INTRODUCTION 

The NHS Plan set out the governmentís agenda to create a reformed and modern NHS which is patient centred. The intention is to move away from an outdated system of patients being on the periphery of the NHS, towards a new model where the views of patients, their carers and the public are heard through every level of service acting as a powerful lever for change and improvement. 

Launch of the Patient Forums- the draft report is available here. See below the Photos.	Photos of the event.

In September 2001 the Department of Health produced a consultation paper ìInvolving Patients and the Public in Healthcareî to discuss how patients and the public can become involved. In particular, this document summarises the work carried out to develop the proposals in the NHS Plan to create a patient-centred NHS. In November 2001 the government produced a response to the Listening Exercise which set out a comprehensive package of new measures although this is subject to legislation. 

In the meantime Bexley Community Health Council was successful in receiving funding from the Department of Health and Bexley PCT to develop a Pathfinder Patient Forums. In particular it was felt important to involve the local community and voluntary sector groups, and membership recruitment is targeted towards and inclusive of hard to reach groups. The development of membership criteria and appointment process would be conducted in consultation with the Department of Health and, where appropriate the NHS Appointment Commission. Finally, it was felt important to organise and develop training requirements. As a result it was agreed to hold a half-day event on the 27^th February. 

PURPOSE OF THIS EVENT 

The purpose of this event was to raise awareness, identify issues and consider the processes involved in establishing Patient Forums in Bexley. In particular, to promote the understanding of involving patients and the public in local Healthcare services as well as to inform voluntary groups and health professionals on current proposals (see appendix 1). 

WHO ATTENDED THIS EVENT 

It was the intention to make this event as inclusive as possible. This was achieved by contacting a few specific voluntary organisations as well as circulating flyers in the February edition of the Bexley Voluntary Service Council Newsletter. Flyers were also circulated to health professionals, local councillors, local authority and local health services, for example G.P practices (see appendix 2). Furthermore, this event was advertised in the local newspaper. 

A variety of different people attended including Health Professionals, members of the CHC, members from voluntary sector organisations and self help groups and members of the public. In total 77 people have been recorded as attending. 

FEEDBACK FROM THE EVALUATION FORMS 

In general, the vast majority of people felt the seminar was well organised, interesting and informative. 

Participants felt that the speakers were knowledgeable, concise and informative. Four people suggested that the presentation could have been longer and more detailed. 

The group discussions were described as interesting, useful and productive. A few people described their group discussions as lively and thought provoking. Four participants suggested that the time limit was too short. 

When asked if the Seminar had achieved its aims the response from participants was quite mixed. The overall consensus was that it had successfully achieved its aims. Two participants suggested that more time was required, while another two individuals felt that it would be a good idea to have a follow up seminar before decisions are made. Also, four participants commented that there is still a long way to go in informing the general public of the existence of Patient Forums. 

The majority of participants felt the event could not have been improved. Seven participants did suggest that either more space was required or the discussion groups could have been smaller. Another seven participants commented that the event could have been longer in time, especially for group discussion. Eight people felt that wider publicity would have encouraged more public participation and three participants suggested that more information on Patient Forums was required.  

ISSUES RAISED AND DISCUSSED 

The following ideas were raised through group discussions: 

®      The vision of Patient Forums 

Each group had a slightly different vision; however, it was generally agreed that Patient Forums should be focused on representing patients and promoting patient centred care. For this to be achieved, Patient Forums need to be inclusive and incorporate the needs and views of everyone. 

Overall Patient Forums should be working towards a more efficient and effective health service. They should be independent, flexible in their approach but critically constructive and positive. In particular, Patient Forums should not operate in isolation but should open up lines of communication and network with other groups and organisations. The idea of having smaller forums or sub committees specialising in specific areas, which could then feedback into the main Patient Forums, was explored. 

Participants recognised the complexity of health service provision in Bexley and acknowledged that, while Government plans were for one Patient Forum for each NHS Trust, there was a need for a more holistic view to be taken. The first issue raised in this regard explored the fact that it is not infrequent for patients to be referred between primary care and the hospital services, which often result in complex patient care pathways. Consequently, there was a feeling that there needed to be some linkage between Patient Forums so as to identify common concerns or themes that resulted from these patient care pathways. One group suggested that there should be one point of contact for Bexley, which would cover Bexley PCT, Oxleas NHS Trust as well as Queen Maryís Hospital Trust.  

A second dimension to the issues of a holistic approach was the need for inclusive representation so as to address the issue of diversity amongst the membership of Patient Forums. This would require specific attention to recruiting people from more marginalized communities such as the disabled, black and ethnic minorities, parents who find it difficult to get out of the home and perhaps younger people and those of working age who may have time constraints.

®      What would we look for in a Patient Forum member?®      Who would they represent? 

Overall it was felt important that these forums should consist of patients and service users. In particular, the main aim would be to achieve a broad spectrum of people and encourage the participation of people who would not normally be involved. These issues of engaging more of the local population were explored further in some groups, resulting in a variety of different views. All groups agreed that these Patient Forums should comprise of some representatives of the voluntary sector because these individuals would have good links with the community. This idea was developed further in one group who suggested that possibly 50% of members should have a constituency so that they report back to the community. 

In general, groups felt that members should have a good local knowledge and the majority should live in Bexley. New members should be able to demonstrate a commitment to the work of the Patient Forums in terms of time. Others suggested the importance of including people who can communicate with other groups as well as being good listeners. In particular, members must have the ability to engage with the local population, for example community groups and employers. The inclusion of health professionals in the membership of Patient Forums was another suggestion that elicited opposing views. 

®      What would be their responsibility? 

In some groups this topic area was not debated in great detail. This could be a reflection on the fact that Patient Forums are a very new concept. Nevertheless, widespread agreement from participants felt they should be the voice of the public views. Members would be involved with gathering views and monitoring local health services. It was hoped they would be able to work in partnership with the health service trust to help introduce improvements to services. One group felt that Patient Forums must be impartial whilst signposting people to relevant information and help. Again, it was felt important that Patient Forums should not work in isolation but to network and feedback to others, which will help them to establish and develop. One group mentioned that Patient Forums should network with PALS (Patient Advice and Liaison Service).

®      What type of guidance and support is required? 

Ideas generated through group discussions were generally quite similar in regard to the type of guidance and support required. Overall, It was considered important to provide administration support, for example minute taking, report writing, administratory budgets for expenses, funding etc. Others suggested the need to have an induction programme for new members to promote an understanding of the structure and functions of local health services along with training on health service issues. One group explored this topic area further and suggested that a brief booklet should be supplied to new members explaining the aims and objectives of Patient Forums. Wherever possible technical language should be explained and members would need to be trained in communication and presentation skills.

®      How would we publicise Patient Forums? 

A variety of different methods of publicising Patient Forums were suggested in the discussion groups. Open days, displays and exhibitions at public places were felt to be useful along with media coverage such as hospital radios, local radios and local newspapers.  Other suggestions were to expand on traditional methods of publicity, which would include distributing leaflets and notices in a variety of settings, such as GP surgeries, local clinics, libraries, local councillorsí, surgeries and other places of public access. Yet another thought was to target correspondence to interested agencies and individuals that had shown a specific interest in those topics. One interesting idea was that certain meetings of the Patient Forums should be given over to a health topic such as diabetes, epilepsy etc. Patients receiving services for these conditions or otherwise a voluntary agency that work on these issues could be invited in specifically to have the opportunity of making their views known on service provision in these areas.  

®      How can we evaluate this process? 

This issue was one that challenged participants because of uncertainty about the mode of operating and possible outcomes from the work of Patient Forums. However there were one or two general issues that were raised.  There was an acknowledgement that evaluations would be of both a qualitative nature, which for example may look at the development of partnership understanding and a change in climate of service provision, which integrates the needs and views of patients, carers and their families into the core working of the NHS. There was also recognition of the need for quantitative evaluation, which groups felt, should be kept simple. This would include the logging and reporting on visits, and comments received from patients and other interested parties, as well as accounts being kept of how services had changed over time as a result of Patient Forums intervention.

GMC doctors should always prescribe responsibly whether online or following a face to face consultation. A full health assessment should be made before offering patients treatment. Extra care to Medikamente sinnvoll und sicher verschreiben through the online channels should be taken for patient safety. The doctor must ensure medications are for personal use and must encourage the patient to make frequent contact for on-going health care

Patient Forums have proved useful in increasing transparency of medical services and reporting patient experience of health services in the UK. Patients who are concerned about the level of care they may receive on the National Health Service or require medical services not provided on the NHS can explore the possibility of going private. Acheter pilules Pfizer 50 mg originaux en ligne can be an option for those unable to source the medications from their GP, and there are many good services available. Legitimate Care Quality Commission registered services are not to be confused with the hundreds of illegal sites selling generic tablets made in China or India. User of the Patient Forum can find a reliable service and ensure a real doctor prescribes treatments and that medications come from the UK.

Another aspect of this kind of service is to give citizens the opportunity to voice their opinions on the quality of health and social services provided. For example Bexleyheath recently trialled price check between British and German suppliers on preise billing Sildenafil oder Tadalafil and users were able to comment on their experiences online through the forum helping others to choose which medications to use when treating their erectile dysfunction problems.

There are many plans for future schemes to improve patient health and to increase feedback opportunities for patients in the area. Smoking cessation and weight loss clinics are being designed to help patients take a more pro-active approach in looking after themselves, and it is hoped that this will reduced the amount spent on health care in future years. For example, patients prescribed Viagra Pfizer 50 mg pillole senza ricetta may find losing excess weight and quitting bad habits like smoking beneficial for their erection problems. Money spent on treating these patients could be saved or better spent elsewhere in the health system.

With the new CQC online clinic registration Online prescrition has come a long way. However, despite increased regulations on online clinics there is still much confusion as to where to buy the pill online safely. The Pill's the most popular contraceptive, despite this most women are on cheap low quality NHS pills and don't know there're better contraceptive pills available on private prescription.

Relenza polvere per inalazione contiene il principio attivo zanamivir, un inibitore della neuraminidasi. Il farmaco viene usato per trattare e prevenire l'infezione con il virus influenzale. Relenza Zanamivir funziona legandosi alla neuraminidasi sulla superficie del virus. Ciò impedisce che il virus dell'influenza si diffonda infettando altre cellule e così l’azione del farmaco limita l'infezione. Questo rende i sintomi dell'infezione meno gravi e rende più facile per il sistema immunitario per uccidere il virus.

L'influenza è causata da un virus altamente contagiosa che colpisce i polmoni e le vie aeree (vie respiratorie). Il virus viene catturato da inalazione di goccioline microscopiche bordo che si producono quando una persona parla infetto, tossisce o starnutisce. Il virus può sopravvivere anche per un breve tempo sulle superfici, quindi può essere recuperata, se una persona tocca una superficie infetta e poi si strofina il naso o gli occhi. Quando il virus entra nel corpo invade le cellule delle vie aeree, dove si replica a formare un sacco di nuove copie del virus. Le nuove copie del virus lasciare le prime cellule e passare a infettare le cellule vicine, dove viene ripetuto il processo. Dopo un paio di giorni abbastanza cellule sono state infettate che il paziente si sente sintomi influenzali come mal di testa, febbre e dolori e dolori generali. Queste proseguire per circa una settimana fino a quando il sistema immunitario del corpo uccide il virus. Al fine di lasciare una cellula ed infettare un altro, il virus dell'influenza usa un aiutante chimico che si trova sulla sua superficie. Questa sostanza è un enzima chiamato neuraminidasi. Senza di essa, le copie di recente formazione, il virus non può lasciare le cellule infette, di infettare altre cellule.

Nelle persone sane zanamivir è capace di ridurre la durata dei sintomi influenzali di circa 1 giorno. Per il trattamento dell'influenza negli adulti, il farmaco dovrebbe essere iniziato entro 48 ore dalla comparsa dei sintomi. Nei bambini deve essere iniziato entro 36 ore. Zanamivir può anche essere usato per prevenire l'influenza in persone che hanno avuto contatto con una persona contaggiata col virus. In questo caso la cura farmacologica deve essere iniziata entro 36 ore. Relenza polvere per inalazione è confezionato su dischi di lamina utilizzati con dispositivo apposto. Il Diskhaler trafigge la bolla quando viene utilizzato e la polvere viene poi inalata attraverso il boccaglio. L’inalatore deposita il farmaco in gola e nelle vie aeree dei polmoni, dove può attaccare il virus. Per la massima efficacia si consiglia di seguire le istruzioni fornite con la Diskhaler e di rivolgersi al medico o al farmacista se avete problemi.

CONCLUSION 

The seminar was seen by participants to be highly successful in achieving its aims. Nevertheless, it was acknowledged that this was the first step in the development of Patient Forums and that other events and open days may be advisable in order to raise awareness and attract members from a wide range of backgrounds. There seemed to be a clear role for Patient Forums but there was a consensus amongst participants that this role needed to be developed in a flexible way. This would then allow Patient Forums to adjust to new developments and to be able to accommodate new ways of working in order to elicit the views of a variety of different groups and communities within Bexley. 

This theme of the need to attract views from a broad range of people was a common theme throughout the event and it was interesting that of the 77 participants at the seminar, 30 put their names forward to contribute to the work of Patient Forums in the future. It was also suggested that there should be further events to attract or elicit further interest and commitment. 

The seminar acknowledged that the legislation of the Patient Forums has yet to be implemented and therefore Government guidelines on how they would operate have not been received. This lack of information has created a divergence of views and opinions about requirements of Patient Forums members, who they would represent, the specific membership and their responsibilities. However there was more consensus about the support, guidance and training needs of new members. 

The seminar represented a major step forward in the local development of Patient Forums. However, all those present recognised that this was an iterative process and that further developments would be required. With this in mind, this report is commended for information and comment.

Rachel Horder

Patient Forum Co-ordinator- Bexley CHC

April 2002