There is nothing more powerful or effective than feedback from a patient
Healthwatch Oxfordshire, the independent consumer watchdog for people using health and social care services in Oxfordshire, engineered and supported no less than 40 key service changes last year. Their core purpose being, to hear the views of local users of health and social care services and ensure their feedback is a benchmark for care quality. Rachel Coney, Chief Executive of Healthwatch Oxfordshire, sat down with us to discuss just how they drive change and why service user involvement is key to service provision success.
Why do you think Healthwatch’s existence is so important in providing quality care?
Our core purpose is to hear the views of local users of health and social care services. To hear from them what’s working and not working, and then to lobby the authorities for change. What makes us unique is our statutory position, meaning the person/organisation in question must respond to us within 30 working days. We can give patients quite a powerful voice at the highest level of policy and strategy making in health and social care – which is quite a powerful position.
We 100% exist to benefit service users and patients, our staff are incredibly highly motivated to make a difference to patients, maybe it’s because we are dealing in local level change, as Healthwatch you are able to lobby for change much more immediately than the long, slow burn change that is often present in commissioning.
Why do you think it is so important to involve patients in their care?
Very often patients know best, there is nothing more powerful or effective than feedback from a patient. We have asked patients about where they think discharge pathways are going wrong, and though this information has not been officially released or analysed yet, we can already see core messages materialising. Despite all the investment in Oxfordshire addressing the discharge problem, people are still unsatisfied. Policy says that everybody should have an estimated date of discharge (36 hours after admission to hospital). However in reality we think that is probably only happening to less than a third of patients. People are telling us they are not being given their date of discharge, they are not having the process explained to them, they and their families are not being involved in decision making and they are being left sitting around for ages waiting for their medicines . To me that is clear, factual, basic information. If each point was addressed you could fix the main areas where patients are experiencing delays easily. It doesn’t have to be complicated – you can learn a lot from your patients.
“We exist to hear from the public what’s working and not working, and to then lobby the authorities for change. What sets us apart from any other organisation is the statutory requirement, that when we write to a commissioning body they have to respond. So we can give patients quite a powerful voice at the highest level of policy and strategy making in health and social care. – Quite a powerful position.”
Why do you think the service user voice is so powerful?
There is nothing more powerful than the service user or worker voice. When meeting with county councils to discuss service issues, it’s the individual case examples which give my argument the weight and make the difference.
Particularly for subjects like dignity in care, when you share a story of someone in Didcot routinely sitting on the toilet while their carer attends to another patient; or a lady in Banbury who has told me her husband is regularly left standing naked for 20 minutes while his carer takes a phone call in the middle of bathing him. There was also a gentleman with a physical disability of working age, who has his bedtime dictated to him by his carers only being available to put him to bed at 9pm every night.
Personal accounts and stories are at the heart of what we do, and are the greatest weapon against poor care and can and will engineer change. That’s why getting the patient voice into policy making is so important.
“Also I think it doesn’t matter what sector you work it, it is when the boss hears the real voices of key staff and customers that you get the really powerful change Healthcare is no different.”
How do you keep the general public aware of project developments and keep them involved in the care quality conversation?
We aim to do as much as of our work as possible in the public domain so it is accessible at all times, from hosting content and updates on our website to copying the media in. We also follow up each individual letter with regular reports through both the Health Overview and Scrutiny Committee and The Health and Wellboard Board at the County Council, ensuring that as well as our own files, there is also a matter of public record, documenting what we have said to people and what they have said back to us.
What standout achievements have you made using this process in the last year?
A substantial amount actually. We enabled local university students to talk to each other about access to primary healthcare, A&E and mental health services. The two projects conducted with those particular students eventually led to the South Central Ambulance Service providing a paramedic staff vehicle on Friday and Saturday nights. The local Health Overview and Scrutiny Committee received a report that showed since the launch of this service, it has reduced A&E attendances by an estimate of 40/50 young people every weekend.
Also, on the back of a series of events called “Hearsay”, we listened to adult users of social care. Essentially, service users said to us, “we don’t think the quality element of care contracts is good enough” and we shared that information. The County Council has now put new customer standards – designed with input from service users – into all of its contracts with major providers. It’s not as complicated as the system makes it out to be sometimes. You can learn a lot from listening to your patients.
Highlights from the year so far?
Increasingly we get calls for help, both from individuals and small, voluntary organisations. At the moment I’m involved in several individual campaigns:
Campsfield House – where we are supporting a group of voluntary organisations who have real concerns about the quality of care in Campsfield House, the local immigration detention centre. Our involvement lends some weight to their lobbying of the health provider.
Treatment time targets for prostate cancer
This work is focused around the consistent inability of hospitals in Oxfordshire to meet the 62 day cancer treatment time targets for prostate cancer. An individual patient has been running his own letter writing campaign for 4 years but despite his efforts, has been unable to engineer change on his own. After we backed his campaign, the CCG altered their contract with the Oxford University Hospitals Trust, to put specific emphasis on getting that target nailed.
Learning disabled community
We are also lobbying now on behalf of the learning disabled community. A number of learning disabled adults, carers and staff came to us saying they were really worried about a recent consultation outlining changes to learning disabled services. Concerns included, how the consultation was managed, what the outcomes were, and how the changes are going to be managed. We are now actively involved in their campaign, and have taken it to the county council.
Basically we are very busy!
What do you see as your greatest organisational challenges?
Our capacity and age sometimes can be a barrier. Healthwatch was established as a concept in 2010 and Healthwatch Oxfordshire has only been active for about 15 months, so we are a young organisation, with six staff and a relatively small footprint – so there’s plenty of work to do.
Due to resource issues and the need to prioritise our agenda, some areas are less develop than others – such as providing the public with information, advice and signposting. The system is very complicated and hard to navigate, so it’s a really important role. One of our challenges going forward is to make our website more functional and accessible, so we are looking to build the marketing and communication skills of our team.