1. Service Pledge User involvement Successes Recognised model Next steps Angela Spiers Magny 18 May 2009

2. Service Pledge User involvement Successes Recognised model Next steps Breakthrough’s Service Pledge “A tool to enable patients and healthcare professionals to work in partnership towards better local breast services.” Localism Entitlements PPI

3. Service Pledge User involvement Successes Recognised model Next steps Components Service Pledge template Collecting views on existing service Partnership working Improvement goals

4. Service Pledge User involvement Successes Recognised model Next steps Service Pledge standards Department of Health guidance Clinical guidelines Patient views Service Pledge Advisory Group Local standards

5. Service Pledge User involvement Successes Recognised model Next steps The aim Healthcare professionals and patients work together to improve local breast cancer services. Breast units produce a local Service Pledge which informs patients about the standards of care they can expect. Breast cancer services improve at breast units as a result of the written local Service Pledge. A culture of patient involvement and service improvement is established in participating breast units.

6. Service Pledge User involvement Successes Recognised model Next steps Service Pledge sites: Pilot and second wave Friarage, North Yorks Scarborough Lincoln, Boston, Grantham Norwich The Harley Street Clinic Royal Surrey County Prince Charles (Mid Glamorgan) University Hospital of Wales (Cardiff) Ipswich Buckinghamshire (Wycombe, Stoke Mandeville) Hull Isle of Man Basildon

7. Service Pledge User involvement Successes Recognised model Next steps Service Pledge sites: Third wave West Middlesex (Hounslow) Countess of Chester Musgrove Park (Taunton) Macclesfield Frimley Park (Portsmouth) Barnsley Worthing Western General (Edinburgh) Bristol

8. Service Pledge User involvement Successes Recognised model Next steps Involvement is key Each site will… Nominate and support a Pledge Lead who attend one day’s training Recruit CAN members to carry out interviews who attend one day’s training Breast unit review the national survey template and make local amendments Through surveys, recruit two Patient Representatives

9. Service Pledge User involvement Successes Recognised model Next steps Reviewing the existing service Questionnaire Based on Picker Institute model Evaluation of existing service, based on Service Pledge standards Adapted locally and posted to patients Patient interviews 12 patients interviewed by Breakthrough CAN members 30 minutes per interview Interview prompts used, to allow patient to tell their story

10. Service Pledge User involvement Successes Recognised model Next steps Agreeing improvement goals Each site will… Discuss and agree improvement goals, in consultation with Patient Representatives Discuss survey and interview findings as an MDT Detailed action plans for each improvement goal prepared Patient representatives continue to support unit to achieve improvements and maintain focus

11. Service Pledge User involvement Successes Recognised model Next steps Using involvement to enable service improvement Information AccountabilityInfluence “It’s a tremendous boost to getting change to hear from patients, ‘these are the problems’.” Breast Care Nurse

12. Service Pledge User involvement Successes Recognised model Next steps Improvement goals photographs showing the results of surgical treatment and reconstruction options “To offer patients the opportunity to see a book of photographs showing the results of surgical treatment and reconstruction options. This book will be produced by the Breast Care Team, the Photography and Graphics team and with the help of our patients.” “I saw [the results of] two different operations and this helped me decide what I wanted done…the book is up and running now and I have had my photos done and I have been included in it …it was done really carefully…and I had the opportunity to see them before they were included in the portfolio…No heads seen, no identifying jewellery, really carefully done.”

13. Service Pledge User involvement Successes Recognised model Next steps Key successes Dedicated breast unit at Pilgrim Hospital and at Cardiff by 2010 Drop-in clinic in North Yorkshire community Fully booked Look Good…Feel Better at The Harley Street Clinic Doubling of weekly rapid diagnostic clinics at Norwich Photographic guide to reconstruction at Royal Surrey County Hospital

14. Service Pledge User involvement Successes Recognised model Next steps Key successes A dedicated breast unit in Boston, Lincolnshire

15. Service Pledge User involvement Successes Recognised model Next steps Recognition One year on report: Included as a best practice case study and highlighted for our work on NHS environments Shortlisted 2009 – results announced on 27 May

16. Service Pledge User involvement Successes Recognised model Next steps Recognition Involvement 2 Impact Awards: Runner- up in Partnership Working category Improving Patients’ Experience best practice factsheet “Having the backing of a large charity was invaluable in overcoming hurdles and gaining the interest of patients.”

17. Service Pledge User involvement Successes Recognised model Next steps Secretary of State for Health, Alan Johnson welcomed Friarage Hospital’s Service Pledge for Breast Cancer saying: "It is vital that patients are fully involved in shaping the health services they receive. Breakthrough Breast Cancer's Service Pledge for Breast Cancer is an excellent way of involving both patients and health professionals in developing and improving local breast cancer services.

18. Service Pledge User involvement Successes Recognised model Next steps What they say “It has been empowering and satisfying to work on the goals of our local Service Pledge as it helps us to focus on what patients tell us they want from us rather than what they get from us." Doreen Macaskill-Refaat, Breast Care Nurse and Pledge Lead “I wanted passionately to work with the Breast Care Team to ensure that through tailoring the Service Pledge, having listened to patients' needs (of which I was one), we would together make that difference in the overall standard of care and support, to all those undergoing Breast Cancer treatment at the Harley Street Clinic in future.” Patient Representative for the Harley Street Clinic Service Pledge

19. Service Pledge User involvement Successes Recognised model Next steps What Next? 1. Further evaluation on impact 2. Updated Service Pledge template rolled-out to third wave sites Sept-Oct 2009 3. Scoping national roll-out: - acknowledging role in commissioning cycle - links with peer review - links to cancer commissioning - cross over with Cancer Reform Strategy (patient experience survey and commissioning) 4. Sharing as a model of best practice

20. Service Pledge User involvement Successes Recognised model Next steps Thank you Further information please contact: Angela Spiers Magny Health Campaigns Manager angelas@breakthrough.org.uk