Abstract
West London NHS Trust provides acute inpatient mental health services for a population of around 1 million residents of three boroughs. Admissions are to nine wards across two hospitals. The majority of patients are admitted involuntarily under Mental Health Act. The Trust has historically found it challenging routinely to gain meaningful feedback to inform service improvements using established methods.
In 2022 Your Voice in Health and Social Care (YVHSC), the provider of Healthwatch in the three boroughs, was commissioned to deliver an inpatient engagement project. Healthwatch has a statutory function to obtain views of local people to support scrutiny, and to make recommendations about improvements. The Trust’s investment provided additional capacity for YVHSC to inreach and provide detailed regular feedback.
Approach: YVHSC recruited volunteer experts by experience (EBE) to undertake engagement, and provided training, support and debriefing.
EBE visited each ward once per month and undertook one-to-one discussions with consenting inpatients using a co-designed structured questionnaire to gain qualitative feedback. The questionnaires were adapted each month in light of emerging themes.
YVHSC analyses responses and feeds back themes and recommendations on a frequent basis.
Results: YVHSC reported conducting one-to-one discussions with inpatients is often challenging. Some questionnaires were not fully completed due to the patient’s willingness or ability to answer questions. Some of the patients in the mental health units are initially acutely unwell and the EBE reported observing responses varying depending on the patients’ stage of recovery.
In total, 531 responses were received between June 2022 and April 2024. During this period there were ~2715 admissions, therefore and this represents feedback from ~20% - substantially higher than rates of feedback elicited through other routes.
Data gathered by Healthwatch produced 8 themes, accompanied by (to date) 30 patient ideas for improvement and 31 Healthwatch recommendations. Each of which has been acted upon and/or responded to using a “you said… we did” approach.
Themes:
•Staffing and staff attitude
•Facilities and surroundings
•Treatment and care
•Medication
•Availability of information and support
•Ward activities
•Continuity and integration of care
•Dignity and Respect
Examples of interventions implemented as a result of the feedback provided include:
•‘Getting to know you’ staff information boards fitted
•Increased staffing and protected interaction time
•Dedicated ward domestics
•Patient-led menu design
•Coproduced admission induction packs
•Patients allocated keys to secure bedrooms
•Activity programme, including fresh air, gym and hairdressing/beauty
•Improved information on illnesses and medicines in multiple languages/formats
•Improved communication with community teams to plan discharge
•Nicotine replacement/advice
Implications: Patients and ward leaders have been positive about using this approach to receive real-time feedback about service user experience in this setting. The evolving co-designed approach works to collect information and implement meaningful changes. The Trust has agreed to extend the programme for the foreseeable future. The work has been presented jointly with Healthwatch at Council meetings, and it is hoped this approach will be extended to other services and similar organisations.