Heard mentality

Patient and public involvement poses particular challenges for emergency care services, says Robert O'Connor

Nobody ever said patient and public involvement was going to be easy. Extending a consultative role to patients and the public would inevitably call for major adjustments from an organisation as vast and varied as the NHS.

The challenge is especially marked in the realm of emergency care. Just ask London Ambulance Service trust.

Crews based in London's 70 ambulance stations respond to about 1.1 million 999 calls a year. Tapping into the views of patients and the public, says spokesman David Jervis, is a priority for LAS. 'But It is something That is a big challenge for us, because of our size, ' he says.

Patient and public involvement roles range from providing information to carving out an equal role for patients and the public in all of a trust's activities. These would include committees, board meetings, working groups and audits.

LAS is experienced in using information to educate the public and win its support. 'We do a lot of work with schools, 'Mr Jervis says, 'teaching them about the ambulance service, teaching them about the appropriate use of the ambulance service.'

LAS has run publicity campaigns designed to curb verbal and physical attacks on ambulance crews and to discourage people from calling ambulances unnecessarily. Such calls divert the ambulances from genuine emergencies. A PR campaign, which won an HSJ Award in 2002, included a poster showing an ambulance and a black cab, with the tag: 'Only one of these is a taxi service.'

A third LAS initiative, the 'live or let die' campaign, has been teaching members of the public how to help heart attack victims, and was devised after consultations with focus groups.

The idea of discussing procedures and treatment in advance with the public is relatively new for ambulance services, according to Dr Iain McNeil, an associate director of the performance development team for the Modernisation Agency's clinical governance support team.

He says it is now common for patients or their group representatives to sit on key ambulance service committees.

'Everybody, I think, is moving down the line of developing patient forums.

Some of those are ambulance servicespecific forums and some folk are looking at whole health system forums in which the ambulance service is involved.'

Dr McNeil says ambulance trusts are busy with patient surveys, particularly regarding the quality and timeliness oftransport. The ambulance trust will have the names and addresses for future reference, and letters are sent to patients, who have the option of responding or not.

LAS is committed to the patient advice and liaison service, which allows patients and their relatives to inquire about the service's response to events.

LAS adopted PALS in June 2003.

LAS PALS manager Gary Bassett says the goal is to evaluate how things happen and why, and then pass on the information to interested parties.

Inquiries have ranged from a case of a missing scorpion to clinical incidents and untoward events that might have resulted in death. Clinical issues may be referred to a clinical governance committee.

Mr Bassett says: 'One never knows what to expect when you pick up the phone. Every day is different.'

Mr Bassett, who describes previous response mechanisms as ad hoc and less patient-oriented than the present system, says inquiries have increased 300 per cent since the launch of PALS.

He cites efforts to publicise the service among both the public and LAS employees.Mr Bassett stresses that PALS does not attempt to replace the existing complaints system. People who have had bad experiences are given the choice of routes to follow.

And anyone who has used PALS and remains unhappy can still lodge a complaint.

A number of calls stretch beyond the boundaries of LAS and affect other care providers.He suggests that the public still tends to see the NHS as a single entity, rather than an amalgam of independent trusts.

Dr McNeil says the spread of PALS throughout the ambulance service has led to the creation of networks among PALS representatives at local trusts.

He says there are particularly good opportunities in some areas for patient and public involvementsupported PALS links between ambulance services and acute and primary care trusts.

'In some areas We are actually looking to support the development of whole health economy strategies around PPI, including work on PALS.'