Working in partnership with service users who are homeless and a local housing trust, this project has enabled clients to develop authentic relationships with GPs and primary care teams through sharing their stories digitally. The participants’ psychological safety has been maintained through the support of trusted professionals and a Clinical Psychologist to safety net against any trauma incurred from triggers when discussing past experiences. Specialist leads and matrix working enable collective leadership to deliver the project examples of key stakeholders:

• The digital inclusion team to worked with a social enterprise to co-design the technology

• The Safeguarding and Corporate Governance leads ensured psychological safety and consent

• An Advanced Nurse Practitioner working with the housing trust manager and patients. The project adopted an integrated neighbourhood team approach (as outlined in the Fuller report).

The Project team successfully secured £40,000 in funding from the Health Foundation to develop this innovation. Some of the monies have been used to purchase 10 Dictaphones for the Experts by Experience (EbE) to record their voice messages ensuring GDPR is implanted allocating one device for exclusive use per EbE.

In addition to this, funds have enabled a robust governance framework monitored by the project board with representation from the Project Manager, A Psychologist, Safeguarding Officer, Advanced Nurse Practitioner and Housing Trust Officer.

What does this look like?

The quality improvement initiative commenced in August 2023. A Project Board was established and a comprehensive portfolio of Governance was compiled led by the project manager.  A small group of voluntary participants were identified and the direction of the project was shaped by  them to ascertain the trigger points in their life which resulted in them having to “tell their story” repeatedly, its impact and what they feel is needed to eradicate being in that situation. This feedback is fundamental to understanding the direction required to commence this project.

Considerable time has been spent with the participants by scheduling fortnightly Project Board Meetings in the first 6 months of inception. Listening to each person provided rich insights and it became apparent that this proof of concept  is pivotal to helping them to have a voice and eradicate the need for repeating the sound track of their lives. The method of choice to capture  this narrative was an audio recording, and how this would work.   Further discussions resulted in purchasing 10 Dictaphones each patient having their own device to use which ensures GDPR is in place, ie no risks of recordings being mislaid/shared.

For the remainder of the Project, the key focus will be the promotion and implementation of our digital concept.

Things to consider:

In order to improve both equitable access to primary care services and enable sustained engagement , a tool kit required  exploration to ensure an audible voice for the service user. The options being a succinct recording,  or more comprehensive dialogue. These are examples of a plethora of ideas posed. The digital development is currently the main focus of the project. Collaborative working to scope the  cost and  type of devices with corresponding system interface capability to facilitate this were essential.

This led to the next stage working collectively with practices within the Norwich Primary Care Network (PCN) to undertake the proof of concept and upload the audio onto their operating systems (specific practices based on where participants are registered) This will identify the most viable and compatible process to progress. Please see the information below)

Idea sharing:

A superb addition to the audio recording suggestion was a concept which is now officially known as the “Symbol of Consideration”

This was co-produced with the participants during the scoping sessions. The design and colour scheme aligned to the digital element blending their ideas and words to create the logo. The participants and board members acknowledge the impact of this bespoke creation which is an integral part of the project to be implemented alongside the digital element. This philosophy will be transcribed onto lanyards and also pop up alerts on medical systems, which will then ensure that the reception team who are the first primary care interface are aware of the patient and the need to respect the symbol of consideration, and can then alert the clinician prior to the appointment to enable the health care professional to listen to the audio and additionally be aware of the symbol, to ensure the patient feels “Safe, Respected and Heard”. This trademark will be secured as part of the funding to allow us to implement into medical services.

Promotion/Sharing of Project:

This quality improvement initiative has been showcased locally and nationally presenting to interprofessional audiences with superb feedback and professional interest.

The most significant promotion opportunities were:

• Pathways to Homelessness Conference – London March 2024
• Integrated Care Board (ICB) Inclusion Health Conference – Norwich March 2024
• Visit to our service from the active NHS England Board, presentation re Project. – April 2024

Learning/Challenges:

A number of challenges presented to date:

The sustained engagement of patients to commit to the duration of the project – as the programme progresses, the engagement levels significantly.

Liquidation of the Project Manager’s employers caused a 2 month delay as a restructure ensued at pace, and the process of identifying a caretaker provider impacted upon progress .

The Project Manager has attended 3 Q Exchange webinars which were extremely valuable as the professional support provided by the Q Team enabled opportunities for shared learning and access to a repository of online resources.

Next Steps:

1. The completion of recordings to be shared with the Digital Team
2. The promotion and trademarking of logo with a vision of implementing into Practices
3. Attendance at any relevant Networking events to continue to promote awareness and seek feedback/input to embed this project system wide.

Timeframe:

The aspiration is to promote initial implementation by September 2024.

The current funding envelope will enable continuation of the project post Q Exchange funding.

This innovation is a superb social movement to progress as a team, we are very proud of the genuine interest from an abundance of professionals and patients, and have admiration and respect for the amazing commitment from the patients to create a trademark that may have the potential to be recognized nationwide in the near future.

Conclusion:

“We all have a voice, if only a whisper” (Berwick 2013) , this quote originated from a patient safety publication and is the crux of this proof of concept. The psychological safety has been paramount throughout in order to ensure physical safety where possible .Working with people with chaotic lifestyles who despite their personal adversaries are prepared to commit to influencing current practice, is both humbling and inspirational. The Power of One, The Power of Many,  social movement theory echoes throughout this project; 10 individuals have taken the initial whispers and transformed them into an audible shout, creating awareness and respect for themselves and fellow patients.

The aspiration is to replicate this process across Norfolk and Waveney to enable sustained access to primary care services and engagement with health care professionals. Improving the lives of seldom heard service users and enabling equity of esteem by being “Safe, respected and heard”.

Nicholas Guy – Project Manager

Aim: To enable cultural inclusion of people who have experienced homelessness through a co-designed video cast to communicate individuals’ stories to health and care professionals. Approach: Working in partnership with patients who are homeless and a local housing trust, this project will enable patients to develop trusting relationships with GPs and primary care teams through sharing their story digitally. Specialist leads and matrix working will enable collective leadership to deliver the project:

• the digital inclusion team will work with a social enterprise to co design the technology
• the Safeguarding and Corporate Governance leads will ensure psychological safety and consent
• an Advanced Nurse Practitioner will work with the housing trust manager and service users. The project will take an integrated neighbourhood team approach (as outlined in the Fuller report).

Where we are so far:

August 2023 – January 2024

The initial stage of the project commenced in August 2023. Our first priority was to form a Project Board, and ensure that the board consisted of members that could contribute effectively to the project, and also to provide the governance required to ensure all angles were covered prior to participant identification.

Project Manager Nicholas Guy working closely with Lucy Bone from St Martins to share regular dialogue and ideas, and dedicating as much time as possible to gauge interest from potential participants, and working exclusively with those potential participants to ensure that the project direction was dictated by the participants to allow us to ascertain exactly what issues they have faced in their life which resulted in them having to “tell their story” repeatedly, how this affected them, and what they feel is needed to eradicate being in that situation. This feedback is the fundamentals of understanding what direction we needed to go in to commence this project.

We have spent a lengthy amount of time with the first 5 identified patients by holding 2 weekly Project Board Meetings, and in those meetings, we listened and learned so much from our participants, and it was abundantly clear that this project is the key to helping our participants to have their voice heard, and eradicate the need for repeating their story.

We have held very productive meetings up to now, the meeting content focused on asking the participants how they felt they would like to share their story with clinicians going forward, and the general consensus was to start with focusing on an audio recording, and how this would work.

Things to consider:

Audio – What do you think is key that you want to ensure you are heard? Would this be a short recording, a more lengthy recording etc. These are 2 example of a plethora of angles that we needed to cover to ensure we could identify this as a viable option. This part of the project will be the main focus for Part 2 of the project. Close working with Digital Team, Project Manager and participants to create and record the audio, taking all factors into consideration ie: Cost, devices, system interface capability to facilitate this initial chosen option.

Idea sharing:

A wonderful addition to the audio recording suggestion was an idea which is now officially known as the “Symbol of Consideration”

This was created from the participants during our idea-sharing sessions. We provided pens and paper and they all came up with a design/colour scheme that they felt should accompany the digital element, and from this, we were able to merge their ideas and words to create the logo above. The participants and my fellow board members are delighted with this, and we have therefore declared this logo as an official part of the project to be implemented alongside the digital element. The end result from this logo will be in the form of lanyards which we will create, and using available colour schemes and pop up alerts on medical systems, which will then ensure that the reception team (who are the first port of call) will be aware of the patient and the need to respect the symbol of consideration, and can then alert the clinician prior to the appointment to allow the clinician to listen to the audio and additionally be aware of the symbol, to ensure the patient feels “Safe, Respected and Heard”.

At our most recent meeting, Nick and Lucy shared time with the participants, and received even more excellent ideas from the participants, this being to have a recent photo of the patient on their medical record to accompany the audio and symbol of consideration.

What have we learned so far?

I can resoundingly state that we have learned so much from our participants, and how great the need for this project is. We have heard so many stories and times gone by where the participants have regularly found themselves in a “repetitive story situation”. We have learned that this pilot has the potential to really change the way patients are approached and examined, and really break down those barriers that have been so evident in the past.

We have faced challenges regarding commitments from participants, for example, 1 participant dropped out after 2 months, so we had to move quickly to identify new individuals that would be interested to join the project. Of course, this was completely acceptable as it is all about the participant’s choice. The way we went about this was to hold Q & A sessions with any interested parties and address any concerns to ensure transparency and of course to ensure the potential replacement participants were “Safe, Respected and Heard”.

We also created a “Participant Information Sheet (PIS)” which was provided to the participants prior to commencement which offered a huge amount of reassurance to them, and helped them to understand what was involved in the project.

The whole project thus far has been shaped by experts by experience, these are participants from the community learning and development centre. The individuals who attend includes Core20plus groups that Norfolk and Waveney have identified who are at risk of more health inequalities.  – Core20 Plus Groups – Norfolk Insight

A consent form was created and implement for the first stage of the project.

Next Steps:

January – August 2024

The next stage of our focus will be to bring in the participants to ensure a smooth transition for the stages, to work towards our end goal of creating our digital solution. We have focused on experts by experience to help us shape the chosen method of the digital element.

We will be working with the practices where the patients are registered to implement the chosen solution and working closely with Digital to identify options of recording and implementing.

We will be focusing on accessibility, solutions to problems, further costings scrutiny, and promoting our project within the Primary Care Network of Norwich.

Nicholas Guy

Project Manager