NHS Reset: Community engagement? Don’t they know there’s a pandemic on! | Alex Stewart


NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic. 

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Alex Stewart tells us how Healthwatch has embraced the changes brought on by the pandemic to work collaboratively across health and social care.

The advent of COVID-19 has necessitated that all acute trusts create capacity in order to save lives. In order for this to continue, it requires engagement with clinicians, care sector leaders/providers, politicians and the general public to ensure that we do not regress back to ‘form’ but embrace the ability to make integrated care a true and meaningful reality. This will require collaboration and a willingness to transgress historical and hierarchal boundaries across health and social care.  

Love us or loathe us, Healthwatch organisations around the country do an amazing job representing the needs of patients and carers working across the aforementioned boundaries of health and social care, and cover from pre-birth to death. During COVID-19, Healthwatch Norfolk has been running online surveys to gather information from patients and carers about their experiences of living with lockdown, accessing appointments or not, as the case maybe. Findings have been reported back to various commissioners, acute and community trusts as well as NHS England and NHS Improvement.

Recognising that we have the opportunity to embrace change, Healthwatch has been grasping the nettle and working on ways in which to help systems improve through collaboration. 

A particularly good example of collaborative working is taking place between Healthwatch Norfolk and the Queen Elizabeth Hospital in King’s Lynn (QEHKL). In October 2018, the CQC rated the hospital inadequate and a new management team was brought in to deal with the 206 actions which consisted of a combination of conditions, must dos and should dos.

From the outset, it was recognised that patients needed to be at the heart of transformation, as well as a change in the mindset of staff that just because “we’ve always done it that way” didn’t mean that was necessarily the best way. Healthwatch provides regular reports to the trust’s chief executive and meets with her and members of her team on a regular basis. From a patient perspective, we have been pleased to notice an upward trend in patient satisfaction with a star rating out of five (one being lowest) rising from two to 4.5 and remaining at that level for the past two quarters.

Complacency is no longer a word that is used in QEHKL. The trust, along with Healthwatch, has identified a number of areas where more information is required in order to help continue to drive improvements, thereby achieving better patient outcomes and, in turn, potentially saving the NHS money – earlier coordinated discharge, fewer 90-day readmissions, etc. For example, staff have, in the past, not always been aware of the need to assess a patient’s capacity to consent to care and treatment and there has been confusion as to when a mental capacity assessment should be undertaken.

Healthwatch has proposed and it has been agreed that an observational approach to engagement is undertaken across both in-patient and out-patient care. The Healthwatch team will be made up of a mixture of staff and volunteers – the knowledge base consists of recently a retired consultant radiologist, consultant oncologist, a community paediatric director of nursing, a former CCG chief executive and Healthwatch Norfolk chief executive alongside staff who are experienced in health and social care. They will be triangulating various codes of professional standards and utilising the 15 steps approach, along with undertaking a survey of all patients admitted within the last six months. This will cover issues which we know are important to people including treating people as individuals, having their dignity upheld and listening to them, and responding to their preferences and concerns.

Through undertaking observational engagement in a systematic way, the insight and intelligence data gathered can be used by the QEHKL as a means to continue to improve patient care and increase satisfaction levels. Furthermore, it can ensure that staff are enabled to articulate their concerns and suggestions for improvement.

In so doing, they will be dealing with pre and post COVID-19 which will allow the potential to frame findings and provide the trust with a quantitative analysis against qualitative evaluation.

Why this approach? It demonstrates to both staff and patients something that we all frequently forget; we work in a multi-disciplinary and functional environment and, whilst there are management structures in place, we all have a collective responsibility to ensure outstanding patient outcomes.  

This piece of work will be taking place from July through to the end of December with Healthwatch Norfolk providing a full report of its findings to the QEHKL in October.

This work shows how services can collaborate with Healthwatch to get a view of patient experience at the time. By working together, we can support services with the issues that are important to them. The response to the pandemic has seen many changes – implemented with great speed and with little engagement or consultation – but our approach is one way that services will be able to test out what the changes mean in day-to-day practice.

Alex Stewart is chief executive at Healthwatch Norfolk. Follow them on Twitter @HWNorfolk    

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