A Report of NHS Lanarkshire s Urology and Gynaecology Inpatient Services Consultation

A Report of NHS Lanarkshire s Urology and Gynaecology Inpatient Services Consultation October 2005

You can read and download this document from our website. We can also provide this information: by email in large print on audio tape or CD in Braille, and in community languages Scottish Health Council Lanarkshire Office Airbles Road Motherwell ML1 3FE National Office Delta House 50 West Nile Street Glasgow G1 2NP Phone: 01698 250131 Phone: 0141 225 6887 Email: admin@scottishhealthcouncil.org Website: www.scottishhealthcouncil.org 2

CONTENTS 1 SUMMARY...4 2 INTRODUCTION...5 3 CONTEXT...5 4 EVIDENCE SOUGHT...6 5 THEMES...7 6 FINDINGS...7 7 CONCLUSIONS...12 8 RECOMMENDATIONS FOR FUTURE CONSULTATIONS...13 3

1 SUMMARY The Scottish Health Council has a remit to consider whether NHS Boards have adequately consulted their local populations in relation to significant NHS service change, in accordance to existing guidance 1, 2, 3, 4. During September 2005, NHS Lanarkshire wrote to the Minister for Health and Community Care, Mr Andy Kerr MSP, requesting approval for a change in how urology and gynaecology specialties will be provided in Lanarkshire in the future. Following an engagement process, a formal 12-week consultation on the proposal to centralise the inpatient services for urology and gynaecology services began on 10 th June 2005 and concluded on 2 nd September 2005. On 14 th September 2005, the Board of NHS Lanarkshire approved the proposal, and noted that issues concerning travel, transport and the future clinical provision at Hairmyres Hospital, which had been raised during the consultation, still needed to be addressed, and that action was ongoing. Evidence on how well NHS Lanarkshire involved patients and local people in this proposed redesign of services was gathered by the Scottish Health Council from 1) documentary material (e.g. communication, including reports, about the consultation), 2) feedback (e.g. from staff and patient representatives) and 3) interviews (e.g. with representatives from local voluntary groups). In reviewing the consultation process, the Scottish Health Council concludes that NHS Lanarkshire did take sufficient steps to involve patients and the public in the redesign of the urology and gynaecology specialties. The Scottish Health Council notes that this consultation is in accordance with the appropriate guidance relating to patient focus and public involvement. 1 Patient Focus and Public Involvement, Scottish Executive Health Department (2001) 2 Informing, Engaging and Consulting the Public in Developing Health and Community Care Policies and Services, Scottish Executive Health Department (August 2004) 3 National Standards for Community Engagement, Scottish Community Development Centre and CoSLA (April 2004) 4 Signposts: A Practical Guide to Patient and Public Involvement in Wales, NHS Cymru Wales and Office for Public Management (2001) 4

2 INTRODUCTION The Scottish Health Council has a remit to consider whether NHS Boards have adequately consulted their local populations in relation to significant NHS service change. During September 2005, NHS Lanarkshire wrote to the Minister for Health and Community Care, Mr Andy Kerr MSP, requesting approval for a change in how urology and gynaecology specialties will be provided in Lanarkshire in the future. This report contains an assessment by the Scottish Health Council, carried out by the Lanarkshire Local Office, of NHS Lanarkshire s consultation and wider engagement on this proposed redesign of services. The assessment was made against existing standards and guidance 1 2 3 4. 3 CONTEXT In the Autumn of 2004, an independent organisation, FRMC Decision Support, carried out Developing Values workshops as part of the A Picture of Health engagement process. These workshops involved the general population of Lanarkshire and focused on identifying values and principles impacting on health and health services such as: those underpinning service redesign; balancing improved health outcomes with traveling for specialist attention; and how to provide a more responsive accident and emergency service. In November 2004, A Picture of Health Public Engagement Report was issued. This report is seen as an overarching framework to plan and consult on the changes required to ensure healthcare services in Lanarkshire are fit for purpose. It sought views that would ultimately contribute towards the shaping of future health services in Lanarkshire, and identified that services such as urology and gynaecology needed to be addressed earlier than some other services. A questionnaire inviting people to be involved in the process was included in A Picture of Health, and of those that indicated a wish to be consulted on the redesign of services, 14 people said they wanted to be consulted on planning for urology services and 14 wanted to be consulted on planning for gynaecology. In January 2005, service redesign workshops took place on urology and gynaecology, and those who had expressed an interest were invited to take part. 1 Patient Focus and Public Involvement, Scottish Executive Health Department (2001) 2 Informing, Engaging and Consulting the Public in Developing Health and Community Care Policies and Services, Scottish Executive Health Department (August 2004) 3 National Standards for Community Engagement, Scottish Community Development Centre and CoSLA (April 2004) 4 Signposts: A Practical Guide to Patient and Public Involvement in Wales, NHS Cymru Wales, the National Assembly for Wales and Office for Public Management (2001)

A formal 12-week consultation on the proposal to centralise the inpatient services for urology and gynaecology services began on 10 th June 2005 and concluded on 2nd September 2005. On 14 th September 2005, Lanarkshire NHS Board considered the outcome from the public consultation. NHS Lanarkshire supported the proposal, but further issues (concerning travel, transport and the future clinical provision at Hairmyres Hospital) remain to be addressed. The Scottish Health Council Lanarkshire Local Office has made an assessment of how much and how well the needs of patients, carers, the public and staff had been taken into account during the consultation and the wider engagement process. Information on this assessment is given below, together with the Scottish Health Council s conclusions and recommendations for future consultations. 4 EVIDENCE SOUGHT Evidence on how well NHS Lanarkshire involved patients and local people in this proposed redesign of services was gathered from documentary materials, feedback, and questionnaires and interviews. 4.1 Documentary materials reviewed: Communications, including reports about the engagement and consultation process NHS Lanarkshire s A Picture of Health wider engagement process and consultation Correspondence that had been archived by Lanarkshire Health Council A Picture of Health website www.a-picture-of-health.org, also accessed through the NHS Board s website www.nhslanarkshire.co.uk. 4.2 Feedback was sought from the following groups: Staff and patient representatives who attended redesign workshops on Urology and Gynaecology Inpatient Services held at Wishaw General Hospital on 7 th January 2005 Scottish Health Council Local Advisory Council members (recruited from 1 st April 2005 onwards) and former Lanarkshire Health Council members and staff who were either involved in the above workshops or who had information on the engagement process prior to their recruitment to the Scottish Health Council North Lanarkshire Carers Together who had been actively involved in the redesign workshops 6

Members of the Scottish Health Council Lanarkshire network (formerly the Putting People First Network) who had been invited to take part in the formal consultation on the proposed redesign of services. 4.3 Questionnaires were distributed to and interviews were conducted with: Representatives from community and voluntary groups and organisations in Lanarkshire Members of the Scottish Health Council Lanarkshire network. 5 THEMES The findings of this report follow the relevant themes of the Communities Scotland National Standards for Community Engagement 3, which the Scottish Health Council has endorsed: Involvement Support Planning Methods Sharing Information Feedback Monitoring and Evaluation. In addition, the assessment considered the timescale for the consultation exercise, whether equality and diversity principles were adopted, and whether staff were adequately involved and prepared to be able to offer support and information to patients. 6 FINDINGS 6.1 Involvement As a result of the consultation on A Picture of Health, 14 people had expressed an interest in taking part in a urology engagement workshop and 14 in a gynaecology workshop. Those who had expressed an interest were contacted by telephone and the purpose and procedure for the day were explained. Various community groups and patient representatives were invited to attend the workshops, including Better Government for Older People 3 National Standards for Community Engagement, Scottish Community Development Centre and CoSLA (April 2004) 7

(South Lanarkshire); Lanarkshire Links; North Lanarkshire Carers Together; and South Lanarkshire Carers Network. Lanarkshire Health Council was invited to take part in the workshops: a member of staff and a Health Council member attended. The community and staff engagement workshops were held on 7 th January 2005 at Wishaw General Hospital. One workshop focused on urology redesign, and the other on gynaecology redesign (62 participants and 10 facilitators). The aim of the workshops was to involve service users, carers, staff and partner agencies in developing the proposal for service redesign prior to the formal consultation process taking place by mapping patient journeys, and then reviewing current practice. The workshops included two presentations: An introduction to the current urology and gynaecology services (Mr I.A. Ross, Divisional Chief Executive, Acute Operating Division) and An overview of issues that impacted on current service delivery (Dr T. Nunn, Divisional Medical Director, Acute Operating Division). The workshops also included facilitated discussion by Health Board staff. Of the 62 participants, five were patient representatives and two were from North Lanarkshire Carers Together. Participants had an opportunity to meet with the project managers prior to the workshops taking place. There were some issues and frustrations experienced in both workshops. Staff, who comprised the majority of participants, felt that decisions concerning the proposed services had already been made and questioned why time was being wasted on a full day s discussion. It was also felt that there was insufficient time spent on defining and considering the options during the urology workshop. One participant thought he would be participating in a consultation exercise and then found that in fact he was involved in listening to a presentation and then taking part in a discussion. Some people felt that the programme for the day was disrupted due to more time being spent on identifying patient pathways for both planned and unplanned care instead of spending more time on defining and considering the options. The workshop report was sent to all participants with a covering letter requesting feedback on its accuracy in March 2005; comments were considered and used to inform the final report. Some participants did not recall being asked to comment on the workshop report or receiving it. Overall, 3,000 copies of the consultation document were distributed throughout Lanarkshire to stakeholders this included over 450 individuals and organisations (including clinical interest groups, 8

community councils, patient and carer groups, general practitioners, MSPs, hospital clinical groups, managed clinical networks, local authorities, professional advisory groups, the Scottish Ambulance Service,). The consultation document was also made widely available within each of the three acute district general hospitals. A range of methods was used for promoting the consultation: website; posters; press releases; advertisements in local newspapers; briefings with key stakeholders such as other NHS Boards and constituency MSPs; and staff meetings within NHS Lanarkshire s acute district general hospitals that were publicised internally. 16 formal responses to the consultation were received. Most of these were from professional or community groups such as Nursing, Midwifery and Health Visiting Committee. Five public meetings were held across Lanarkshire. These meetings were generally poorly attended: 6.2 Support o 20 th June at Wishaw General Hospital 8 people attended o 21 st June at Monklands Hospital 5 people attended o 22 nd June at Hairmyres Hospital 16 members of the public plus staff attended o 2 nd August at Burngreen Hall, Kilsyth no members of the public attended o 3 rd August at Roadmeetings Hospital 10 members of the public attended. An additional public meeting was arranged at the request of the Community Council in the Symington area: only the person requesting the meeting attended. Some individuals invited to the workshops were offered a preworkshop meeting to discuss the purpose and process of the workshops: this offer was accepted by at least one person. A buddy type system was put in place to greet some individuals on arrival and then provide support, where needed, throughout the day. People who had to leave before the workshop finished, or who had difficulty articulating their views, were encouraged to share their comments with staff informally, such as over lunch. Participants at the workshops were able to claim out-of-pocket expenses; guidance for service users and carers was made available. Dietary requirements were also sought and catered for. 9

6.3 Planning Most participants felt they were provided with sufficient information prior to the workshops to enable them to take part. Key issues such as travel and transport were identified in the workshops and NHS Lanarkshire decided to establish working groups to include members of the public to attempt to address these. Comments from workshop participants were incorporated into the feedback report and the consultation document. A record of the questions and answers was taken at the public and staff meetings. 6.4 Methods NHS Lanarkshire used a range of methods to inform, consult and engage with patients, staff and the public including their website, posters, advertisements in local newspapers, press releases and meetings. In addition a communications strategy for the proposed redesign of services was developed and implemented. While there was no formal evaluation of the public meetings, NHS Lanarkshire recorded any issues raised at these meetings. Hospital inpatients and their carers were not directly targeted 6.5 Sharing Information A Picture of Health documentation was made available in a range of formats appropriate to various needs such as large print or audio version: the documentation was also available in a number of community languages on request. It was felt that relevant information was made available within the workshops and that participants had sufficient opportunity to express their views. The information provided was easily understood and the workshop facilitators ensured that technical terms were explained using plain English. It is evident from information fed back to the Scottish Health Council that the majority of individuals who participated in the consultation received relevant information that was clear and understandable to them. They were informed of the reasons for the proposed changes to services. The consultation took place over a twelve-week period. 10

People could respond to the consultation using e-mail, post, or by logging on to the NHS Lanarkshire website, although some difficulties in accessing the relevant information on the website were reported. 6.6 Feedback NHS Lanarkshire fed back to participants by report, thank you letters and through face-to-face contact. The feedback highlighted issues raised by individuals and indicated what steps will be taken to address these issues. 6.7 Monitoring and Evaluation Of the 104 members of the public and staff the Scottish Health Council approached for their views on the engagement and consultation process, 31 people responded. Views were elicited through questionnaires and interviews. The Scottish Health Council received no negative comments regarding NHS Lanarkshire s engagement and consultation process. Participants felt that issues they had raised during the workshop had been addressed by NHS Lanarkshire, such as transport. Three respondents highlighted that they thought their contribution would impact on the outcome of the consultation, and three thought it would not. Three of the 31 respondents did not recall receiving feedback following the workshops or the consultation exercise. One respondent indicated that they did not realise that support was available to help them participate in the workshop. 11

7 CONCLUSIONS The Scottish Health Council concludes that NHS Lanarkshire took sufficient steps to involve patients and the public, as well as staff, in the redesign of urology and gynaecology specialties, and that the consultation process used is in accordance with the appropriate guidance relating to Patient Focus and Public Involvement 1. The methods used by NHS Lanarkshire were appropriate for the purposes of the engagement process to enable diverse views to be elicited. NHS Lanarkshire was also responsive to concerns raised, for example, in setting up working groups to explore issues such as transport. Within the constraints of this evaluation, NHS Lanarkshire appeared to have offered appropriate support (in the form of out-of-pocket expenses, the opportunity to attend pre-workshop meetings and the provision of a buddy system). NHS Lanarkshire attempted to involve members of the public from the start of the engagement process. Steps were taken to include members of the public in the working groups set up to examine key issues. The Scottish Health Council Lanarkshire Office was kept informed by NHS Lanarkshire throughout the consultation process. While NHS Lanarkshire did provide information and feedback during the process, some noted that information was not always received in time to inform participants in the redesign workshops, or that information was not always provided within an adequate timescale (the feedback report). In addition, there appeared to be some confusion about the purpose of the redesign workshops. 1 Patient Focus and Public Involvement, Scottish Executive Health Department (2001) 12

8 RECOMMENDATIONS FOR FUTURE CONSULTATIONS Whilst overall NHS Lanarkshire did involve patients, the public, and staff appropriately, there are areas for improvement. The Scottish Health Council recommends that in future consultations, NHS Lanarkshire: Ensures all participants have sufficient information and support to take part, and that any information is relevant and received in good time. Ensure patients, carers, the public and staff are clear about the consultation process and their involvement within it. Develops better-planned workshop aims and objectives, with a clear purpose and communicates this to participants. Ensures workshop facilitators are well briefed and are realistic about what the workshop will cover. Ensures that where wider engagement takes place, those who participate genuinely have an opportunity, and feel they have an opportunity, to generate and influence the options put forward. Ensures that full access is available to all relevant websites and links. Considers alternative methods of engagement other than public meetings and directly contacts patients and carers (such as in clinics) to ensure that a greater and more diverse range of individuals participate, particularly those who are hard to reach. Carries out an evaluation of the methods used in the consultation and in the broader A Picture of Health engagement process, and reviews the consultation and engagement systems to be used in future in the light of these findings. A stakeholder analysis would have been useful to identify appropriate potential participants. Ensures that the evaluation findings are shared across NHS Lanarkshire in order to maximise the organisation s learning. 13