fred Hayhurst was one of the founding members of the Patient Panel until he stood down in July 2021. Fred advocated to be the Panel’s link to Cromer Hospital as he is a local resident and user of its services from time to time.

Fred had a keen interest in how Cromer Hospital could benefit both local people, holidaymakers and have a wider impact on the whole experience of care for our patients. With a health and safety background, Fred felt able to bring his professional as well as personal insights to bear for the greater good of Cromer Hospital. He was proactive in visiting and meeting with Anita Martins, Matron, to support, provide real-time feedback and ensure Cromer Hospital patients and staff had their voices amplified alongside all who use NNUH.

Anita Martins, Matron at Cromer and District Hospital, said:

“Fred became a Patient Panel member supporting Cromer as his local hospital for over a year. It was a truly sad day when he stepped down from the role. We had a catch up in the diary every month to discuss activity, concerns, progress on building projects etc. He regularly attended the site to undertake walk rounds of the site making suggestions on any improvements talking to staff and patients. He had such a vast knowledge of projects within the Trust and always ensured that Cromer was at the forefront of all discussions. He was always so positive and very engaged in his role.”

Digital Transformation

and

Chris and John lead on digital transformation for the Patient Panel - ensuring a clear voice of patients, visitors and Carers is central to all the developments for NNUH and across Norfolk and Waveney as part of the work around digital inclusion.

Chris

I have been particularly impressed with the Virtual Ward, and how both clinicians and managers have engaged with patients and the Patient Panel. I believe that the Virtual Ward is a real game changer in how patients are discharged and managed from their own homes.

The Trust is on a digital transformation journey, this includes a new Electronic Patient Record system, and electronic document management for many clinical systems in use across the hospital. This will revolutionise how patient records and care are managed and improve patient care and patient outcomes. Combined with I.T. updates across the Trust, improved wi-fi, and better systems, both patients and staff will have improved experiences.

The great thing about all of these projects is that the staff leading this work have been very welcoming and engaging and have listened and taken action on our suggestions.

John

The staff running these projects have been most welcoming and all have a genuine interest in improving patient outcomes. I feel privileged to be part of a team that is able to connect and engage with the hospital professionals and feel that they value our contribution in moving the NHS into a new era.

New ventures for 2022 include contributing to the Shared Care Record (a way of sharing information across system providers so staff have easy access to information they need to treat patients more quickly and efficiently), a Quality Improvement Hub and Academy (all services using the same approach to improving quality with patients at the heart and involved) plus a number of research programmes with UEA as well as continuous support to the digital programme and the Virtual Ward.

Ed Prosser-Snelling, Chief Digital Information Officer at NNUH said:

“John and Chris have been exceptionally supportive to the digital health team, - bringing not only their lived experience of healthcare, but a far wider range of skills and attributes to meetings.

“They have actively campaigned for the digital advancement of the hospital and continue to be an asset to us! The perspective that they bring is unique and we hope that they will be joined by more patients as we seek to co-produce our Electronic Patient Record deployment.”

Chris Hind

John Patman

Clinical Support Services (CSS) - Divisional Patient Panel

Richard Drew, Deputy Chair Patient Panel and Chair of the Clinical Support Services (CSS) Divisional Patient Panel

I feel that it’s a sign of patient involvement becoming embedded at the Trust, that Clinical Support Services wanted to set up its own Patient Panel at the divisional level. Several members of the main Trust Patient Panel are now also part of the CSS Divisional Patient Panel. One of the first things we helped the Division do was to develop their own aspirational vision:

“To establish a representative group of clinical staff with patient and public representatives to identify means of improving the patient experience at NNUH and within Clinical Support Services specifically. Participants will work in partnership to encourage the application of service improvement ideas and represent patients’ interests in areas of development within each of the service areas.”

We were also involved in developing an induction pack for the CSS Patient Panel which was created for use with new staff and managers in the division to highlight the panel and their role in representing and championing the patient voice.

Now we’re supporting the development of the Diagnostic Assessment Centre (DAC) – a joint project for the James Paget, NNUH and the Queen Elizabeth Hospital King’s Lynn where each will have their own DAC. We’re working collaboratively with patient representatives and project managers across the three hospitals to provide input on the look and feel, patient journey, accessibility and sharing information for the new centres.

Other projects include a scheme with pathology trainees using innovative patient engagement for laboratory-based staff who work on patient samples but have no direct patient contact.

Marc Lillystone, Directorate Operational Manager in CSS said:

“I’ve really enjoyed activating our divisional patient group, releasing the leadership to one of our patient representatives and helping to draw in the patient voice and experience. This is alongside encouraging our diverse divisional teams to engage with patient experience and build this into their service improvement and projects.

“We’re on a journey to ensure our group is representative and all our services are actively engaged, but we’re also proud of the priority the patient experience has here and the progress we’ve made as a division so far.”

Working with Medicine Division

- Patient Panel member Caroline Price

As a Patient Panel member, I have had the privilege of being associated with Team Medicine and Divisional Clinical Governance for more than a year. Some of the very important work underway is in falls prevention. This project is both interesting and progressive with the major overall objectives being to reduce the number of patient falls through the implementation of studied ways to improve patient safety and thereby improve patient care. The process is one of continuous quality improvement based on the Plan, Do, Study, Act, (PDSA) design.

Weekly meetings are led by Tanya Moon, the Medical Divisional Nursing Director, with her team of Medical Matrons who are directly involved in hands-on patient care. The previous week is discussed, the number of patient falls reported, associated factors are analysed and the next steps are planned.

There have been some innovative interventions successfully designed to raise awareness amongst all clinical staff, extra training in falls prevention has been undertaken and supporting written information for staff and carers reviewed and redesigned.

A Falls Steering Group has been formed and meets monthly, taking oversight of this project to a higher level, thus a progressive, continuous cycle of improvement is underway.

Another project undertaken by this same group focuses on patient nutrition.

The main objective of this project is to ensure that each patient receives adequate nutrition and hydration in a safe environment during their hospital stay. Meal times are protected, patients receive the appropriate meal tray and are assisted to eat as needed.

Meetings to discuss this project are also weekly, a nutrition steering group has been formed and meets monthly.

It is a multidisciplinary approach with dietetics and rehabilitation departments involved and again, supporting information for patients has been redesigned and updated.

Tanya Moon, Divisional Nursing Director, Medicine said:

“Having Caroline join us with her personal experience as a patient and her professional background as a nurse means that she brings immense value and insight, which is a huge benefit to us.

We feel it’s increasingly important to listen to the patient voice to help us make improvements, and we’re extremely grateful.”

PRIDE Awards - Judith Elsey

I became a member of the Patient Panel in 2020 and a few months later joined the PRIDE awards panel.

The monthly award scheme aims to recognise and reward both teams and individuals who have gone the extra mile and demonstrated our PRIDE Values:

People focused Respect Integrity Dedication Excellence

I am the lay representative on the Awards Panel and meet online with others from various offices of the hospital under the chairmanship of Paul Jones, the Chief People Officer. The other members of the committee are very welcoming and inclusive to me. Nominations are submitted every month for our consideration for being highly commended or, indeed, to win an award.

What l find very inclusive is that, when one thinks of a hospital, one thinks of clinical staff, but we have nominations from right across the spectrum, from ward housekeepers to employees responsible for rota arrangements or travel claim reimbursements, people who are unsung heroes.

I very much enjoy being a member of the PRIDE Panel and believe that any person or team who is nominated is recognised for having an exceptional work ethos and commitment to their colleagues, patients and the hospital itself.

Paul Jones, Chief People Officer, and Chair of the PRIDE Awards panel, said:

“Our PRIDE values are fundamentally important to us and run through our developing culture – the way we work, how we recruit and who we are. This is why these Awards – featuring nominations by both the public and staff - have such a key role in giving staff the recognition they deserve and in supporting our culture.

“Patient Panel involvement in the monthly judging process for these Awards is immensely valuable as it is another way to help us to listen to and prioritise the patient voice. We are very grateful to Judith for taking part.”

Caring with PRIDE

- Rosemary Moore

- corporate strategy

A corporate strategy for any hospital Trust should be a powerful and important document. As Panel members we were delighted to be so closely involved in the design and formulation of the NNUH five-year corporate strategy “Caring with PRIDE”.

Jim Barker, Head of Strategy, attended many Patient Panel meetings between August 2021 and the publication of the document in April 2022 to obtain our input and comments on the design and content of the strategy.

We had some very inclusive and thoughtprovoking discussions, and our ideas and suggestions were listened to at all times. Our focus was on patients and staff to make sure that they were at the centre of the Strategy. We were able to contribute both to the actual wording to ensure simplicity and clarity of message, and also to wider aspirations and goals for the next five years. It was a big piece of work but an enjoyable experience for the Patient Panel. This was a very good example of co-production and co-design in action.

Caring with

five years

Head of Strategy, Jim Barker said:

“It has been more important than ever, for us to take time to build an inclusive and community-focused approach to developing our five-year plan. In the summer we launched a campaign to ask our community for views on healthcare at our hospitals and other services, and to help us develop a plan for the next five years.

“Reaching out across our community has been crucial in shaping our five-year plan “Caring with PRIDE” and the feedback from the Patient Panel was a big help to us. I met with the Panel several times and was very impressed with their commitment and dedication to representing the patient voice and helping us to improve quality in everything that we do.”

Supporting Clinical Strategy development. 1

2

Strengthening links with all NNUH Divisions – building on the learning from different approaches taken within Medicine and CSSD to embed NNUH ‘working together’ approach .

3 Supporting and enabling the development of Patient Safety Partners (people with lived experiences working with NNUH to implement Patient Safety Strategy).

4 5

Supporting ICB and ICS to develop its system wide approach to co-production and partnership working with those with lived experience.

Recruitment drive for early 2023.

If you would like to apply to join the Patient Panel email: patient.experience@nnuh.nhs.uk 6

Further work reaching out into the community to make links with seldom-heard groups.

Liaising with patient panels at other Trusts for networking opportunities.

Dementia Strategy.

Portfolios of Patient Panel members

Current Members Portfolio

Chair

Patient Engagement and Experience Group (PEEG)

Quality & Safety Committee

End of Life Group

Staff recruitment participation

Complaints redesign and monitoring group

Care Assurance visits

Vice Chair

Clinical Support Services Patient Forum – Chair

Patient Engagement and Experience Group (PEEG)

Consent (acute hospitals joint work) – Committee and Task & Finish groups

Staff recruitment participation

Hospital

Infection Control Committee

Complaints redesign and monitoring group

Veterans Group

Patient Led Assessment of the Care Environment (PLACE)

Patient Assessor

Carers’ Forum

Nutrition Steering Group and Task & Finish Groups

Complaints redesign and monitoring group

PRIDE awards group

Clinical Support Services Patient Forum

Digital Health Committees and work streams including Digital Transformation, clinical informatics groups, Personalised Outpatient Programme (POP) / patient Initiated Follow Ups (PIFU) (outpatients redesign) project group, Quality Management Approach initiation across Integrated Care System (ICS)

PRIDE

Rosemary Moore

Richard Drew

Barry Capon

Chris Hind

Dementia strategy group

awards group

Judith Elsey

Current Members

Portfolio

Clinical Support Services Patient Forum

Complaints redesign and monitoring group

Environmental Arts Project Staff recruitment participation

Hospital Infection Control Committee

Personalised Outpatient Programme (POP) / Patient Initiated Follow Ups (PIFU) (outpatients redesign) project group

Complaints redesign and monitoring group

Veterans Group

Care Assurance visits

Patient Led Assessment of the Care Environment (PLACE) Patient Assessor

Digital Health Committees and work streams

Quality Management Approach project (across Integrated Care System (ICS)

Research centre support activities

Virtual Ward

Medicine Division representative role – supporting their Quality Improvement (QI) work

Complaints redesign and monitoring group

Lilian Hodgson

Colin Jones

John Patman

Caroline Price

George Mills

Current Members

Portfolio

Personalised Outpatient Programme (POP) / Patient Initiated Follow Ups (PIFU) (outpatients redesign) project group

Clinical Support Services Patient Forum

Radiology Aged Assets Group

Together Against Cancer (TAC) group

Outpatient Forum

Care Assurance visits

Complex Health Board

Personalised Outpatient Programme (POP) / Patient Initiated Follow Ups (PIFU) (outpatients redesign) project group

Complaints redesign and monitoring group

Care Assurance visits

Thank you to members who have served their time and helped create the Patient Panel….

Health & Safety Committee, Mental health, Cromer link, Veterans Group

Personalised Outpatient Programme (POP) / Patient Initiated Follow Ups (PIFU) (outpatients redesign) project group, Carers’ Forum, Complaints redesign and monitoring group, Care Assurance visits, Clinical Support Services Patient Forum, PRIDE Awards group, DAC review team

And

- Geoff Dorrie, Kevin James, Paul Pacey, Hazel Smith, Serena James

Alan Stephens

Eva Zaprel

Michael James

Judy Tryggvason

Fred Hayhurst