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HULL & EAST YORKSHIRE HOSPITALS TRUST
PATIENT ADVICE & LIAISON SERVICE (PALS)
ANNUAL REPORT 2002/03
1. PURPOSE OF THE PAPER
For 2001/02 the Patient Advice & Liaison Service (PALS) was reported within the
Patient and Public Involvement Annual Report. The development, activity and
impact of PALS necessitates that a separate report is produced, this report will
detail the development, activity and impact of PALS for 2002/03
2. BACKGROUND
Hull & East Yorkshire Hospital Trust were a PALS pathfinder and as such have
had a PALS service since April 2001 with the first PALS Officer taking up post in
August 2001. The principle aim of the service is to advise and support patients,
their families and carers, and assist them in their journey through the NHS
system.
Feedback through the PALS service provides a focus for improvements to
services for patients and the public.
2.1 National Developments
The Department of Health has established a National PALS Development
Group in order that the PALS agenda is taken forward in a coordinated
way. PALS standards published in ‘Supporting the implementation of
patient advice and liaison services’ (DoH, 2002) are being revised and the
creation of a central PALS office is being considered. A Department of
Health guidance document on the evaluation of PALS is being developed,
it is anticipated that the guidance will be published during 2003/04. There
is also a drive for PALS to be linked with other initiatives associated to the
patient and public involvement agenda for example, the review of the
NHS complaints process (NHS Complaints Reform, Making things right,
DoH, Feb. 03), Choice for Patients, Local Authority Overview and
Scrutiny, Strengthening Accountability – Policy guidance on Section 11 of
the Health and Social Care Act (DoH, Feb. 03)
3. CONTACTS TO PALS
The number of people contacting the service continues to increase. The number
of contacts from August 2001 when the first PALS Officer was appointed to
March 2003 is detailed below.
Number of PALS Contacts July 01 to March 03 by Month
100
90
80
Contacts
70
60
50
40
30
20
10
0
pt
ov
pt
ov
ay
02
b
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03
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Fe
Fe
Au
Au
Ju
Ju
Ap
Se
Se
O
O
M
M
N
N
M
D
D
n-
Ju
n-
Ja
Ja
Month/Year
The graph below shows the number of PALS and Complaints issues coming into the
Trust from July 2001 to March 2003. In the early stages of the PALS development it
appeared that the PALS was having the impact of reducing the number of formal
Complaints coming into the Trust. The trend does not seem to be continuing as referrals
to both services are increasing.
PALS & Complaints Contacts July 01 to March 03
PALS Complaints
100
Number of Contacts
90
80
70
60
50
40
30
20
10
0
ne
02
03
ay
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Month
2
The increase of PALS contacts within Divisions and Directorates can be seen
below with comparisons between 2001/02 and 2002/03. The greatest increased
being in the Medical and Surgical Divisions. The two years cannot be directly
compared as the PALS did not become fully operational until August 2001 and
the Division of Cancer services was not in operation for the total of this period of
time. This chart does however provide an overview of the PALS activity by
Division.
PALS Contacts by Division/Directorate 2001/02 & 2002/03
Number of Contacts
350
300
250
200 2001/02
150 2002/03
100
50
0
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Division/Directorate
4. REPORTING MECHANISMS & FEEDBACK
The reporting mechanisms to the Trust and feedback to the
Divisions/Directorates work at various levels.
4.1 Trust Board
During 2002/03 the Trust Board has begun to receive a joint PALS and
Complaints report at every meeting, this report includes the changes that
have taken place as a result of the patient experience as described by
patients to the PALS or Complaints Service.
4.2 Shadow Patient Forum
The Shadow Patient Forum have a role in monitoring the activity of PALS.
During 2002/03 they have participated in the Evaluation of the PALS
Service, supporting and agreeing the subsequent action plan. They have
received a report on a quarterly basis on PALS activity.
4.3 Trust Committees
The Complaints Committee was reviewed during 2002/03 and is now
entitled the ‘Learning from Patients Committee’; its terms of reference
have broadened to include PALS. The PALS have taken the service
Training Strategy for endorsement and provided details of PALS training
provided in the Trust. The committee have supported PALS in securing a
visible point of contact for patients at the Hull Royal Infirmary site.
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4.4 Divisions & Directorates
From June 2002 PALS have produces quarterly reports for Divisions that
are disseminated to Divisional Managers, Nurse & Service Managers,
Modern Matrons, Clinical Director and Nurse Advisor. In addition reports
are sent to all Directorates that have received a patient concern. The
reports are anonymous from a patient and staff perspective but provide
information by speciality and contain:
• Patient ID number
• Date Received into PALS
• A synopsis of the problem
• A synopsis of the outcome
• Primary subject code e.g. DELAY
• Sub-subject code e.g. Delay in procedure/investigation
• Unit i.e. Hospital site
• Date PALS closed the case
Clinical Governance Facilitators progress these reports through the
Division via the Clinical Governance arrangements.
Divisional and Directorate senior staff are encouraged to contact PALS to
request further details on the cases if required.
5. PALS STAFF
During 2002/03 the number of PALS staff has increased to 3.00 WTE including
the establishment of a Senior Management Post. This has been in direct
response to the increase in the number of referrals to the PALS service.
In line with the national recognition that the role of PALS Officer is very stressful,
the provision of external counselling for PALS Officers has continued. PALS
Officers find this helpful and have requested that it continue.
Core training requirements for PALS Officers has been identified and addressed
locally; this includes core investigation skills in line with the aim of the
Directorate. An induction package that includes PALS training requirements has
been developed for new staff. In addition PALS staff are undertaking specific
training that ensures the direction of the service for example, Counselling
Certificate and Certificate in Education.
6. PALS BASELINE AUDIT AND EVALUATION AGAINST CORE STANDARDS
The PALS baseline audit and evaluation against core standards covered August
2001 to March 2002 and reported in August 2002. The evaluation takes an
inclusive approach considering the Hull and East Yorkshire Hospitals NHS Trust
PALS from a number of perspectives, including users of the service, partner
organisations, Trust staff and examines the statistics covering the eight month
period.
The evaluation report has been shared with other NHS organisations both locally
and nationally. The approach to the evaluation has been adopted by a number
of local NHS Trusts and the Trust has agreed to it being shared as an example of
good practice in a Department of Health PALS evaluation framework document.
4
The baseline audit and action plan informed the development of the PALS during
2002/03. The PALS Baseline Audit and Evaluation Against Core Standards is
attached as Appendix 5 (Page 22).
6.1 Training
A PALS Training Strategy has been developed and agreed by the
Learning from Patients Committee. The purpose of the strategy is to
ensure staff are aware of their role, responsibilities to help patients
pursue concerns, raise comments and feedback compliments.
PALS have developed a number of training packages that are flexible in
order to meet the needs of specialties and specific staff groups. Real
case studies and open debate are an important element of the training,
and where possible PALS statistics and examples of the patient
experience are used in sessions. During September 2002 a PALS
training database was developed and data inputted from October 2002.
Accurate information on the numbers and profession of staff is held.
Below are the numbers of staff by profession (where available) that have
received PALS training from October 2002 – 31 March 2003.
Training October 2002 - 31 March 2003
450
397
400
350
300
Numbers
250
200
150
98
100
42
50 21
3
0
Lay Members Managers Mixed Staff Groups Nursing Staff Pharmacists
Staff Groups
The 42 lay people who have received PALS training are from a lay group
working in the Trust, the Cardiac Support Group and members of a non
profit young people’s organisation from ‘The Warren’
PALS have been presenting jointly on the Trust Induction Programme
with Complaints since September 2002 evaluation from attendees has
resulted in the time allocated to the PALS/Complaints element of
Induction to be increased. Further, the combined PALS and Complaints
Training is one of the most requested training sessions that PALS
provides, as seen below. Combined training is also delivered on the
Trust Induction programme
5
Type of Training Delivered Oct.02 - March 03
400
Number of Attendees
350 367
300
250
200
150
100 107
50 39 48
0
PALS Basic Awareness Induction PALS Workshop PALS/Complaints
Type of Training
All training sessions are evaluated and training modified as a result of the
feedback from participants. The availability of training is promoted in the
Trust Training Manual, on the PALS intranet site and opportunistically at
meetings.
6.2 Accessibility of PALS
6.2.1 Presence at Hull Royal Infirmary
It is recognised that PALS requires a visible point of contact at the
Trusts main hospital site. During 2002/03 the Complaints
Department were relocated and became less accessible to
undertake ‘face to face’ consultations. A suitable area in the main
entrance of Hull Royal Infirmary has been identified for a visible
PALS frontage. This will be further progressed during 2003/04
6.2.2 Modifications to CHH
Modifications have been made to the PALS reception area at
Castle Hill Hospital to ensure that the PALS Officers are
accessible to children and wheelchair users.
6.2.3 Modern Matrons
A specific relationship exists between Modern Matrons and PALS
(HSC 2001/010). How this relationship translates into practice
has been examined with the Trusts first two Modern Matrons
based in ICU. There has been an acknowledgement that this
work has been limited as the Modern Matrons were not generic,
however an evaluation has been undertaken and the modified
model will be rolled out across the organisation.
6.2.4 Choice for Patients
The Choice for Patients initiative promoted the relationship
between Choice for Patients and the PALS. A national job
description was developed that made the role of the Patient Care
6
Advisor (PCA) accountable to PALS. The relationship between
the PCA and PALS in the Trust is established and cohesive.
6.3 Partnership Working
The Hull and East Yorkshire Hospitals NHS Trust PALS has continued
during 2002/03 to work in partnership with local NHS organisations (the
four local PCT’s, the Ambulance and Community Trusts). The
partnership working continues to ensure that the PALS across the ‘patch’
are seamless from the perspective of the patient. This approach also
ensures that PALS is promoted across the primary and secondary
interface, for example, most GP practices in the area have leaflets and
posters promoting the PALS.
PALS networks exist at a strategic and operational level, through
structured meetings as identified in the Patient & Public Involvement
Annual Report 2002/03.
Further partnership working has been explored and agreed with East
Yorkshire Council with the Citizenlink Project. This ensures that hard to
reach people that live in rural area are able to access the PALS service
through the use of interactive technology.
The ongoing development and co-ordination of the PALS activity in the
patch continues to be supported by the two local Community Health
Councils.
6.4 Promotion of PALS
During 2002/03 a number of initiatives have taken place, in addition to the
provision of training, for example
• 10,000 leaflets have been circulated across the Trust.
• All wards and departments have been supplied with PALS posters
• Articles in the staff and GP newsletters
• Poster presentation at the ‘patch’ Service Improvement Day
• Presentations to Hull City Council Overview and Scrutiny for Health
Committee
• Presentation to Social Workers in East Yorkshire
• Attendance at team meetings
• Roadshow at the new Women’s and Children’s Hospital
6.5 Patient Surveys
Within the PALS Standards (DoH, 2002) there is a requirement for PALS
to actively seek the views of services users, carers and the public to
ensure effective services. During 2002/03 a staged approach has been
taken to achieving this standard, as follows
• PALS Baseline Audit and Evaluation against Core Standards
• A patient survey database has been established within the Clinical
Audit Department
• Patient Surveys are registered on the Clinical Governance Project
Registration Form, which ensures that they have been approved
7
through the Divisional Clinical Governance structures prior to
commencement.
A small working group has been established to ensure that the Trust has
a regular programme of structured surveys to assess the views of
patients and their carers on the services provided. An inclusive approach
is being taken and foundations are in place to base the surveys around
the Essence of Care agenda.
6.6 Quality Standards
A number of operational guidelines have been developed during 2002/03
for PALS Officers that address the consistency of the quality provided by
the PALS, these include:
• Operational Guidelines for facilitating meetings
• Operational Guidelines for requesting a case review from a
Consultant
• Operational Guidelines for training
6.7 Ongoing Evaluation
Findings from the baseline audit of PALS indicated that evaluation of the
service from a patient perspective should take place nearer the contact
with the service. An evaluation tool has been developed to address this.
7. RISK MANAGEMENT
In January 2003 PALS discontinued the use of the dedicated PALS database
and integrated issues raised by patients with the Complaints, Claims and Risk
agenda via the Datix Risk Management database adopted by the Trust. Themes
and trends can now be tracked across these elements to provide a more
cohesive picture of the patients experience in the Trust.
8. LEARNING LESSONS
In 2002/2003 the following are examples of learning from patients arising from
PALS issues:
2002
• Content of “access to medical records” letter altered
• Routine admission letters changed to include more information.
• Plinth placed across entrance door for easier access for disabled
• Visitors toilets fitted with shelves and hooks
• Urology, a major service investigation and review was undertaken prompted
by an increase in the number of patients raising concerns about their
experiences in the service to PALS.
2003
• Diary of events of an individuals experience used for staff awareness
sessions
• Department protocols altered regarding faxing information external to the
Trust
• Gaps in training identified in a ward area
• Faulty vacuum replaced on a ward
• New signage for reception area at CHH
8
9. RECOMMENDATION
That the Trust accepts this report and notes the considerable progress made
during 2002/03.
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