Findings of User Focussed Monitoring

of 

Mind in Camden’s

Patients’ Advocacy Project

(YEAR 2)

at

The Royal Free Hospital

HISTORY

In 2002/2003 Mind in Camden (MiC) and Camden Mental Health Consortium (CMHC) jointly bid for and were awarded the Advocacy contract in the Level 2 Wards at The Royal Free Hospital; MiC to provide the Advocacy Service and Camden Mental Health Consortium to monitor it.

Development and recruitment to the CMHC Working Arm, Camden Borough User Group (CBUG) provided an opportunity to monitor the Patients’ Advocacy Project with CBUG members interviewing clients of the service.  The model chosen was part of the Clinical Governance Protocols of the Camden and Islington Mental Health and Social Care Trust.

[Subsequently, the model has been handed over to The Peter Bedford Organization for wider use in the statutory and voluntary sector.]

CBUG Members were trained in the methodology and assisted the Project Leader (Linda Polan) to devise a questionnaire.

Irrespective of the numbers of interviews conducted, it was decided to report the position at the end of April 2004.

CONCLUSIONS & RECOMMENDATIONS FROM YEAR 1

CBUG recommended that MiC should try and address:

     a. the number of patients who did not know of the 

          Service        

     b. the time taken for advocates to see new patients

c.    the reported difficulty in obtaining an Advocate once a patient requested advocacy assistance;

     d. the lack of knowledge of a complaints procedure

·        It was felt that MiC should look at the way their Advocacy Service is publicised and that all Patients should have access to an Advocate within the first two weeks of admission.

·        We reported that some respondents were concerned that the Advocacy Service stopped at their discharge; they wished it could continue into the Community.

 

RESPONSES  BY MiC & ADVOCATES

·        Target set to meet all new Clients face to face within two weeks of admission and to inform them about the Project

·        Review the literature given to Service Users in order to make it clearer and more straightforward

·        Community Advocacy to be introduced October 2005, which would then allow Grove Centre Advocates to continue working with clients after discharge.  (CBUG visits had ceased by October)

·        Additional Innovations:

·        MiC in partnership with OT held a competition for inpatients to design a new poster for the Project.  This is displayed on the wards with the Advocacy Project’s code of practice.

·        ‘Comments’ boxes were placed on all wards.

ACTION TAKEN BY CBUG PRIOR TO YEAR 2

The first 5 questions in the Questionnaire were used to divide the participants:

Group1 – those who had not so far received Advocacy and

Group 2 - those who had received Advocacy who were also asked the remaining 24 questions to establish their satisfaction with the Service. 

REPORT  YEAR 2 – November 2004 – October 2005

The next pages in this document contain Verbal Testimonies, Statistics, and finally CBUG’S Conclusions - all for Year 2.

VERBAL TESTIMONIES (YEAR 2) 

• “My recovery is hindered by my treatment at the hands of other people”
• “The Advocates are excellent at the job”
• “I was not offered Advocacy but saw one on the Ward and approached her myself.  I do prefer a female Advocate but as the one I approached was female, the matter of being offered a specific gender didn’t arise”
• “The Advocate was helpful – when I asked for certain information, he came back with it the same day”
• I found it very hard to get anyone to listen to me or take any notice”
• “I asked the Advocate to attend my Ward Round but they only came once and I meant every time”
• “I didn’t receive the same care as everybody else”
• “I told them I don’t want to stay here; being together with my family and children is the most important thing to me but they didn’t help me”
•  “I don’t know why I’m being detained.  I said I want to be in a Women’s Ward and no one has provided an interpreter although I requested one”
• “Some Nurses are bad – they shout at Patients.  I’m a Nurse and know how they should behave but when I informed an Advocate, they still shouted”
• “I told them I don’t want to stay here; being together with my family and children is the most important thing to me but they didn’t help

 

STATISTICS

 

CBUG CONCLUSIONS 2004 - 2005

 

We found that 24 at least of the patients interviewed had been

in hospital for more than 2 weeks, had received Advocacy and

went on to answer part 2 of  Questionnaire. 

12 knew of the existence of Advocacy when admitted.(Q 2)  

19 were offered advocacy whilst in hospital.(Q3)

Satisfaction with Advocacy was high (Q8/17/19/20/21/23/).  27 respondents said working with the advocate had been helpful (Q 27)

20 people acknowledged that they’d seen printed material about

the advocacy service (Q3) whilst 11 said they hadn’t and three were unsure (Q3)

There were no strong feelings about gender of advocates only 3 people expressed concern on this point whilst 27 had no preference (Q9); but only 8 people said they had a choice (Q10)

There is some confusion about whether advocates regularly

explain to patients what their rights are whilst in hospital (Q11/12)

 The majority of people seemed to understand that advocacy is an

independent  service (Q18)

Only 7 acknowledged being informed about the complaints procedure (Q22.)

 26 respondents would use the service again (Q28) and the same number would recommend it (Q29)

Our findings were virtually the same as reported in the 1st Year of Monitoring and the following points continue to need attention:       

 We still found a number of Patients who did not know about the Advocacy Service and a substantial number (80m 21f) who had waited longer than 2 weeks before their first meeting with an Advocate.

 

Although not included in the statistics for this year, this number is significant enough for some conclusions to be drawn.

The causes for these high numbers may well be: 

·        Clients unaware of exactly who they have seen

·        High turn-over of patient admission/discharge on the wards

·        Patient memory lapses due to illness and/or medication

·        Advocates unable due to practical and administrative pressures of time, to introduce themselves to all who may need them.

We recommend that this apparent discrepancy requires some investigation to ascertain the reasons more exactly.

There is still some confusion amongst Patients about what Advocates can and cannot do. The very nature of their illness means that Client information often needs repeating.  However many times this has to take place, it will be worth it in making things clear.

Patients still seem unsure about the difference between Advocacy and PALS.  This is shown by the clear contradictions in the responses to some of the questions -  patients who had seen a PALS Team member, often thought it was an Advocate or vice versa. (This was gleaned from notes in the margins rather than answers to questions)

We suggest that the two Services co-operate on the wording of their respective leaflets indicating what each service can and cannot do for patients.  In this way no-one will be left in any doubt about the work of each service.