A good thing, but …
The NHS is talking a good talk about patient involvement, and it’s great that the idea is gaining such acceptance. But the mechanics of implementing it are still falling well short of a good walk.
I’ve been exasperated by two lots of communication recently related to patient involvement. Probably out of all proportion, you’ll think, but I’m SO tired of NHS England talking up patient involvement and then just doing it in a very half-arsed way.
Back-office silliness undermining good intentions
The first was a couple of months ago when I was invited to speak at a conference which was, splendidly, dedicated to ‘empowering patients to manage their long-term conditions’. It promised to ‘go beyond the usual rhetoric’ and to take a ‘holistic, person-centred approach…’, and even constituted a People’s Panel to ensure discussions were centred on service users, and to hold the conference to account.
So, anyway, you’d assume that it would have its patient involvement sorted.
So I was a bit surprised to get an email one day from the organisers asking me to let them know my travel requirements by close of play so they could book them. I was out, and busy with – yer know – life, so emailed back to say I’d sort myself out and would presumably be able to claim afterwards. No, they wanted to make the arrangements, and could I send them details. Well, no I just couldn’t.
I pointed out that I’d need to organise my own transport – I live deep in rural Beds, and travel isn’t straightforward at the best of times, but I also need to sort assistance for myself on the train with the splendid people at First Capital Connect (good) and their S-L-O-W and cranky system (bad). When they conceded on this, they then insisted I do it that day, right then, so that I could tell them what it would cost. Well, no I still couldn’t, for the same reasons I couldn’t fulfil the original demand. Did they think I was making it up the first time?
So, trying to help, I offered to provide a quick estimate of the cost, based on previous experience. I explained that I’d use the bus in London (free, no expense to them, so yippee), unless it was really tipping down, in which case I might take a taxi. Your legs get really wet in the rain if you’re sitting down. So I fired this off from the train, only to have some embryonic management trainee email me twice in quick succession to ask:
- whether I ‘was sure that the train station I’d specified was the nearest to where I live?’ Sighhhh. Really?
- and, whether I couldn’t use the tube in London? As though I didn’t know there were tubes, or hadn’t considered it. Or maybe I’d never been to Lunnon before? Actually using a wheelchair puts the vast bulk of the tube system utterly off limits. 
This was all a bit ironic, considering that the conference – and pardon me if I shout here – WAS ABOUT PATIENT CENTREDNESS!! I was so incensed by these emails, this querying of my wits and my integrity, that I came within a hair’s breadth of pulling out altogether.
Now, I may have a short fuse, but this stuff matters. Patient involvement, patient centredness, call it what you will, includes listening to, respecting, hearing, integrating patients. Then this? An assumption by the organisers that I’m dim, that I wasn’t used to organising myself, didn’t know where my local trains station was. Also – and you get this quite often – that I had an empty, barren life in which I could drop whatever I was doing and respond to emails instantly with detailed requirements.
And all this hassle, so that I can give my time voluntarily, freely, to support their stupid conference? It beggars belief.
Actually the conference was great.
Then on Tuesday I opened an email from an NHS organisation. (Nope, dangle me from the ceiling, I still won’t say.)
It invited me to apply to be a Patient Champion, and to sit on a panel validating the assessment of young NHS professionals on a training programme. The email was very annoying for a number of reasons, not least by patronisingly assuming that I’d get excited about potentially being designated a ‘Champion’. What? Do they think I’m six?
The email went to great pains to assure me how seriously the organisation took patient participation’; how they are looking to ‘ensure that patients are equal partners blah blah…’
However, while trying to reassure me about how seriously it took our participation, it simultaneously failed in several ways, and I can’t tell you how much I was put off by the following:
- It didn’t have a signature at the end, so came only from a mysterious ‘administrator’. So that was friendly.
- It was sent mid afternoon on Monday, with a closing date for applications on Sunday. Because, of course, patients-users-carers aren’t doing anything with their crap lives except watching Homes Under the Hammer, and can leap to this stuff. But six days seems like short notice to me, and I’m really not sure if I can fit it in. And you can’t help wondering if the HCPs involved only had six days’ notice.
- We were asked to follow the application instructions in the attachments, and to ‘send in the application form below.’. But in fact there wasn’t an application form, so how does one apply, actually?
I was at a meeting of my regionally based Cancer Partnership Group today, and several people I spoke to had had the email, opened it and ditched because it was a mess.
The thing is that patient involvement, and patient-centred self care etc, isn’t just a good idea, it’s an absolute necessity for lots of reasons; it’s going to be the only thing that stops health provision from imploding all over the western world. It has to be done, and there are brilliant people in the NHS working hard to try and make it work. Hats off to the folks at the Patient and Public Voice Team, and to those at the Coalition for Collaborative Care, and in the East of England for busting guts to make this stuff real.
But lots of people are paying lip service. It isn’t good enough to bleat on about the importance of the patient voice, constantly to harp about the crucial input and contribution from patients, without putting in place the appropriate mechanisms and systems (including expense and travel systems) that actually allow patients and carers to participate and engage.
It isn’t enough to remember at the last minute to ‘get a couple of patients along’ and wheel them out as proof that you’re listening. If your systems don’t work, if you don’t give credence to what you’re being told, if you don’t give time and notice in which to act and prepare, you aren’t.
Believe me, I know where my nearest station is.
 For those with time on their hands, try plotting the journey from Custom House to Southfields using TfL’s splendid step-free tube map. The map is splendid, the tube ain’t.
9 thoughts on “Patient involvement – still some way short of a good walk”
Thanks for taking the trouble to get this down Fiona, it is so clear about the frustrations and points up so many absurdities. I am printing off a couple of copies to carry round with me and stick under the noses of people in the NHS who I think should READ IT!! And not just that but hopefully they will take note and influence how things are done locally.
Thanks, Carol, that’s very nice of you, and supportive. Delighted that you might find a use for it!
I work in the NHS – in patient involvment – and this is my frustration too – that we’re expected to make involvement happen on goodwill without the system actually resourcing this effectively. thank you for voicing this! will be sharing
Thanks very much. I know how frustrating it is for you guys. Resources are so important: not just for expenses, but for finding the right people, covering lost earnings (not often done) so that working people can be part of this, and much more.
This struck a chord with me and even though it can downheart me, it is no surprise. I work in 3rd sector involvement and Co Production and have lived experience of being a service user experiencing involvement and participation. It is a passion because it empowered change in me and others. I work hard to enable meaningful participation and I experience issues you write….in some places…shout about. Sometimes its a culture thing in services, others its lack of trust but some do get it right and hopefully show the way for others improve and enable a meaningful and Co created, health service across all sectors. Thank you
Thanks, Scott. I’m sure that there are a lot of us with similar experiences. I suppose we need to remember, that we ARE pushing at an open door. But it’s a heavy door. There’s still a lot of complacency and I think an assumption that ‘other’ people have got patient involvement covered.
Good post pointing out what I think is common sense but seems often to be missed.
As a person with LTCs I often think that professionals forget that when need people need help or try to access services it is because they are not feeling great so may not be at the top of their game-and they have not fully considered their requests, services or access through the eyes of a patient.
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Thanks for that useful insight, Christine.