The House of Commons

Supporting Good Hospital Environments:
The Introduction of Patient-led Assessments of the Care Environment (PLACE)

19th March 2013
Chaired by Baroness Thornton

MRSA Action UK was invited to participate in the event at Westminster Palace introducing Patient-led Assessments of the Hospital Care Environment, chaired by Baroness Thornton. Dr Dan Poulter, Parliamentary Under Secretary of State for Health gave the ministerial address "The Government's commitment to improving patient and public engagement in healthcare".

Andrea Jenkyns, Derek Butler and Maria Cann joined other patient organisations, including Leonard Cheshire Disability, C.diff Support, Group B Strep Support, SURF, the Infection Prevention Society, and many others.

Dr Poulter, in his keynote address, said that patient-led inspections were particularly important in view of what's happened in the light of the Francis Inquiry. It is incredibly humbling to hear about the failures at Mid Staffs. He said "we want to make sure this never happens in the future. Patients should be forever more at the centre of care. Patients tell me a lot more about their healthcare, than anyone else can."

He said "Every patient has the right to be treated with compassion, dignity and clean, safe care." It was essential to listen to patient feedback - April will see the implementation of PLACE, and you can be involved at your local hospital."

He thanked the steering group, including patient representatives, for our contributions to the assessments and said that we will continue to develop these tests and continually improve them. Patients know better than caterers and staff, and he was pleased to see staff and patients working together for the benefit of patients. He said we want to ensure it's not a platitude and tick box exercise. It's about driving up the quality and passing the friends and family test.

Jane Cummings, Chief Nursing Officer NHS Commissioning Board said she had spent the last 12 months speaking to colleagues, nurses and midwives, and they want to make a difference and drive through care and compassion and spread the best of what's happening in the NHS. The Francis Report has had a big impact on her personally. She said "poor care is a real betrayal of what we stand for".

She said compassion in practice is based on the 6Cs: care, compassion, courage, competence, communication and commitment, everyone is talking about them. The NHS Commissioning Board is charged with the oversight; we are clinically led and are driven by outcomes. We will champion patient and public involvement, Neil Churchill, Chief Executive of Asthma UK, is the Chair and is passionate about patient involvement. We will link with voluntary groups and charities.

The assessment teams are made up of 50% of patients and members of the public, findings will be reported back to the national quality board.

Liz Jones gave a presentation on how important a good environment is to patients and staff. A good environment really matters, seeing places that are clean, organised and tidy, good food, all are really important. Patients are aware of what standards they should expect.

There were opportunities for questions. The Women's Institute asked if involving patients was an admission of failure, not a view that MRSA Action UK would take. Derek questioned the Minister and the panel on the Francis Report. Maidstone and Tunbridge Wells, Basildon and Thurrock were all cited as one-off occurrences at the time, yet we know this was not the case. With the family and friends test, this should be a question for staff, not just patients, how happy would they be to recommend their hospital to family and friends? Lord Walton, a neurologist said the patient needs a voice, views are not acted upon and ignored; will HealthWatch be more effective at making the patients voice heard?

The Minister replied that it's right that we do ask patients about care, we need to reinforce what frontline staff are saying already. The sister on the ward will raise concerns, but management didn't listen at Darlington Hospital. Patients reinforced this and it led to change, the way meals were served etc. The Minister said he remembered Maidstone and Tunbridge Wells and the filthy wards, he remembered working as a junior doctor at the time and that bad managers who have failed patients should not be recycled into the system. He agreed that we need to listen to staff feedback - and to listen more effectively. The dots were not joined up effectively enough. Bruce Keogh was looking at this.

Lord Walton said link organisations have been variable; some have not been as effective, we need to make sure we join up in social care and join up with housing. The Minister said there will be different priorities on the health and well being boards, friend and family is about patients.

Jane Cummings echoed the Minister; she said we should not be paternalistic in our approach. Doctors and managers will be asked if they would recommend their hospital or care facility as a place to work, or where their loved ones would be treated. She said "we are concentrating on how we can address what staff say, how often would we be asking those questions - should be more than once a year" Whether it's the CQC or HealthWatch shouldn't matter, it's about the culture of the organisation.

A Governor of King's College Hospital commented that we need accountability; it was difficult to be involved unless you are part of HealthWatch. He asked how family and friends feedback to the government will be passed on.

The Minister said that from April, in urgent and acute care, patients and families will be routinely asked the family and friends question. The feedback will be published at a local level, so you can compare straight away and act on the information. The data will be available on a daily and monthly basis and be able to trigger early warning signs. There will be more information published next week in parliament.

Bruce Keogh will report on his investigation into the 14 hospitals where mortality rates were higher than expected. The NHS Commissioning Board has a patient involvement team and will be looking at the results of the family and friends test feedback.

Betty Smithson, a retired nurse-teacher, gave a presentation on her experience of the pilot. She said PLACE had been developed in collaboration with patients, staff and the National Quality Board. She had been involved with PEAT since its inception, and like the advert says "I like PEAT but I like PLACE better!"

Betty said she was asked where she wanted to go for the inspections. Ward sisters and doctors were not upset by patient-led inspections; Betty was contacted after the inspection to say they had got a lot of things done. Betty didn't like the scoring system on the pilot; this has been modified and improved since. The inspection is scored after each ward visit. Betty said she introduced herself as a patient representative, she said that patients will talk to you as you are independent of the staff. If there are things on the ward they don't like they will give you feedback.

Privacy and dignity is very important, and you can see if the patient is having care with curtains pulled, if they are being spoken to, are relatives communicated with, if there are places to go to talk in private.

Food is important. People do listen to what you say act upon things. There is a food group of about 30 people with food tasting every month.

Recommendation 101 of the Francis Report endorses the need for independent peer review, Kevin O'Regan said he invites a colleague from another trust and operates as an observer in the inspections, this was an opportunity to empower patients, carers volunteers and the third sector, colleagues are looking forward to PLACE.

Lyn Samuels, HCAI Service User Research Forum, asked how much notice hospitals will get. Liz Jones said that this has been challenging, patients have to have notice, there was a need to compromise, 6 weeks notice was therefore given. Maria Cann asked if patients themselves will have an opportunity to feedback, giving an opportunity to do an exit survey if they are willing to take part, using the PLACE questions. Liz Jones said the PLACE assessment form is not good for providing patient feedback, so no. Jane Cummings said that patient groups set the agenda and dictate when inspections will take place. There was only one trust that didn't do PEAT for one year, but they went back and did it the following year. PLACE should have the same level of support. Liz said that they were constrained to deliver in cost neutrality - it will be an annual assessment, but there will be monthly local assessments - giving an opportunity for 12 people to be involved.

Hospitals must adapt the assessments; they must reflect the needs of the patients, language support, dementia or Alzheimer sufferers, people with hearing difficulties, all accessibility needs will be covered in the local training, and easy read version of the assessment will be available. Support needs, will be funded locally; there will be some recommendations from the Commissioning Board, DH and CQC. The Information Centre will collate the data. Individual results will be published on websites.

If anyone is interested in becoming a patient assessor they can contact their local Healthwatch group or their local hospital's Volunteer Coordinator at their NHS Trust.

If you or someone you care about has been affected by a healthcare associated infection and you wish to discuss this with us, please contact us at

The information on this website is for general purposes only and is not a substitute for qualified medical care, if you are unwell please seek medical advice.

(c) MRSA Action UK 2013