The NHS Plan 2000 and the Department of Health paper “Involving Patients and the Public in Healthcare” (a key document but no longer available on the DoH site!) led to PALS being established in every NHS trust (including PCT and Ambulance trusts). This was done through the allocation of finance for the purpose and pilots and prompting through Strategic Health Authorities. The main factor here is that, unlike PPI Forums and Independent Complaints Advocacy Services (ICAS), there is no specific statutory basis. The official description of PALS can be found at: DoH PALS overview.
From the Official DoH “PALS Standards” The core functions of PALS are to :
• Be identifiable and accessible to patients, their carers, friends and families.
• Provide on the spot help in every Trust with the power to negotiate immediate solutions or speedy resolution of problems.
• Act as a gateway to appropriate independent advice and advocacy support from local and national sources.
• Provide accurate information to patients, carers and families, about the Trust’s services, and about other health related issues.
• Act as a catalyst for change and improvement by providing the Trust with information and feedback on problems arising and gaps in services.
• Operate within a local network with other PALS in their area and work across organisational boundaries.
• Support staff at all levels within the Trust to develop a responsive culture.
Interestingly, I needed to consult my local James Paget Hospital PALS myself yesterday(22.08.05.). I'd had the results of a biopsy taken 13.07.08. and the information in the results letter was contradictory to what actually took place. My concern is that results might have been mixed up.
First observations are:
•Access to PALS at the James Paget hasn't changed since it was set up. There is a phone in a corner of the main hospital foyer labelled PALS and pressing button one (as per written instructions) puts you straight through to the office. Not what I would really call: “identifiable and accessible to patients, their carers, friends and families.” - a particular barrier to those who, for whatever reason, are unable to read!
•I was seen within 5 minutes and taken to a room borrowed (presumably by prior arrangement) from one of the adjacent out-patients clinics. It was like a turkish bath in there and I felt very uncomfortable throughout the interview, rushing it in consequence.
• The PALS officer I saw I have know for years. I used to work with her before I retired in another hospital. She is excellent: very approachable, no side, and with effective communication skills, she creates a positive initial impression with patients contacting her (not just my own evaluation).
•Having carefully noted the details of my problem, she said she would have to get my notes and speak to the doctor who had sent me the results letter and get that doctor to send me another letter (the doctor is not one whose name I recognised and not the one who had taken the biopsy - it became clear that this doctor was from the ward I was urgently admitted to later on the day of the biopsy and not from the department which had taken the biopsy!).
•I requested that “I would like this investigated by a person independent of that doctor and I would like to personally examine my notes alongside that person.” The response was that this necessitates me filling in a request form to see my notes we agreed one would be e mailed to me straight away (it was). I came away feeling slightly miffed at having to jump through bureaucratic hoops to look at my own notes.
I'll wait and see what happens.
Mike Cox 23.08.05.
hi mike
i had a brush with PALS. i had a complaint against a senior manager and the
PALS manager was assigned to investigate it. he strung me along and led me
to believe it would be upheld which it wasn't tho i took it as far as i
could and those responsible for my medical care thought it fully justified.
the PALS manager was also very difficult to get hold of and did not respond
to either email or voicemail. advocacy has beenn very helpful for me but it
is essential that an advocacy serrvice is not 'in house' and that advocates
are not NHS employees.
hope this is of interest.
This time last year SUIP (Service User Involvement Project) bought up concerns that had come back from an SU questionnaire that we sent out. Service users were unhappy with the Advocacy service...as in not being seen and also feedback that they did not deal with complaints. (No comments came through about PALs ...although I doubt service users really know who they are and what they are there for).
It has taken us a year to get the Commissioner who funds them to do an evaluation...awaiting to hear what type of evaluation he has in mind. As I have been chasing this up on and off...am very sceptical...although he has now promised to get back to me as soon as this meeting has taken place. Think I will ask him to come to a SUIP meeting so my colleagues can discuss directly what is what...and where SUIP want to go with it.
In the Advocacy service's defense they are holding weekly meetings in acute units now and when I referred a service user on to them...the chap who dealt with this was pro-active. So maybe...in a year things have picking up.
So getting back to PALs....speaking personally, I would rather go to other support services or directly to the CEO than bother with them.
Thanks. I really was clueless about the PALS. Still don't think I would bother with them...particularly in light of comments coming through about negative attitudes and singing from NHS Hymn Books.
Am just perplexed by all these people doing stuff for the same reason so separately. Never ceases to confuse me.
Mandy
Thanks for your reply, but I am fighting the corner for PALS. Please don't be totally influenced by negative comments coming through the network. I am the PALS facilitator for xxxxx xxxxx Mental Health Partnership NHS Trust, and I work alongside many other PALS people throughout xxxxxx and also belong to a Mental Health PALS network covering many areas of England.
I can honestly say that PALS staff are working very hard to support and resolves issues and concerns raised by service users, carers, family and friends. I admit that PALS may not be able to resolve everyones issues to their complete satisfaction, but many people who use PALS do so again and recommend others to do so. I have on average 40 calls a month from people, and only one or two people may not be satisfied with their outcome. Also PALS feeds back the information received from callers within reports to the trust board and service governance. Contacting PALS can make a difference to the services provided, so don't feel that it would be a waste of time.
PLEASE don't discount or judge all PALS on those instances that may not have appeared to help. Just give PALS a ring and make your own judgement.
I take on board what you have said. Perhaps the PALS could be a service that SUIP could refer people on to, should they come to us with concerns and then we can seek feedback on how they feel about the service given. I need clarification on exactly what PALS roles are. If they do not deal with complaints what type of service is provided.
It does quite amaze me that there seems to be no link between NHS Direct and the PALS. If the PALS are there to offer advice and support. If that is their roles. Perhaps I am wide off the mark but if the PALS are part of a support service then there must be a need for NHS Direct to link into them, particularly with MH issues. The gaps in the services are mainly about different services not working with others and almost acting as stand alone provisions. I think closer working between departments/sections of the NHS is a priority but haven't seen much of it in action over the years.
Have you any thoughts about this or experiences you can share?
Mandy
I think you have hi-lighted the fact that there are so many changes, orgs, opportunities that people are confused. Let's face it Mandy you will know a darn sight more than your average Jo Bloggs using the NHS. I don't think the way the PPI was marketed helped as an awful lot of people felt it was a MH Trust body, rather than an independent body scrutinising a particular MH Trust. We found that in Norfolk as when the PPI (quite rightly) held a meeting about the EMI changes people turned up expecting to talk directly, and have answers from, the Trust + the trust people who turned up thought they were there for a 20 min agenda item and had to leave to go to another meeting.
I contacted the PALS service here on Monday, because I didn't know what was happening or not for my care and had already sent 2 letters and an e-mail to the clinician involved and had no response. Tuesday I had an e-mail from the PALS service saying they had spoken to the secretary, requested a care plan be sent to me and my GP and were going to make sure that happened. So hats off to them! PALS is an in-house service.
BUT...you've raised an important issue - what about NHS Direct? Am I right in thinking that they are a special Trust and if so do they have a user org? Our out-of-hours service is run by the Ambulance trust but I don't know if they monitor complaints etc?
NHS Direct are aware of PALS and do refer people on to the relevant service (I know that as I have been in touch with the xxxxx area NHS Direct and have had people referred to our trust PALS from there.
The word "complaint" can cover a multitude of situations. Often this isn't a complaint but a concern or issue and it needs to be dealt with as quickly as possible. PALS would deal with lots of different issues and concerns, we also give information regarding our trust services we would also refer people to other PALS if that was the most appropriate PALS to deal with the concern. PALS offers a service that will try to resolve issues/concerns asap, (usually within 1-2days) rather than going through the Complaints procedure (20 days).
If the situation is a definate complaint then we would give information regarding how to make a complaint and we would also give the contact details for ICAS (Independent Complaints Advocacy Service) who would be able to represent and support the person independently.
There is a lot of cross referring via other trusts PALS / ICAS /ADVOCACY / Patient & Public Involvement Forums / NHS Direct / Service User groups / Minds / voluntary sectors / Carers organisations, etc. so we are all working together (of course I can only speak for xxxxxx).
In my PALS role I attend many service user forums and regularly receive feedback from these groups and from inpatient/outpatient community meetings. All this information is used to ensure that the trust services are meeting needs. If you ever want to discuss PALS do give me a ring (I can ring you back to save your call charge).
I don't think the PALS/NHS DIRECT link is working in Beds.
I had been involved with trying to help a woman....and she rang NHS Direct...quite a bit..and was at no time referred on to the PALS Service..Pity I didn't know about the service..would have referred her myself. Also when trying to get my friend help the other month NHS Direct referred us to Primecare..who were worse than useless. My friend and I have a meeting with the CEO of Trust this week. At this meeting, I think I shall question the relationship between NHS Direct and Beds PALS service.. See what he has to say about it. If xxxxxx can do it, why can't Beds?
What really gets my goat is the varying levels of support across the country..And Beds always seems to be pitifully poor on most things.
Our Beacon...of good practise is Progress House ...which is a rehab..hostel type centre for people with severe mental illnesses. They are leading the Recovery Programme and seem to have that real caring philosophy..much lacking elsewhere.
Every other story I get is of neglect, dealing with bad attitudes of staff and service users here seem to almost be in a state of deflated surrender. Not many believe positive change can take place...let alone will...(except the likes of me that try...but feel the battle is a very hard one).
There is much to be miffed about.
Mandy
Hi Mandy! It might be a good idea to contact the Beds SHA who should have a named person that supports all PALS in the county. There should be a PALS network incl MH, PCT and Acute trusts. You could ask them to look into the links between NHS Direct and their knowledge of PALS. Our SHA always sends updated contact details to NHS Direct xxxxxx.
dear mandy
i am worried that you should be recommending PALS. i know that you have been very cautious about this, but they are totally unaccountable and unmonitored. my own experience with them was very bad indeed, though there are probably regional variations. does anyone know anybody who has had any sort of positive experience with them in the MH context?
I could try the patient advice and liason service, they've got an office at the hospital where i see the shrink, a bit of a journey, when i phoned i didn't get much help.
I've just filled in a mind questionaire about advocacy, i'm wondering why minds asking.
When i approached a mind in enfield advocate, i was told "My job is to represent people who can't represent themselves and this file you've got shows you can"
Could boast about such things but doesn't really get me anywhere, the way these people hold any HEALTH against you is something else-