Roger Easter (RE): This morning I’m at the Dene Hospital for a meeting and I’m with Philip Greenhill, the Managing Director of First Community Health and Care and also with Liz Mouland who is the Chief Nurse and Director of Clinical Standards.
Philip, how does First Community fit into the overall structure of the NHS services that are provided to the patients?
Philip Greenhill (PG): First Community Heath and Care is a social enterprise that delivers NHS services, so we are contracted by the GPs to provide local, community based NHS services to the residence of East Surrey. So we’re a provider of NHS services.
RE: So does that mean – for example – you’re a sub-contractor and they just give you a fee or a payment for the services over the year and you just deliver within that structure.
PG: That’s completely right Roger, and the kinds of services we deliver, which some of the listeners might understand things, like Health Visiting and District Nursing and the services we provide here at Caterham Dean Hospital, so yes we are contacted to provide those NHS services.
RE: Which were previously run within the NHS, obviously before First Community Health and Care came along?
PG: That’s right they used to, I mean it’s a bit of a complex history really, and Liz may know better than I, but basically community services used to be part of what many people know as the Primary Care Trust the PCT.
RE: The PCT, yes.
PG: Yes, and then, some years ago the government took a view that we needed to take Community Services out of the Primary Care Trust because that was a commissioning body and it was felt there was a conflict of interest to have an organisation that both commissioned and delivered services and so some community services have become NHS Trusts and some have merged into hospital services and some like ours, because the staff wanted to form their own company, became a social enterprise.
RE: And when did that start, Liz?
Liz Mouland (LM): The process started early in 2010. The government enabled providers of community services to do something called a Right to Request and the staff actually felt very passionate about providing services locally and a number of staff here working still with us to produce this Right to Request and that actually was the start of our journey.
RE: Ah, I see
LM: So all of us were working within the previous provider community service, called Surrey Community Health, and we put together a business plan and went to the PCT and we actually put together a case to say we wanted to provide services locally to the people, residents of East Surrey.
RE: Now, your role within First Community is?
LM: I’m Chief Nurse and Director of Clinical Standards. So, my role is really at Board level is to ensure that we provide safe services. So the sorts of things I take the lead for are the patient engagement, the patient experience, the quality and safety of our services but also to provide a professional leadership at Board level. Because we’re such a small company, I think it’s fair to say that everyone in First Community does everything. None of us are too proud to get involved and none of us want to be too far away from the patients and the clinical services so, we have a saying ‘floor to board in 5 minutes’.
RE: I like that
LM: That means that anybody, any member of our staff can get hold of any Board member within 5 minutes and we’ve never let anybody down so far.
RE: Fantastic. I mean this is really good patient care isn’t it?
PG: That’s right.
RE: I mean, I guess it’s a controversial subject because you know, you ask one person “What did you think of the service you had?” I don’t mean from your company, I just talking generally and you listen to other programmes and you get a lot of negative and people phoning in programmes but I’ve talked to people and personally I’ve seen fantastic care from the hospitals and GPs in this area. Talking about that, your area really covers east Surrey and West Sussex down to Lingfield?
LM: That’s right starting really in the north, its Whyteleafe, Woldingham, Warlingham, Caterham and we cover Redhill and Reigate. Also down to Horley, Lingfiled, Dormansland and we cover all the villages and towns in between.
RE: Excellent.
LM: But we also do provide some services in West Sussex as well.
RE: I know that one of the services you provide is the Friends and Family Test?
LM: The Friends and Family Test was launched by the Prime Minister David Cameron last year.
RE: I remember that.
LM: Where he wanted patients who had been in hospital or who had attended their local accident and emergency department to be able to, in real time, say what their experience was of receiving that service. It’s a simple question to say would you recommend this service to Friends and Family with a follow-up question, can you tell us why? Now this was mandated across the all of acute hospitals in England in April this year but First Community Health and Care took the position that we wanted to understand what our patients were saying and wanted to actually roll out Friends and Family in April this year. So, for patients who have been in Caterham Dene Ward and for patients who have attended our Minor Injuries Unit, we have already rolled out Friends and Family with the follow-up question and been getting some really, really valuable data back from our patients which has been helpful.
RE: In other words, ok they’ve been scoring you and that doesn’t always reveal some of the more critical items where you get feedback that you can make improvements to your services, is that correct?
LM: That’s absolutely right. People can give a score but it doesn’t always mean to say what was their experience. Their overall experience might have been very, very good, but they might have some other comments to feedback to us and it has been really valuable.
RE: So somebody has to go through those?
LM: I go through every single comment individually, I read every single one and we share those with our Board and with our managers so everybody has a chance to read them. We also display them on a public facing noticeboard in Caterham Dene Hospital, both on the Ward and Outpatient area so that people can read for themselves and where we’ve been able to make some changes, we’ve started a board that says ‘You Said, We Did.” So, you tell us where we’re getting things that are maybe not as well as they could be and this is what we’re doing about it. I can give you some examples.
RE: Yes, please do.
LM: We actually get an overall score out of 5 and so we actually get if you like an organisational figure. So we can track these month by month, whether we’re getting better of whether we need some improvements. Let me give you an example from a patient who attended the Rapid Assessment Clinic here in Caterham in August. Firstly, one patient said “The extreme cleanliness of the premises is wonderful and the treatment I received was beyond exception and as far as I can see no improvement is needed” which for us is really lovely. Another patient said “This facility is first-class. I was seen and treated very quickly. The staff were extremely pleasant and caring and I left feeling like I was looked after as if I had been to a private hospital.”
RE: That’s fantastic.
LM: It’s really fantastic but one patient, who’d attended the Minor Injury Unit, gave us a score of one so…
RE: That’s of concern obviously.
LM: That’s on the other end of the scale. This is the first one we’ve ever received so it makes us think, what’s happening here? “The care was well executed. Good explanation and efficient. The only point I would make is that I have never heard of the hospital and I have lived in the area some 20 years. I only found out by calling the NHS111 helpline.” So, for us that is actually of quite a concern, that we really want to ensure that we are a visible part of the community so we need to do some work on ensuring that our residents and our patients and local people know what we offer here. So, that’s a piece of work for us to do.
RE: So in other words, you need to look at your press, PR and promotion and the image which I would have thought was a very exciting one Philip?
PG: Absolutely and that’s partly why it’s great to be here talking to you so that we can get the messages out to our wider community. The more that we can spread the word about our services the better really, you know, fantastic.
RE: From a personal point, my mother was here earlier this year and I can’t say enough about it, you know, that the care that was provided from the Ward, by the staff and in fact we almost had a job to get her out of here as she was enjoying it so much! I can see that’s of great value because we all get asked to complete surveys, but you don’t often get the opportunity to be able to highlight important critical points and you wonder, you know, how much value it is when you’re ticking boxes saying “Will you score between one and ten”, whereas when you say, “Tell us a bit more”, you really get down to the nitty gritty about what people really care about.
LM: It’s absolutely true and we have real plans now to roll this out across all of our services so not just here at Caterham Dene but for people who receive services in their own homes or in clinics. So, we’ve a plan to roll this out next month across all of our services and we’re quite excited about it and the next stage is to do exactly the same with our staff and to ask our staff every month “would you recommend your service to your friends and family and if so why?”
RE: That’s good.
LM: So, it’s going to enable to actually as a board and as a management team to see what actually really happens when you’re a patient or a service user when you’re receiving services from First Community and what’s it like to work here? It will enable us to, it sounds a bit wordy, but it will enable us to look at putting in a cultural barometer so it gives us a slice through time saying, what’s the organizational health like? Are people happy working here? And we feel if our staff are happy working here then our patients will get a much better service.
RE: I can’t think of a finer example that I have seen for many, many years that what you’re operating here is what they call total quality. Having been exposed to it 20-odd years ago, actually seeing total quality is a superb model and I think that the way that you are structured it seemed to me that when you, and I mean you mentioned Philip your motto “floor to board in 5 minutes”, and that enables this I think to work so speedily and so accurately and effectively.
PG: It’s probably worth just adding that all the Board members, particularly the Executive team so Liz, myself and other colleagues, we all try and go out and spend time directly with the services as well, so a few weeks ago I spent half a day with a District Nurse and that way we don’t get remote from our services, we get a real feel of what’s going on.
RE: That’s brilliant, that really is isn’t it? And in the end the service you’re delivering to the customer i.e. the patient is of the upmost importance.
LM: That’s right. I mean, Roger, it’s also probably worth mentioning that we have a real passion as well, not to be NHS services that we sit here waiting for people to access, but we want to infiltrate the community itself.
RE: Philip, I noticed also that one of your services is headed also ‘Community Forum’? What’s that about?
PG: That’s right Roger, if I just briefly explain. When we were set up as a social enterprise as part of our governance processes, i.e. how we’re run as an organisation and who we’re accountable to, there were two key components. One was that our staff elect governors and the governors can appoint the Board members and the Managing Director so that the staff actually have a say in how the company is run but also, we said we would establish a Community Forum to make sure that we link in with our local community and they have a say in how we go forward as a company as well.
RE: So how does that work?
PG: Our approach with the Community Forum is to make it a network. So, rather than have a meeting every month where we might invite a few local representatives which is the way some NHS bodies run, we feel we want to get to a wider group and a wider cross-representational group of people in the community. So we do have two meetings a year where we invite people, but really most of the work is outside of the meeting where we contact local voluntary groups, local residence groups, charities and we keep a data sheet of all these local groups and we keep in contact with them and try and get their ideas and their views, for example, we think there is a particular need to work with carers, not just the patients but the carers of patients. So, we’re going to join a carers event in a few weeks time with carer representatives to see how we can improve our services and work with carers. That’s one example. We’re also linking into the schools and colleges, we heard about the apprenticeship scheme. We’re not just an organization delivering services we are a local employer as well and a key local company. We want to work on that as well.
RE: That sounds like pretty exciting stuff to me. Really good.
PG: Yes it’s great. I think it’s just, we had a really successful first Community Forum, first launch, we’re following up with the next one in December and we’re getting really good contacts with everybody and getting their views and hopefully we can get better known amongst the community and that will help us improve what we do.
RE: What do you see as great fulfillment from where you’re sat?
PG: Well for us I think in First Community Health and Care, our key services are about supporting people in their own homes and in the community and we think we have wonderful services that could possibly prevent people going in to hospital and facilitate people coming out of hospital sooner so that they can get home, we can help restore their independence and they can thrive at home and avoid being dependent and being admitted to a hospital. That I would say is one of our key purposes and we think there is a great opportunitiy to deliver more services in the community.
LM: I would like to add that also that, it is about that, but it’s also about preventing unnecessary admission to hospital. So, where people need to go to hospital we make sure that it is recognised early and we get the right patient in the right place at the right time, but what we need to be able to do is strengthen our services, that if people want to stay in their own home we can support them and their carers to actually receive the services they need as close to home as possible.
RE: That’s really important because I think people can get hospitalised I think if they’ve been in hospital for too long, and I think one of the issues, certainly 15 years ago, is there wasn’t that sort of service and facility and people were staying in hospital beyond when they should’ve been and became hospitalised and I think psychologically that isn’t good. What you’re able to do is make people feel happy and if they’re happy I think they get better quicker.
LM: I think you’re right. I mean, people do get poorly and they do need the services of an acute hospital.
RE: Which in our case would be East Surrey.
LM: East Surrey is the local main hospital and it’s absolutely right that when people need that service that they get in quickly and they’re treated properly but we also know that sometimes their recovery can be better if it’s around loved ones and in a home environment. So, as soon as it’s safe for them to come home, we’d like to support them home and look after them in their own homes.
PG: The other important thing is that sometimes we can avoid, it’s not just about hospital, but also sometimes going into a care home or nursing home.
RE: Yes.
PG: If we can support people in their own homes it may delay or stop them having to go into nursing home provision.
RE: Thank you very much indeed to you both for giving up your time this morning and I feel that the services that you’re setting up are really starting to achieve good results. So, thank you.
PG: Thank you.
LM: Thank you very much Roger.