Each Hospital Trust and Integrated Care Service has a statutory duty to engage and involve patients in the development and planning of their local healthcare services under section 242 of the consolidated NHS Act 2006. The duty to consult with patients was also similarly legislated for in Wales (section 183), Scotland (Section 7) and Northern Ireland (Section 20).

The  NHS Constitution for England sets out rights for patients, public and staff using the NHS. These national principles are shared across all health care services provided in Wales, Scotland and Northern Ireland.

There are a variety of ways in which dermatology departments can proactively involve and engage with their patients, such as administering patient experience surveys, responding to patient queries and complaints and establishing a patient panel, to influence service change / redesign decisions undertaken with or without consultation.

Local Authority Health Overview and Scrutiny Committees (HOSCs) and Local Health Watch must be consulted on any changes to service provision in primary and secondary care.  Similar networks are available for Wales through the Community Health Council (CHC), Health Improvement Scotlandand the Patient Client Council in Northern Ireland.

There are also specific PPI activities regarding improving clinical audit and governance and in training and education.

Useful sources for further information:

• Carers UK
• AvMA – Action Against Medical Accidents
• Patients Association

BAD Public and Patient information can be found here.

Most patient panels are set up to provide input into how secondary care health care services are designed to meet local need. Patient panels work with clinical staff and trust management to offer the patient and carer perspective on how the trusts services are delivered.

Patient panels can:

• Help trusts meet their legal obligations for patient engagement and involvement;
• Act as a forum through which patients can advise from a patients perspective and help to ensure that services are well designed to improve the patient experience;
• Help to improve communication and engagement with patients, encouraging them to take more responsibility for their health and to provide practical support;
• Contribute to commissioning decisions and advising on proposals for redesigning of secondary care services;
• Participate in training and education of staff, clinical governance and audit activities.

Step by Step guide to developing your own Patient Panel

BAD has prepared the guidance, “Getting started: A step by step guide to setting up patient panels in secondary care” which contains some step by step advice on how an effective patient panel can be set up in secondary care.

An example of an existing dermatology patient panel can also be found below:

• BAD Setting up patient panels
• Example Patient Panel

Patient Panel Administration Resources:

The following documents can be used and customised by secondary care departments that are looking to set up their own patient panel.

• Flyer to recruit patients for patient panel
• Example of a first meeting agenda
• Example of a second meeting agenda
• Sample terms of reference
• Trouble shooting – potential pitfalls and tips on how to resolve them

Patients have always been involved in the training of health care workers, but traditionally in passive roles as ‘interesting learning material’. However, the important role that patients play in medical education is increasingly becoming recognised, not least because they are viewed as being experts in their own illness or condition.

Furthermore, recent government policy stresses the importance of working in partnership with patients as part of commissioning processes and therefore new educational strategies are required to ensure that all healthcare professionals (including undergraduate and postgraduate students) can develop their skills and attitudes to support this relationship.

In line with this, there are a number of ways in which the expertise and insight of patients can be utilised within medical education, including:

• using patients in the teaching and assessment of undergraduate and postgraduate health care professionals
• involving patients in curriculum development
• having lay representation on selection panels
• Continuing professional development (CPD) activities
• NHS Appraisal

The involvement of patients in medical training and education has the following benefits:

Clinicians

• it provides students, trainees and doctors with an opportunity to learn and then to apply their knowledge and skills in real and teaching settings;
• it motivates by emphasising the relevance of learning; it helps to develop clinical reasoning;
• it encourages the valuing of cultural diversity;
• it fosters empathy and the development of professional skills including communication;
• Patient interaction in undergraduate education offers students a valuable early insight into the day-to-day role of a doctor and the patient perspective on specific conditions.

Patients

• improved training of the medical workforce, resulting in improved healthcare for the whole population;
• improving their own knowledge of their condition, share their knowledge and expertise with the learner;
• a sense of altruistic notion of greater social benefit from having participated in medical education.

What are they?

Patient experience surveys usually ask patients to complete specific questions in regards to their most recent healthcare experience. Surveys can be carried out by post, telephone, online or electronically with hand-held and other devices.

As part of the NHS Contract arrangements for 2012/13, service providers are required to “engage, liaise and communicate” with patients and their carers. They will be contractually obliged to carry out patient surveys, review the responses received, identify and implement actions where possible.

Furthermore, the GMC’s revalidation process, will also require doctors to demonstrate that they have encouraged patients to provide feedback about the medical care that they have received as part of their annual appraisal.

There are a range of tried-and-tested questionnaires as well as guidance in compiling a specific local survey that is available to NHS organisations, developed by the National Patient Survey Programme on behalf of the Care Quality Commission.

Dermatology departments may wish to adapt existing surveys to target specific groups of patients and develop their own bespoke survey question and response options. However in doing so, they need to consider the following:

• Questions should be developed with patients and staff before they are used to ensure they are appropriate.
• Conduct a pilot before starting an official patient survey exercise. This will help in understanding whether the questions are working as intended and are clear and unambiguous.

Benefits of patient surveys

Patient surveys will allow dermatology departments to:

• Track the experience of your patients over different intervals of time. Regularly repeating the same type of survey enables changes over time to be monitored and performance compared.

Understanding and sharing findings

Patients are asked to complete specific factual questions relating to their most recent healthcare experience. This would provide dermatology departments with an indication of what changes are required to improve patient experience and the care that they receive.

It is therefore important that the results and what you are proposing to do with them are shared with the following groups:

• Dermatology staff at all levels (clinical and support roles)
• Senior trust management
• Public, patients and their carers
• Local community and voluntary groups
• Local authorities and commissioners

Clinical Audit

Clinical Audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Involving patients in dermatology clinical audit activities is fundamental to good quality improvement practices and provides a different perspective from that of clinicians.

The Healthcare Quality Improvement Partnership (HQIP), an organisation commissioned by the DH and NICE to re-invigorate clinical audit and improve quality in clinical care, has collaborated with National Voices (an organisation that brings together a coalition of voluntary sector organisations) to produce guidance on Patient and Public involvement (PPI) in Clinical audit.

Their guidance provides the following information:

• How to best involve and engage patients
• Examples of good practice in PPI identified from an HQIP mapping project which identified a number of clinical audits that have practised effective PPI with successful outcomes.

HQIP has also produced guidance for patients which dermatology audit teams may use when involving patients in clinical research.

The Department of Health is developing a set of guidance on clinical governance for clinical governance practitioners including clinical governance leads in commissioners and providers, leaders of clinical divisions and teams, and individual clinicians.

It will provide convenient access to guidance on a number of recent developments, including medical revalidation, responsible officers, clinical performance issues and the new system of death certification. It will also include separate guidance aimed at commissioner and provider boards.

Dermatology consultants can collate feedback obtained through indirect sources to proactively engage with and respond to patient concerns and improve patient care, as part of wider patient involvement strategy.

Patient Advice and Liaison Service

The Patient Advice and Liaison Service (PALS) at your trust has a vital function in supporting patients to navigate through the health system and have a role in seeking the views of service users, carers and the public to ensure that services are effective in meeting patients needs. They provide service users with on the spot help and listen and seek to resolve service user concerns. They can also diffuse potentially difficult situations and facilitate co-operation between service users and staff.

PALS can therefore act as a catalyst for change and improvement by providing the departments with regular information and feedback on problems arising and gaps in services. Dermatology consultants can liaise with PALS to understand what queries and concerns they have received from patients relating to dermatology services, work with them to resolve recurrent issues and put in place arrangements to prevent further issues.

Reviewing complaints and compliments

Patients may contact your service directly to make a complaint about the service that they have received, or alternatively they may contact the local primary care trust from which your service has been commissioned from. Complaints are a rich source of feedback that can be used constructively to improve the quality of services as well as demonstrate that the concerns of patients are being listened and being responded to.

Similarly patients may want to make positive comments on the care and services that they have received.  Reviewing compliments received are just as important because they can be used to inform commissioners which factors are contributing to a good experience for patients.

NHS Website (formerly NHS Choices)

The NHS website has introduced patient feedback for NHS services in England including hospitals and GP Practices. This allows members of the public to post comments about their experience of individual NHS services – which can include their experience of accessing hospital based dermatology services – and helps them make informed decisions about their healthcare.

Patient comments also help providers assess their level of service and make changes where necessary. Furthermore, as well as reviewing the results and outcomes of national and local patient surveys, the Care Quality Commission will also review patient feedback posted on NHS Choices and how individual departments have responded to them as part of the process of demonstrating that providers are actively engaging with and responding to patients.

The NHS website has produced a summary guide about how best to respond to patient feedback.

Links for further information

• The NHS website (formerly NHS Choices)
• Patient Advice and Liaison Service (PALS)
• Care Opinion – Independent feedback website (formerly Patient Opinion)