User Involvement

User involvement has become a fundamental aspect since the Health and Social Care Act stated NHS reformation due to the Francis, Keogh and Berwick Reports. The NHS constitution states the rights of the patient, what the NHS promises to provide and what patients should expect from the NHS.

"The NHS belongs to us all" - The NHS consitution

User involvement ensures this is the case.

It improves patient care, experience and outcomes alongsidge hospital services, accountability, partnership between patients and providers. Users include Patients, Relatives, Carers, Friends and representatives.

There are several forms of involvement:

• Informal - through comments and suggestions
• Formal - Surveys, PALS, Service User groups, Patient representation on hospital committees.
• Statutory - Complaints to Trusts, involvement on Healthwatch England or Foundation Trust Governors boards

User Involvement gives service users a voice; it gives value to the patient's opinion to implement change within the NHS. Patient Led Assessment of Clinical Environment allows for the fact that often, hospitals and it's staff can become blind to problem areas, whereas service users have the ability to see areas which could be improved for the sake of both patients and staff. It allows for openness and transparency - user involvement can be used as a platform to promote ideas, complaints and response.

"Expert Patients" can be involved on the CQC inspection boards which regulate the quality of care provided by hospitals. Patients can be involved in the design and delivery of services and influence change within services for a better, safer NHS.

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Structure and services of the NHS

The structure of the NHS is so that service users are at the centre of everything we do.

There's the Governmental sections:

Department of Health - Creators of policies, legislation, law 

Parliament - Passes these laws

The Non-Departmental and Regulatory Bodies:

NHS England - Set out from the Health and Social Care Act'12

 runs the day-to-day life of the NHS including finances and budgeting

 Care Quality Commission - Regulate all NHS services through inspection 

to ensure they meet protocol, law and legislation 

 Monitor - Regulate all Foundation Trusts through inspection

 to ensure they meet protocol, law and legislation

 Health Research Authorities - Regulates research within the NHS to protect patients,

 ensures evidence based practice.

The National Organisations: 

Clinical Commissioning Groups - Commission Any Qualified Provider 

for patients to choose their care from.

HealthCare Professions Council - Provide protected-title registration for

 Healthcare Professionals who meet their standards.
Healthwatch England - Local health groups which raise awareness
of patient's concerns to the CQC 

The Local Services:

Primary Care providers - Provide prevention, advice and

 initial treatment (GP's, Dentists)

Secondary Care providers - Provide acute treatment (Emergency Departments)

Tertiary Care providers - Provide care for chronic illnesses (Oncology departments)

Finally, the most important:

Service Users - Patients, Carers, Family and Friends.

The White Paper'10

The NHS has committed to constantly improving it's services to provide the best care possible, best value and better efficiency. The White Paper (2010) set out the NHS to become more efficient and less bureaucratic. The White Paper changed Primary Care Trusts to Clinical Commissioning Groups of general practice, who are responsible for choosing and buying health services from AQP's. £80 billion of the NHS budget will be held by GP's (who need to be trained in financial and managerial aspects of commissioning). CCG's allow for more user involvement when planning service delivery and allow the patients to have a better choice of care. Also, by allowing healthcare services to be commissioned away from the NHS, it increases motivation within departments to be better, so that the patient would choose their service.

The Patient Advice and Liaison Service (PALS)

PALS provides general advice to patients about their care, but also is platform for patients to raise concerns and complaints about the care they have received. Every hospital must have a PALS department, and must advertise it's existence and encourage it's usage. 

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Leadership within the NHS

Lack of leadership within the NHS has been highlighted in reports such as the Francis, Keogh and Berwick.

Well established chains of command, structure and management is important within a healthcare organisation, however, individual leadership of all staff members is also vital to establishing a well-motivated and efficient National Health Service. 

The difference between management and leaders? We're all called to be leaders.

Managers administer and maintain previously existing views and is very much focussed on the system and control, with a short term view. They ask the questions such as "How?" and "When?"

Leaders innovate and develop ideas whilst inspiring trust; they're more people focused and look to the long-term. They ask questions such as "What?" and "Why?"

Organisational culture, the shared attitudes and values of an organisation and it's members, gives the NHS, it's departments and hospitals, a sense of identity. By individuals having leadership qualities, they can aim to affect the management style which is effective to the group, the organisation's decision making processes and it's determinants of success. 

Previously, the NHS was focused on:

• The needs of the business
• Functional aspects of care
• Efficiency, productivity and clinical outcome
• There was no emphasis on feedback
• Management (not staff) empowerment

Transactional leadership was the main method of organisation. This involved emphasis on the chain of command, authority and obedience to such, target meeting and based on a reward/punishment scheme. 

However, since 2011, the aim is to be:

• Patient focussed (with user involvement in planning of pathways and service provision)
• Relational and emotional aspects of care 
• Staff experience and empowerment
• Integrated care
• Better feedback handling
• Better information sharing

By the NHS being supporting leadership within the NHS, they are empowering staff to become more proactive, innovative and involved. This moves the NHS towards Transformational leadership, this is where a leader adopts and expresses the whole group's goals and values, it enables us to advance one-another in best practice, it allows for intellectual stimulation with greater emphasis on Continuous Professional Development and takes into account each individual's needs. Transformational leaders become influential through respect instead of necessity, they inspire motivation through a clear vision.

Professional Autonomy teaches us to challenge and question, to implement change and audit the effectiveness of our practice. This increases higher standards and gives each individual a voice -thereby bringing a cudltral change. This change is represented through the Healthcare Leadership Model  

This model brings leadership through a change in care, by sharing the vision of the NHS and integrating our services with better communication and information sharing. 

We're accountable to our actions as Healthcare professionals - so why not make those actions make a difference?

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