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Hester: Therefore, I would like to introduce Graeme, who became a PSP in 2020 and has worked with us to co-design approaches for medical examiners and medicines safety.

I’ll now handover to Graham to tell you a little bit more about himself.

Graham: Thank you, Hester, and thank you for inviting me to join you today. I’m best described as a lad from Leeds. I have two children, four grandsons, whom I’m very proud of.

My involvement work, I guess, started around 2011 when my general practitioner invited me to join what was then called the Patient Reference Group in the Practice, that subsequently morphed or became the patient participation group, and that was the opportunity to be involved in more patient involvement work both locally and nationally, and it all started from that.

Hes: Thanks. It sounds like you’ve been involved for quite a long time, actually. And only more recently with us though. What made you get involved in patient safety, particularly with and wanting to work with a national patient safety team as a patient safety partner?

Graham: Well, that stems back to the start, when I was working with the clinical commissioning group, I became a member of the Quality Committee. And in the Quality Committee we saw a lot of importance of safety in terms of delivering good quality of care. So safety became very prominent in my experience.

Then involved with Healthwatch and the local forum for racial equality, I realised that there are far more opportunities for improving patient safety. So I had this hunger to look at ways in which safety could be improved.

To achieve good quality care, we need an effective, safe and positive experience for patients. And so safety becomes a fundamental part of patient involvement and care. Patients contribute hugely to good care in various ways, and it was the opportunity to explore that that really attracted me to working with your team.

Hester: Thank you. I love the idea of being hungry for patient safety. I think that reflects quite well on how I feel about things around patient safety. And did you have any more personal reasons for getting involved in patient safety?

Graham: Well, yes. As a patient, you quickly see opportunities to improve safer care.

For example, I was in a ward in hospital for four weeks and in a ward of six beds, you can see many opportunities for improvements in just little things that could make a difference to people’s outcomes and people’s experiences of care.

And also the work with medicines. I was brought up by two pharmacists, both my mum and dad were pharmacists and I was taught that medicines, whilst they have a lot of benefits, medicines can also cause harm. In fact, medicines can kill you.

And so we have in our hands a tool to be both effective and safe and also harmful and dangerous. And therefore the patient involvement in that, seeing things, seeing issues through the eyes of the patient and the patient side of the story rather than the clinician side of the story, I felt was always very important to bring that side of the story to the table, to the debate, to the discussion was always important to me.

Hester: And how do you see those main benefits of us involving patients more in patient safety?

Graham: Well, the patient is in fact in charge. Some people may balk at that idea. But I choose as a patient when to seek help. I choose what to tell the clinician when I sit down with them and go through my story, my experience. I choose what medicines to take after they’ve been prescribed for me. I choose when to go back from my follow up appointment. I choose when to call for emergency treatment because I’m really worried.

I make all those choices, often in the privacy of my own home, often on my own, or with family and friends, perhaps helping, perhaps interfering.

But they’re all patient activated, their patient doing things. And so a patient’s role in safety is huge. And I think hitherto it has been underestimated how much a patient can contribute to safer, more effective and more appropriate care.

Hester: Thank you. So there’s a real emphasis there on patient choice, but also patient involvement in their own care. And that’s a really interesting perspective.

Can you give us some examples of the kind of work you’ve been doing as a patient safety partner, both within the national team and maybe work you’ve been doing elsewhere?

Graham: Where should we start? Let’s take the medical examiner system. From April 2024 there will be a statutory process in place, a statutory requirement and process in place. for the certification of deaths.

This is to make sure that all deaths are suitably and appropriately scrutinised. And also that the bereaved families and those involved have proper support and proper access to the conversations and the help that they may need.

Implementing that is a big job. It’s been going on for a couple of years now and I’ve had the privilege of being directly involved, not only the steering group and putting that together, but also in the development of guides for various clinical situations and for various groups.

For example, the need to be able to release the body urgently or quickly after a death, which is very important for some ethnic groups. So we can see that the need for a patient perspective is very important in developing and implementing a new medical examiner system.

And related to my hobbyhorse around medicines, the Medicines Safety Improvement Program has been looking at how to pick on some big, big topics and put national programmess together that encourage safer use of what have been important and very effective medicines, but there are still concerns and issues that have to be carefully monitored and managed.

And some of these issues become apparent once medicines have been used more widely. So there are some important programs in place now, to be able to manage those situations where we learn about safety as we go forward with the use of medicines and opportunities to improve things.

An example would be the use of opiates in management of pain and the fact that the medicines tend to become less effective as time goes on. As we use them more, as they’re used for longer in a patient and yet the dose needs to therefore be increased. And this is potentially dangerous. So there are opportunities to look at alternatives for pain management. This is just a small example from the sort of approaches that the programme is encouraging.

So more locally I’ve been lucky enough to be involved in the implementation of the Patient Safety Incident response framework in a local trust. This framework is all about supporting a more positive culture towards safety incidents. Moving away from blame, to move towards how do we solve system issues that mean that this incident or this type of incident is far less likely to occur in the future.

That’s a very important approach to making the health service safer for people and recognising that it’s a difficult job to be safe all the time for everyone. But we can do our best if we learn from incidents as we go. So it’s encouraging that positive learning as we progress.

Hester: Thank you. And then finally, what would you say to others to encourage them to get involved either as a patient safety partner or as a health care organisation who’s not yet fully recruited their patient safety partners. What might you say to them?

Graham: I might start with a discouraging statement. Patient safety is really important to everyone, to organisations, to individuals. It’s very, very important. We have perhaps as patients, stored up some of our patient safety concerns. And if we are invited to become involved in patient safety, we might share a lot of things that are not so pleasant to hear. To start with, we might need to get a few things off our chest.

But for an organisation, may I recommend that you don your tin hat and be prepared and be brave and listen to and take on board those concerns.

Once we’ve shared our concerns, we can then start to sit round the table together and as partners, build some more constructive and more positive ways of preventing these sorts of incidents in the future.

But we need to have that open and difficult discussion. We also need organisations to be prepared to take the rough with the smooth. You can’t just hear the bits that you would like to hear as an organisation. You have to hear it all. And you have to respond to it all. So be prepared to properly support, fund, give time to this work because it is more than initially you would have expected. It will grow and be a little bigger.

So those are my put you off sorts of messages.

But imagine the benefit to the population that the organisation serves. Imagine the benefit to the staff and their sense of enjoyment and wellbeing and value, ff we can get all these issues or many of these issues out on the table, practical things being done to make safer and more effective, then I think that is where it’s at.

And as an individual, our perspective is hugely important, because it’s a collection of individuals that the service is treating. But the service learns, clinicians learn about care through populations. They look at large studies with hundreds or thousands of patients and look at averages and typicals and unusuallies and all that sort of stuff. And yet as individuals we can be sort of anywhere within the spread of those results.

As an individual, I may be very sensitive to some things, are very resilient to other things. And you don’t know which patient I am until you start to work with me and understand. So as a patient, I have a huge amount to contribute, but that is on an individual basis and requires clinicians to think of us as individuals based on their background of the population information they have.

I hope I’m not going on too much about that, but it’s a really important point about the value that an individual brings to this. So it’s interesting, it’s worthwhile and there’s a chance to make a big contribution and it’s surprising how far that contribution can go.

So sometimes we’re given opportunities to get involved, I recommend you take those opportunities. Once you’ve taken those opportunities, then there’s a chance to work with your team Hester and others, to learn how to make the most of that opportunity, make good use of that opportunity for others and for the population in which you are part of the community with which we live, and to make a difference for a lot more people than just ourselves.

And that is really worthwhile.

Finally just like to mention in terms of involving people and becoming involved in this sort of work, one of the main criteria is simply to be a curious person, to have a curiosity about what’s going on, an inquiring mind, an interest and willingness to ask the question, the why, just to be curious.

And if you’re interested in this sort of work and have that curious approach to day-to-day living, then this is just the work for you.

Hester: Thank you, Graham. And I’m donning my metaphorical tin hat as we speak. And actually I think that constructive challenge that we get through the ability to listen to people such as yourself to look or to attempt to understand your perspective from your eyes.

And actually, it’s really important that we can hear those comments even if they may sometimes feel a little bit uncomfortable for us. So thank you for that metaphor, I’m going to think about my tin hat and keep that by my side. Just in case in future. But very much we absolutely value your contribution and the contribution of all patients and people who come forward and help us to try and make patients care as safe and as brilliant as possible.

And so is there anything else you’d like to add to that?

Graham: The overall opportunity for involving patients is of course, the huge gain from addressing some of the inequalities that we have in health and health care and health care needs. People have different needs, different backgrounds, different experiences, different expectations lead to different needs. And if we don’t hear those needs, and if we don’t think about how we can address them by having people from various backgrounds and experiences and needs in the room and give them a chance to share their story, and their perspective, we are never going to be able to design safer, more effective health care services.

So having a positive and constructive approach to inequalities in terms of making sure that we are hearing a diverse view on any particular topic is very important.

When it comes to the patient’s perspective and the clinician’s perspective. It’s surprising how often you hear the phrase I know my patients from clinicians, I know my patients. And yet if a clinician and a patient, or indeed if two people were to simply walk into an art gallery and look at the paintings on the wall, we would see different things.

We would see those pictures differently. We would have a different story to tell. We’d have a different message that we picked out for them. We’d like some things and not others. We have different preferences. They are the differences that we get from seeing things from a different perspective, and they are both equally valuable. And in the consultation and the clinician perspective from the population medicine and the textbook, the patient’s perspective from their day to day experience and all the things they’ve learned through their own lives and how they live their lives, they are two equally important perspectives to bring in to the consultation, the discussion, the shared decision making and the agreement to what to do next, what treatment to take or what procedures to have to go along for. So there is a lot going on in terms of the difference and the value of that difference, and we must respect that valuable difference.

Hester: So thank you for sharing your stories today and sharing your absolute beautiful nuggets of information and challenge to us. And for all the work you’ve done with patient safety, particularly with us in the national team.

For those of you listening to this podcast today, if you want to find more information about patient safety partners and the work we’re doing, you can go to the links in the description below.

It’s also all available on the NHS England website and do please follow us on Twitter @ptsafetyNHS, where we’ll be letting you know about other podcasts in the series.

So thank you for listening today.