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MINUTES OF THE PATIENTS FORUM MEETING HELD ON 18TH JANUARY 2001 AT THE CONSUMERS’ ASSOCIATION 1.
Present: Clara Mackay
– Chair (Consumers’ Association); Jonathan Ellis (Help the Aged);
John Tait (Residents and Relatives Association); James Appleyard (BMA);
Mark Paulson (GMC); Irene Mackay (The Coeliac Society); Geraldine Amos
(Home from Hospital); Marianne Rigge (College of Health); Alison Soliman
(Dementia Relief Trust); Micky Willmott (Age Concern England); Gerry
Mahaffy (Princess Royal Trust for Carers); Les Hill (National
Association for Patient Participation); Brian McGinnis (MENCAP); Penny
Banks (King’s Fund); Emma Bartlett (Diabetes UK); Nikki Joule
(Neurological Alliance); Diana Basterfield (in attendance, Patients
Forum) 2.
Apologies: Judy Wilson (LMCA); Rohana Mohammed (LMCA);
Eileen Nelson (Royal Pharmaceutical Society); Debbie Smith
(Anchor Trust); Barbara Brewster (Sickle Cell Society); Eva Jacobs
(Patients Forum Treasurer); Barbara Meredith (Age Concern London); 3.
Minutes of the previous meeting: Agreed. 4.
Matters arising: on agenda
or in Chair’s report 5.
Clean Hospitals Project: Clara referred to a letter she had received from NHS
Estates about their Patient Environment initiative and the Clean
Hospitals and Food initiative where they had requested input from
patients groups. She felt
it was important that a wide range of patient interests were represented
and put forward. There were
specific issues relating to e.g. the elderly, people with mental health
problems and people with learning disabilities.
She had felt it would be very useful to have a discussion with
Patients Forum members about these initiatives and to take the key
points from the discussion to the forthcoming meeting with NHS Estates,
which several members would be attending.
She had asked Jonathan Ellis to kick off the discussion by doing
a presentation on the Help the Aged campaign around “Dignity on the
Ward” as this was particularly relevant and a good starting point for
discussion. Jonathan said he was
the Campaign Organiser for the “Dignity on the Ward” campaign.
In the context of the Clean Hospitals work he thought it would be
useful to give some of the background and to use the campaign as a
starting point for the new initiative.
Help the Aged launched the campaign in January 1999 and from the
beginning they had wanted to make sure that what they were campaigning
for was what mattered to older people themselves.
They had spoken to older people all over the UK about their
experiences of hospital care and listened to their ideas about what
could be done to improve things.
One recurring comment was “let’s bring back the matron.”
This was far from being sheer nostalgia.
As they had probed into the reasons for this they had discovered
that one of the underlying issues was standards of cleanliness.
In the two years that the campaign has been running (it comes to
an end in February 2001) they had received well over a 1,500 case
studies from older people, their relatives and their carers, which had
helped to identify the key issues that people want Help the Aged to
campaign on. Fairly high on
the list of priorities was standards of cleanliness and hygiene, higher
even than the continued use of mixed sex wards.
People had described their absolute disgust at the state of some
wards. One of the biggest
clinical challenges facing hospitals was the management of
hospital-acquired infection. Last
year, before the NHS Plan was published, the National Audit Office had
estimated that there were some 100,000 infections occurring within the
inpatient population every year. In
other words, almost 1 in 11 patients had acquired an infection while in
hospital at a cost of many hundreds of millions of pounds.
Not all cases of infection arose from poor standards of hygiene
and cleanliness but the National Audit Office had said there was
certainly room for improvement in a number of different locations.
The Clean Hospitals initiative could, then, save the NHS
considerable sums of money and new guidance on infection control was
currently being developed.
The proposals were set
out in Chapter 4 of the NHS Plan – Investment in NHS Facilities.
This talked about getting the basics right and set out a
programme of work that was being developed and overseen by NHS Estates.
The Plan acknowledged that patients had perceived a major
deterioration in cleanliness and provided:
£30 million of immediate investment; an immediate nationwide
cleanup campaign; a series of unannounced inspections; new standards of
cleanliness that would form part of the permanence standards framework
by the end of the year 2000; new authority for Ward Sisters and Charge
Nurses to take responsibility for cleanliness and moves to encourage
domestic staff to be seen and treated as part of the wider ward team,
rather than as an auxiliary service; renegotiations of cleaning
contracts with external companies by Trusts would reflect the new
responsibilities by ward staff and a member of the Trust board would be
nominated to take overall responsibility – the so-called
“Environment Champion.” There
would also be a new role for Patients Forums in inspecting facilities
for their standards of cleanliness.
Finally, standards of cleanliness would be included in the
rolling programme of reviews and inspections that the Commission for
Health Improvement would be carrying out.
The previous day (17th
January) the government had announced an additional £31 million on top
of the £30 million that had been allocated in summer 2000. This would
seem to indicate a certain level of commitment. Immediately following
the NHS Plan, a letter was sent to all Chief Executives outlining
exactly how much of the one-off additional money they would be getting,
based on the size of the hospital under their management.
The letter also outlined the action they would now be expected to
take - with tight deadlines.
There was a new
programme, the Patient Environment Programme, spearheaded by NHS
Estates, set up to look at the environmental issues and to implement
many of the components of Chapter 4. It was designed to provide
hospitals with support and develop a framework within which standards
could be raised. There were a number of
overall objectives including creating hospital environments that would
be well-regarded by patients, visitors and staff, providing patients
with opportunities to give feedback on the environment, highlighting and
enhancing the status of staff, giving control over cleanliness, setting
up a system that evaluated current and future standards and providing
hospitals with best practice advice etc.
The programme’s
priorities for the 2000 –2001 financial year involved establishing a
framework for putting cleanliness on the performance agenda.
There were Patient Environment Action Teams drawn from a list of
over 100 NHS professionals, representatives from commercial
organisations providing cleaning services to the NHS, CHC members and
Patients Association representatives.
Each team was made up of three people and was responsible for a
schedule of hospital visits.
These teams had been visiting hospitals since last August to
review the action plan that the hospital had drawn up and to see how
well they were doing. The focus of these
inspections was the patient’s perspective rather than technical
standards of cleanliness. By the middle of
January 700 hospitals had been visited.
The Patients Association reported that 250 were given red status,
291 were classed as yellow (progress developing) and only 158 met the
criteria for agreed status. The
Patients Association, in particular, was concerned about the level of
variation in standards of cleanliness around the country and also within
hospitals. There was alarm
that so many hospitals were so obviously failing to provide basic
standards of cleanliness and hygiene. One hospital in each region was awarded beacon status and
would serve as a reference for other hospitals.
Those beacon hospitals would also be involved in developing the
new national standards over the next couple of months. Some of the areas being considered were:
entrances and reception areas, internal decoration, the use of
signs, visitors toilets, the number of smells, internal cleanliness,
quality of furniture, quality of linen, presentability of support
service staff, grounds and gardens, external cleanliness, external
decoration, car parking facilities and the general overall appearance.
Each of these 14 aspects of cleanliness and tidiness had minimum
standards against which hospitals performance would be assessed.
Jonathan said the
process was moving incredibly quickly and by April this year it was
planned that all of the basic remedial action would have been taken,
painting and decorating programmes should have been finished, broken
furniture should have been replaced and hospitals should start to feel
more welcoming. On top of
this would be a national network of “Environmental Champions”
working to promote best practice and also to develop the standards that
would be part of the national performance programme. The second year of the
programme, starting in April, was going to focus on the further
development of national standards, developing the traffic light system
of assessment, establishing a programme of training and development for
support staff and managerial training for supervisors, including ward
staff who were now taking on this extra responsibility.
The previous day (17th January) the DH had announced
plans to implement the proposal that ward sisters be given authority to
deal with standards of cleanliness, including the ability to spend up to
£5,000 from the budget on painting and decorating, furnishings etc.
They would be able to buy direct from suppliers. Jonathan concluded by
saying that Help the Aged thought good progress was being made but would
like to see a broader interpretation of “environmental improvement.”
For example, the Royal Institute of British Architects had been doing a
lot of work over the last 18 months with NHS Estates looking at
developing therapeutic environments and at the design of hospitals.
Such ideas were largely missing from the current programme.
Following discussion,
and members giving examples of some horror hygiene stories, Clara
referred to the letter she had received from NHS Estates.
This had asked two specific questions which she put to the
meeting: 1. Was there sufficient interest in the work of
NHS Estates to form a small working group called the Patients
Representation Group, to act as a ‘sounding board’ to discuss the
development of improvements to the patient environment?
The meeting
agreed there was sufficient interest.
2. How can NHS Estates
engage the members of your organisation to construct appropriate
channels or feedback on our work? Clara said she had
already received reports from some organisations on projects they had
undertaken; she suggested that through the Patients Forum, such reports
be collected and forwarded to NHS.
In turn NHS Estates be asked to provide feedback on the work they
were doing. She added
that she would take the points raised during the meeting to the NHS
Estates meeting. She asked
organisations interested in joining the NHS Patients Representation
Group to get in touch with her. 6.
Chair’s report: (a)
Patient and Public Involvement Project:
Marianne Rigge, Judy Wilson and Clara had been working together
to put a proposal to the DH to get some funding to do some scoping work
around the need for a national patient body.
Alan Millburn in his speech on the Bill had said that he
supported this work. Initially
the budget had been very small, £10,000 but today (18th
January) she had heard that the Department had increased this to £20,000.
Clara felt this was partly because the Department wanted the work
completed quickly and this would enable extra resources to be brought
in. The current
position was that individuals and organisations were being asked to
participate in an Advisory Group.
The letters had only just gone out so she felt it would not be
appropriate at this stage to mention names.
In addition to the Advisory Panel and the Steering Group, it had
been made clear to the Department that the Project was committed to
consulting widely and that there would be many opportunities for
individuals and organisations to provide input.
Once everything was in place, a briefing package would be
circulated to all members. The timescale for the completion of the report was the end of
March. (b)
Communication: Clara
said that with the speedy implementation of the NHS Plan and people
being co-opted onto boards, task
forces, working groups etc there hadn’t been time to put in place
communication channels to enable information to be fed in and fed out.
This made it very difficult to get a grip on how the
implementation of the Plan was coming along.
She proposed that after the Patients Forum conference there
should be a Patients Forum project looking to develop appropriate
communication channels. This
was agreed by the meeting. (c)
Health and Social Care Bill. Clara
circulated notes from two meetings held at the DH earlier that week with
members of the Bill drafting team covering social care and patient
representation. She also
provided notes from the meeting held at the Consumers’ Association the
previous Friday (January 12th); this had looked at the social
care aspects of the Bill, the pharmaceutical pilot schemes, the public
private partnership and patient information.
She also included notes from a meeting of patient groups held at
the BMA earlier that week hosted by POPAN and the BMA Foundation for
Aids where concerns had been expressed about Clause 59 of the Bill
around consent and confidentiality and new powers for the Secretary of
States to override Common Law. In discussion members
expressed serious concern about any moves to override patients’ power
of consent and the misuse of patient records.
Article 8 of the Human Rights Act – the right to privacy –
was referred to. Clara
asked Jonathan Ellis to briefly outline the parliamentary process.
He said that the Standing Committee was meeting for the first
time that day and the membership was now known. The Committee would meet
twice a week between 18th January and 8th February (7
meetings). The first
meeting would look at the order in which clauses would be taken and set
the programme with the less contentious clauses likely to be taken
first. Issues
relating to patient representation and CHCs would be likely to be
discussed at the meeting on January 30.
He anticipated that the Government would want the Bill to have
cleared the Commons before the General Election.
Organisations putting
forward amendments to the Bill or lobbying MPs then gave brief outlines
of the issues they were covering. The
meeting agreed that Clara should send members of the Standing Committee
the original Patients Forum briefing on the Bill with additional points
on social care and patient information.
In her original covering letter to the Secretary of State she had
said that many member organisations had particular expertise in
areas covered by the Bill and that MPs should be encouraged to draw on
this. She also
suggested that amendments being put forward by member organisations
could be put up on the Patients Forum website. (d) Guide to the parliamentary process. Clara said that the current Bill had drawn attention to the need for an “Idiot’s Guide” to the legislative process and how it can be influenced. Barbara Meredith had recommended a UK website that provided much of this information: www.citizensconnection.net. The following excerpt on parliamentary bills has been taken from the site: “The
stages of a parliamentary bill
A
similar sequence is then followed in the House of Lords.
If
the Lords amend the bill then it goes back for the Commons to consider
the amendments. If the Commons does not agree to the Lords changes, or
does so with amendments, the Lords again consider the bill. (e)
Date of next meeting: Thursday 18th
March
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| Last updated 14/5/2001 | © The Patients Forum 2001 |