Changing the culture: patient advocacy service, Brighton Penny Dunman has worked as patient advocate at Brighton Healthcare trust for over seven years.During that time, she has championed the concerns of many patients and helped to defuse a few time bombs.

But the secret of her success, she believes, is retaining the confidence not only of patients but also of staff.

When she was first appointed, she recalls, she faced enormous hostility and suspicion from many staff.It was only when she had gained their trust that she began to make significant progress.

'Everybody knows that the patient advocate is there for the patient, but that doesn't mean you're against the staff, 'she says.'If you're wanting to change the culture, the only way you're going to do that is making people feel they're valued - both patients and staff.'

For the same reason, Ms Dunman does not believe the patient advocacy service should be totally independent of the trust - though all patients should have the option of going to an outside agency for help if they choose.

Her experience suggests very few people will take this route if the internal service does what it is supposed to.She has seen over 7,000 patients during her time at Brighton, and only two have asked to go elsewhere initially.

She has noticed that more patients threaten litigation and seek financial compensation these days.But overall she feels people are more realistic about what can and can't be achieved.

'When I first came, the Patient's Charter was out and people waved that at me a lot.Now people are incredibly long-suffering about the struggling NHS.Having said that, they are very assertive about the things that they know are not right.'