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Case study: 5 Boroughs NHS Partnership Trust


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5 Boroughs Trust in Warrington pioneered Care Opinion’s work in mental health services in 2008/09. Maria Slater was there at the time.

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What was your role at 5 Boroughs Partnership NHS Trust?

I was a “head of service” senior manager, looking after all the joint health and social services care for community and inpatients for one part of the whole geographical area served by the trust.

How did you use Care Opinion at the trust?

There was a corporate decision that we would ‘pilot’ the impact on our mental health trust of making feedback about our services more accessible to users and carers. The heads of services were briefed about Care Opinion because they were the ones who would have to respond to postings on the site.

What happened in practice?

The first posting we got was a very negative one, about an area where there were genuine issues that were already causing unhappiness for staff, managers and patients. The posting gave me, as senior manager, an opportunity to call a clinical meeting without middle managers or front line workers feeling that I was interfering or non-trusting. I was able to facilitate some real reflection among staff, and there was a feeling of “enough is enough, let’s change how we do things”

Because the comments came from a service user, people could see this wasn’t ‘management just being critical’. It made the issues real. And because the posting was public on the web, I was able to get a sense of urgency in responding to it. So we called a number of senior staff together from the clinical area for a whole day to create an action plan in response, for posting back onto Care Opinion.

The time invested was well worth it, the fact that our actions were timely made it more pertinent (complaints are usually a month at least out of date) and the fact that staff replied to the patient direct, not via the CEO, created staff ownership and a willingness to sort things out.

Was it a lot of work?

It’s all relative. We have to take feedback on board, and it can be time consuming. Care Opinion is another route for this – but compared to the complaints procedure it is less time consuming and more effective. It also had the impact of reducing the number of complaints via the ‘official’ bureaucratic route.

How did you promote Care Opinion to your users and carers?

Our user/carer forums were very keen and active – before we were – on Care Opinion. So users spread the word themselves. It led to the forums having access to every feedback issue and aided them in ‘monitoring’ us and holding us to account.

How did you involve people in the trust?

We put “Care Opinion feedback” as a standing agenda item on the local governance meeting, so that all our postings and responses were shared and discussed across all clinical areas. Below this, each team manager would compile responses with their clinical team and send that to the head of service, via their service manager, to check that we’ve done everything we can for each response. We also suggested that every area put their postings and responses on display.

How did staff feel about it?

Initially staff were defensive, but having the opportunity to respond in a timely fashion that had the same “audience” as the posting was engaging. It also felt more fair to staff than the “cloak and dagger” feeling around a complaint, where only the complainant can share information.

We made sure to positively engage both staff and service users, with an attitude of “this is about an individual’s experience, not a personal attack, and we need to understand how it feels to go through our services so we can learn and improve”. The increased exposure to direct feedback has got rid of some of the anxieties people had around communicating about standards of care issues with users and carers.

And has there been an impact for service users/carers?

Users now feel more empowered to give feedback and are more informed about services because they can read each posting and response. They can see issues from both sides now and they can see good feedback too – which is nice!

So what have you learnt?

That timely feedback and response has far more impact than any audit or review on effectiveness and satisfaction for everyone involved. That any feedback is positive, and that staff needn’t be precious or protective about the way they do things. And that our responses need to have a simple ‘accredited’ pathway out, in order to ensure that what staff are saying is something the trust would be happy with.