Recommendation 238

Communication with patients

Accepted

Regular interaction and engagement between nurses and patients and those close to them should be systematised through regular ward round:

  • all staff need to be enabled to interact constructively, in a helpful and friendly fashion, with patients and visitors
  • where possible, wards should have areas where more mobile patients and their visitors can meet in relative privacy and comfort without disturbing other patients
  • the NHS should develop a greater willingness to communicate by email with relatives
  • the currently common practice of summary discharge letters followed up some time later with more substantive ones should be reconsidered
  • information about an older patient’s condition, progress and care and discharge plans should be available and shared with that patient and, where appropriate, those close to them, who must be included in the therapeutic partnership to which all patients are entitled

All staff need to be enabled to interact constructively, in a helpful and friendly fashion, with patients and visitors.

As part of its mandate for 2013-2015, the government has asked Health Education England to work with healthcare providers, regulators and educational institutions to ensure both recruitment and selection for training curricula identify and reinforce the values and behaviours identified in the NHS Constitution.

Where possible, wards should have areas where more mobile patients and their visitors can meet in relative privacy and comfort without disturbing other patients.

The Department of Health’s Health Building Note 04-01, published in December 2012, provided best practice guidance on the planning and design of in-patient facilities for adults. The Note recognises the need for breakout space and informal social space to enable patients to socialise, and interview rooms for more private discussions. Planning decisions should take account of privacy, modesty and same-sex accommodation.

As part of the implementation of the Prime Minister’s Challenge on Dementia, on 25 July 2013 the Secretary of State for Health announced details of the 116 successful projects, 42 projects within the NHS (including hospital wards) and 74 within a local authority setting (including care homes) awarded a share of a £50million fund to create pioneering care environments designed with the needs of people with dementia in mind.

Funding was awarded to projects that demonstrated how practical changes to the environment within which people with dementia are treated will make a tangible improvement to their condition. Evidence and findings from these projects will be gathered and developed into policy and to inform best practice guidance for the NHS and Social Care providers.

The many strands of work to implement the government’s information strategy for health and care in England are beginning to bring improvements for patients and services, for example being able to book appointments and order repeat prescriptions online and communicate electronically with health and care professionals.

As it becomes more normal to communicate with our health and care professionals in ways that suit our own circumstances and interact with health and care services electronically, the Department would expect this change to extend to increasing use of technology for appropriate communications with carers, families and relatives. The Information Strategy published in 2012, the Power Of Information, set out an ambition that “we need to be able to communicate with our health and care professionals in ways that suit our own circumstances.’ It referenced the example of online care plans in Graham Care Group homes, as follows:

“Following initial trials at Rodwell Farm Nursing Homes, all residents in the Graham Care Group homes, their relatives and friends can now access securely current care plans and daily reports via email, internet, iPhone etc. Designated contacts can receive text alerts or emails notifying them that updates have been uploaded. The newest and most innovative part of the system allows families and friends to use a text-based system to supply information, photographs etc, which designated care staff will share with residents. The system is being evaluated by the University of Surrey.”

The currently common practice of summary discharge letters followed up some time later with more substantive ones should be reconsidered.

Information about an older patient’s condition, progress, and care and discharge plans should be available and shared with that patient and, where appropriate, those close to them, who must be included in the therapeutic partnership to which all patients are entitled.

The government proposes that the most vulnerable elderly would benefit from having someone in primary care taking responsibility for ensuring that their care is coordinated and proactively managed. Just as patients in hospitals are under the care of a named consultant, we need to ensure that when a vulnerable older patient needs follow-up or ongoing support having left hospital, that somebody is accountable for their care. Although this clinician may not provide the care directly themselves, they would be the person with whom the buck stops and would be an identifiable point of contact for a patient or their family.

The government has been testing its proposals over the summer through engagement with patients, carers, health and social care staff, and will be setting out its plan for improving out-of-hospital care for vulnerable older people in December 2014. This was reflected in the refreshed the Government’s Mandate for NHS England for 2014/15.

In its initial response to the inquiry, Patients First and Foremost, the government committed to draw up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with the Care Quality Commission.

More needs to be done to involve people in their own care and therefore statutory guidance for clinical commissioning groups on involving patients in planning services and in their own care has been published by NHS England along with a set of supportive tools. By December 2013, 80% of clinical commissioning groups will be commissioning support for patients’ participation and decisions in relation to their own care or will have a plan to do so. This will include information and support for self-management, personalised care planning and shared decision-making.

In October 2012 the Royal College of Physicians and the Royal College of Nursing published joint guidance titled: ‘Ward Rounds in medicine: principles for best practice.’ The guidance is available here and includes principles that highlight the importance of regular ward rounds, full multi-disciplinary engagement and attendance, and sharing of information with a patient’s relatives and carers.

Update

Health Education England has begun to promote the assessment of values as part of the recruitment process into NHS employment with the intentions of evaluating the impact recruiting for values has on the system. In support of this, Health Education England developed three work streams: recruitment into NHS funded training programmes; recruitment into NHS employment; and evaluating the impact of recruiting for values.

During October 2014, Health Education England published the national Values Based Recruitment framework, which functions as an interactive resource including the evidence base, case studies and available resources. The resources NHS Employers have published to date are incorporated within the Values Based Recruitment framework, which is intended to run until March 2015. Following the publication of this document, further workshops, case studies and resources will be published. In addition, work will continue to support organisations with their Values Based Recruitment projects and for NHS Employers to maintain the partner network. As local Values Based Recruitment projects develop, the national programme will flex to accommodate the framework’s needs. For employers, Values Based Recruitment will not be mandatory but will be recommended as best practice.

As part of the implementation of the Prime Minister’s Challenge on Dementia, on 25 July 2013 the Secretary of State for Health announced £50million fund to create pioneering care environments designed with the needs of people with dementia in mind. An evaluation of the projects will published shortly, and in March 2015 the department will publish the best practice Dementia Friendly Environments Health Building Note guidance.