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The bottom line

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7 September, 2009

At weekends when running around Hyde Park I pass every person imaginable: pregnant women, older people, people in wheelchairs, children, babies, homeless people, people talking to themselves, people drinking, people doing tai chi, other runners, cyclists and the list goes on… 

 

People are the reason we all come to work, this is the bottom line regardless of our position or level.

 

It might be unpalatable to even suggest this, but I suspect that there are days when many of us do not even consider a patient; I don’t mean purposefully, but it can be quite easy with the enormity and pressure of the agenda to get carried away, which is strange considering the agenda should be the patient.

 

I first met Professor Bob Sang a few years ago during the selection process for The Health Foundation Leadership Fellows and then got to know him better when he would attend our sessions, always ensuring the patients’ perspective was present. Bob was the first Professor of Public and Patient Involvement in the UK.   Bob very sadly and unexpectedly died in early June and at his memorial service one of the speakers said that there was always a risk with the Leadership Fellows (or any leadership programme) of creating a programme where a number of individuals could focus on and better their own careers without focusing on what was important, yet the point of any leadership programme in healthcare is to ultimately influence and improve the quality of patient care.  

 

Bob’s input by ensuring the patient was at the centre of our discussions was hugely important; it was not a token gesture, lip service or ‘just enough’ to tick a box.  In each seminar we had a number of Patient Quality Advisors who would challenge us all in different ways to how we would challenge each other and in an entirely different way to how we had been challenged before.  The Patient Quality Advisors were patients or relatives of patients, some of whom were living with long term conditions, some of whom had been or were users of the service; some were more candid than others, some were quite challenging but all made the discussions richer.   

 

I think it took us a bit of time to get used to having them involved; often they were supportive of our efforts and ideas but they also challenged hard, if I’m honest at times they irritated us, at times you could say that their comments were almost inappropriate and at times they didn’t understand what we were trying to achieve or why something was important, but what a significant difference they made.  I knew this at the time but it’s only since Bob’s memorial that I think I’ve really realised just how important and how significant this was.  

 

I didn’t know Bob well but he seemed to be a very genuine guy; clearly infuriating at times but one of those people with a massive heart who strove relentlessly to do the right thing.  Bob’s obituary in the Guardian mentioned that he had to leave a couple of jobs and faced disciplinary measures in his early career for taking the ‘side’ of the user.   Some might think this wasn’t entirely sensible and perhaps it’s not, but sensible or not, it is brave and impressive and I respect him for it.

 

Bob had an amazing ability to put people in touch with others and to network. I urge you to look at both his Facebook Tribute Page and the Health Policy Insight Editors Blog and read some of the comments to see how many people he affected.  This shows just how remarkable he was.  The links are as follows: www.healthpolicyinsight.com and www.facebook.com/pages/Bob-Sang-Tribute-Page.

 

I was inspired a few months ago by Mary Hinds (the then Director of the Royal College of Nursing, Northern Ireland) with her expression ‘what’s best for Ester’. Ester is your mother, father, grandparent, child, sister, brother, work colleague, neighbour or friend.   Every decision we make should be one which impacts on Ester, if it doesn’t either directly or indirectly impact should we be doing it?  I wonder how many of us, if we asked ourselves that question today, could honestly say that everything we are working so hard on impacts in some way on Ester. 

  

Bob has left a very large gap; I had no idea about the scope of his influence or the variety of his networks, and whilst I always knew he was a true advocate of the patient voice I wasn’t fully aware of his unfailing dedication and perseverance until after he’d passed away, and for that I feel truly sad.   At least I appreciate it now and know that Bob’s challenge to us from above would be to ensure genuine patient involvement.

 

Patient involvement must not be lip service, a tick box exercise or a token gesture; we have a responsibility to ensure that patients are integral to the running of health services, even if it is uncomfortable or even inconvenient at times.  

 

RIP Bob

Readers' comments (3)

  • Encouraging users to also view themselves as owners of the service is a useful way to align the interests of patients with maximising the use of public funds. This concept of mutuality (we all need and we all own the NHS) is at the core of current Scottish Health Policy.

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  • Bob sounds like a real ambassador for patient-centred services and a really sad loss to the NHS. The big question is, how do you replace Bob and clone him to sit in every innovation discussion going on in the NHS? Well, obviously you can't do that, but there's lots that can be done. I love the example of Ester. What you're basically describing is a pen-portrait. These offer great ways of capturing a key customer demographic and focusing attention on them, but they can be a bit arbitrary. I've had many arguments about whether someone's aunt would use x,y,z services! I'd recommend developing personas for particular services - evidence based explorations of typical target service users. They really help galvanise a group around service design by focusing the debate down to something tangible.

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  • Thank you for the mention, Kate. Bob Sang's obituary on Health Policy Insight is at http://www.healthpolicyinsight.com/?q=node/298

    His final article written for HPI is at http://www.healthpolicyinsight.com/?q=node/304

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From The Pearl Catcher

Kate Hall is a Health Foundation Leadership Fellow and has specific interests in leadership and quality improvement.  

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