This is our second Barking, Havering and Redbridge University Hospitals NHS Trust Patient Experience Strategy. It builds on our previous strategy and sets a trajectory for achieving our patient and carer ambitions over the next five years.

We know that the next five years will bring a number of challenges for our Trust. This includes increasing pressures due to our ageing population, increasing costs associated with delivering healthcare and increasing public expectations.

The strategy’s commitments and ambitions set out in this document outline a direction of travel for patient and carer experience. We are clear about our commitment to providing safe, effective consistent and caring services that meet the needs of our diverse local communities.

Throughout this strategy we put our patients and carers at the heart of everything that we do. The strategy demonstrates our commitment to delivering first-class care as our main priority. It also focuses on continuing to embed a model of engagement that supports, enables and empowers staff at all levels of the organisation to identify opportunities and improve quality.

This strategy is closely aligned to the Trust’s strategic plan, PRIDE values, aims and objectives and has been informed by the NHS England and Improvement Patient Experience Improvement Framework (2018).

We remain committed to a cultural shift from ‘doing to’ patients to ‘working in partnership with’ them. In consulting with our stakeholders, patients, carers, staff and external partners we were able to identify key commitments:

• Ensure that patients and carers are involved in all aspects of their care.
• Develop ways to collect, learn from and act on patient and carer feedback. 
• Develop support services for carers and ensure that these are easily accessible.

As a provider of healthcare to the local community, it is important that we have a shared vision and approach to working with patients and carers. Having a strategy helps us to plan our work, allocate resources to the things our patients and carers have told us are important to them and, ultimately, deliver our operational goals.

Patients, carers and the public have a greater expectation than ever before about the degree to which they are involved in their care and in how NHS Trusts design and deliver services. It is not enough to ask what people think – we must work with patients and carers to truly understand their lived experience and to utilise this real resource across the organisation.

We know that developing a strategy is the right thing to do and there are also local and national drivers which support this vision.

The Health and Social Care Act (2012) section 2422, places a legal duty on Trusts to consult and involve the people we serve. We must demonstrate that we are involving people and communities appropriately and proportionately.

This strategy also aligns to the principles and values of the NHS Constitution in England (2012), representing a commitment by the Trust to provide comprehensive high quality services.

The Patient and Carer Experience Strategy is our commitment to our local communities. By development of this strategy, the public will be able to hold us accountable:

• work with us to get it right
• tell us when we get it wrong
• ensure that we stay on track with our Commitments and Ambitions to improve patient experience in our hospitals

Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) is a large provider of acute services, serving a population of over 750,000 people in outer North East London. The Trust operates from two sites: Queen’s Hospital in Romford and King George Hospital in Ilford.

There are approximately 900 beds across both sites. Queen’s Hospital is the Trust’s main acute hospital and opened as a private finance initiative (PFI) in 2006. It is the main hospital for people living in Havering, Dagenham and Brentwood.

The Trust provides one of eight hyper acute stroke units (HASU) in London, has a renal dialysis unit, is a specialist neuroscience centre and has the third biggest maternity unit in the country, delivering over 8,000 babies a year. The Emergency Department (ED) treats over 150,000 walk-in and ambulance emergencies each year.

King George Hospital opened at its current site in Ilford in 1993. It provides acute and rehabilitation services for residents across Redbridge, Barking and Dagenham and Havering, plus providing some services to patients from South West Essex.

To provide the best care to our patients, we also work closely with our health and social care partners so that together, as one healthcare system, we work as efficiently and effectively as possible for the communities we serve. As we are a university hospital we also work very closely with our academic partners.

One of the fundamental areas of our Patient and Carer Experience Strategy is the continued cultural shift from ‘doing to’ to ‘working in partnership with’ our patients.

There are many different ways in which patients and carers might want to be involved in health services and this is often dependent upon their own personal circumstances and interest.

The Engagement Ladder is a model from NHS England that is used widely and which articulates the journey of patient engagement.

It clearly shows the steps that staff can map their services against with a clear journey along the Ladder and will help staff to partner with people using our services.

Although participation becomes more meaningful towards the top of the Ladder, patient and carer engagement at every step of the Ladder is valuable and will deliver essential insight and opportunities for learning.

The NHS Englanf Ladder of Engagement

Devolving

Placing decision making in the hands of the community and individuals. For example, personal health budgets or a community development approach.

Collaborating

Working in partnership with the communities and patients in each aspect of the decision, including the development of an alternatives and identification of the preferred solutions.

Involving

Working directly with the communities and patients to ensure that concerns and aspirations are consistently understood and considered. For example, partnership boards, reference groups and service users participating in policy groups.

Consulting

Obtaining community and individual feedback on analysis, alternatives and or decisions. For example, surveys, door knocking, citizens panels and focus groups.

Informing

Providing communities and individuals with balanced and objective information to assist them in understanding problems, alternatives, opportunities, solutions. For example, websites, newsletters and press releases.

The 2017-2019 Patient Experience Strategy set out a number of aims putting patient experience and engagement firmly at the forefront of our organisational culture.

There have been a number of successes during the three year period covered by the Patient Experience Strategy. We now plan to take those successes: build and embed them even further to put this strategy at the heart of the organisation. We fully commit to a culture and behaviour within our Trust. This will establish us as a leader in delivering outstanding patient experience.

Key successes

• The Trust expanded on the national “hello, my name is...” campaign to develop a minimum standard introduction for all staff which was supported by mandatory training. 94 per cent of Trust staff have undertaken the mandatory training.
• Development of a patient experience dashboard with key experience indicators.
• The Trust participated in the National Patient Experience Collaborative. It was led by Northumbria Healthcare NHS Foundation Trust and the Patient Experience Network, working with 14 other NHS organisations to share learning and improve patient experience.
• Achieved the Royal Association for Deaf People Quality Mark recognising that Queen’s Hospital is a deaf aware hospital.
• Supported by the Trust Charity, produced a number of information films made accessible for our deaf community by the use of British Sign Language.
• Introduction of “I Made a Difference” monthly staff awards which includes a patient partner on the judging panel.
• Introduction of sleep well packs for inpatient wards - containing eye mask and ear plugs to support patients getting a good night sleep.
• In collaboration with NHS England, produces a Dignity in Dying film. This outlined the ways in which the Trust provide dignified, compassionate and professional experiences for end of life patients and their relatives.
• Implementation of Matron calling cards - ensuring patients and families know who to contact if they have a question or issue that cannot be answered at ward level.
• Nearly 300 clinical staff have registered for an account to receive individual patient and carer feedback.
• The public mortuary viewing room at Queen’s Hospital was renovated and made more welcoming for bereaved families.
• Introduction of bereavement condolence cards which are sent to all bereaved families one week after a patient dies.
• Friends and Family Test (FFT) - every year of the 2017-2020 strategy the Trust received around 100,000 patient feedback surveys enabling our Trust to see top line patient feedback for divisions and wards.
• Introduction of staff ID badges to be worn with personal protective equipment (PPE), which helps patients be aware of who is looking after them.
• Introduction of patient activity packs for inpatient adult wards to help with boredom and combat cognitive decline.
• Development of the ‘Because We Care’ film - a visual production of the post-bereavement information that is provided to relatives after a patient dies.
• Installation on both sites, Trees of Life which, by using a bumble bee sticker, shows how many Covid-19 patients have been successfully discharged from our hospitals.
• Introduction of Covid leaflet sent to all discharged patients with important post-discharge information for continued recovery.
• Established links with a range of community groups including those groups that are seldom heard - patient experience attendance at a number of groups to discuss involvement, feedback and learning.
• Introduction of divisional patient experience learning reports.
• Development of a Young Person’s Forum to ensure that the voices of young people are heard and they are provided with opportunities to help improve services that they access across the Trust.
• Increased volunteers in the Trust from 250 in 2017 to almost 600 in March 2020.
• Expansion of regular chaplaincy presence in Emergency Departments on both sites - for patient, carer and staff support.
• Transition of patient experience forums from face to face to virtual platforms enabled continued engagement during the Covid-19 pandemic.
• Establishment of a Learning Disability Working Group and a Dementia Engagement Group - active participation of patients, carers and families in influencing service changes.
• Embedding and expansion of patient partnership in the Trust to support improvement and development of services. This includes the appointment of a patient partner in an advisory role at Trust Board.

Patient and carer experience is about sharing lived experiences of receiving care and providing involvement opportunities for patients and carers. We must ensure patients and carers feel that they have been listened to, that their feedback has been acted upon and that they are able to help shape and co-produce future services.

Our five year Patient and Carer Experience Strategy has been produced with the involvement of our local communities. During October - November 2020, the Trust held a number of events. Patients, service users, carers, staff and other voluntary and public organisations came together to look at how their feelings and experiences could help improve our services for the future.

As part of the development of this strategy we also considered other intelligence that had been gathered - friends and family test data as well as the CQC national survey programme findings. Our strategy commitments and ambitions have been identified and agreed through consultation with internal and external stakeholders.

From all of the patient and carer information, we have received we have developed an approach around three commitments and this forms the basis of the strategy. The commitments identified are ‘involvement’, ‘learning’ and ‘carers’. Contained within each commitment are five main ambitions which the Trust has committed to deliver.

We believe that our strategy for improving patient and carer experience needs to be memorable and impactful and have chosen a simple, effective model to help communicate and embed this to staff, patients and carers.

Together with our local communities we will increase the number of people who become involved in how our services are provided. This will include the diversity of people (black, Asian and minority ethnic (BAME), LGBT+, multi-faith, seldom heard groups etc), as well as expanding the ways in which people can become involved.

We aim to ensure that the needs of our whole community are reflected, understood and met.

Ambition 1

Support the development of co-production across all Divisions and through agreed improvement methodology to ensure that patients and carers are more involved and have more say in the decisions about care and treatment that affect their lives.

Ambition 2

Establish and deploy equality, diversity and inclusion patient pledges and priorities ensuring that equality, diversity and inclusion are embedded in our community engagement, consultation and decision making.

Ambition 3

Develop a framework for patient involvement to ensure that those who wish to become involved are appropriately supported with training and do not incur expenses and can be properly reimbursed for their contribution.

Ambition 4

Expand the reach of our volunteer service across local communities. We can do this by developing innovative volunteer and patient partnership roles. We will ensure there is support and adaptions available to encourage all of our communities to get involved in volunteering regardless of personal circumstances.

Ambition 5

Work with patient, carers and staff to assist with the development of key priorities for patient and carer experience across the Trust.

Together we will support every patient, carer and family member to give feedback about their care and experience so that we can learn from this, understand what matters most to people and use this to improve our services. Responding and acting on experiences in a timely way leads to change which improves our patient and carer experience.

Ambition 1

Support delivery of care and treatment in happy and healthy hospitals. This ensures safe and clean environments with appropriate nutrition and hydration and ensure that we continuously improve what patients and carers see, do, hear and feel during their visit to our hospitals.

Ambition 2

Review all feedback mechanisms and introduce new techniques and technology to enable more people to give feedback. This will include IPads, age appropriate apps and programmes, printed materials and audio including easy read.

Ambition 3

Review the support available to patients and carers with a physical disability (seen and unseen) and ensure that we work together to improve accessibility in all forms.

Ambition 4

Support delivery of the NHS Accessible Information Standard across the Trust, making patient letters, written information and facilities clear, age appropriate and accessible.

Ambition 5

Develop a process that supports analysis and triangulation of patient and carer feedback with other quality measures e.g. complaints, PALS, clinical incidents and which ensure we measure, understand, learn from and act upon patient and carer experience.

Carers are not just visitors – they undertake a range of tasks to support patients, in hospital and in their own homes. The significance of carers cannot be overlooked - they are part of the patient support team and we want carers to feel valued as a partner in care.

Together with carers, we will develop dedicated, structured support for carers which is accessible and pro-actively available.

Ambition 1

Establish a carer support network across the Trust to provide support, feedback and learning opportunities.

Ambition 2

Develop processes and systems to identify individual carer needs and be able to respond to these through tailored support packs and toolkits, in collaboration with the Trust Charity where appropriate.

Ambition 3

Establish a volunteer support programme for carers to provide respite and help and to provide signposting to other public and voluntary health and care services.

Ambition 4

Introduce a programme of post bereavement support through a variety of methods which meet the needs of carers and families.

Ambition 5

Provide our staff with the relevant knowledge, training and support to become carer aware and train them in carer engagement strategies.

This strategy sets out our commitments and ambitions over the next five years and our journey will be monitored through the Trust governance structure, which is outlined below.

• Trust Board
• Quality Assurance Committee
• Quality Governance Steering Group
• Patient Experience and Engagement Assurance Group
  • End of Life Care Steering Group
  • Nutrition Advisory Group
  • Patient Parternship Council

Implementation

The strategy ambitions will be achieved through the delivery of a detailed overarching action plan, identified clear milestones and lines of accountability.

Overall progress on the delivery of the strategy is monitored by the Trust’s Patient Experience and Engagement Assurance Group. Exceptions are reported at the Trust’s Quality Governance Steering Group.

Six monthly progress reports will be presented at all relevant Trust Group meetings.