West of England Sight Loss Council (SLC) developed a high impact partnership with North Bristol NHS Trust (NBT) to make health accessible for blind and partially sighted (BPS) people. In this blog, West of England SLC member, Heather Armstrong, shares their lessons learnt, the impact of this work and an outline of their journey.
“North Bristol NHS Trust (NBT) is the Acute Hospitals Trust for the North of Bristol, serving a population of 500,000 and includes some regional Specialties. West of England Sight Loss Council (SLC) has been working with NBT for about three years with the aim of improving the experiences of blind and partially sighted people visiting or receiving care at any of its premises.
“Our partnership work has had significant successes and continues to make strides forward. This includes raising awareness of vision impairment, digital and physical access to premises for BPS people, and embedding the NHS Accessible Information Standard (AIS) across the Trust.
How our partnership began
“Initially, our West of England SLC Engagement Manager contacted the Trust. We then attended a board meeting to raise awareness of accessibility issues and explain how we could support improvements.
“Subsequently, we began meeting with the Patient Experience and the Equality, Diversity and Inclusion (EDI) teams. At first, we mainly discussed the experiences of BPS people, feedback from staff and staff updates on improvements made.
“Good working relationships started to build. Anela, one of the four West of England SLC members joined the Patient and Carer Experience Group. This provided a way of maintaining our profile at Trust level.
"As I have relevant experience, my career having been in the NHS, I agreed to lead on future work. Several strands of work had started to emerge. These are:
- raising awareness of visual impairment (VI)
- embedding the NHS Accessible Information Standard (AIS)
- digital accessibility
- physical access to premises.
Our SLC drew up a project plan to focus on priorities from the SLC’s perspective and plan our use of available resources. We agreed a work programme with the Trust.
Raising vision awareness
"Sessions with staff to raise VI awareness was the first priority. This was a mammoth task as there are around 12,000 staff (although not all work directly with patients) and over 300 volunteers at the Trust.
"The NBT Volunteer Services Manager joined the working group and was very keen to take forward our vision awareness programme. Together, we decided to train the volunteers who meet and greet patients at the hospital atrium first, and then roll this out to staff.
"We took this approach because volunteers who meet and greet patients are in a prime position to assist BPS people when they arrive. They also model good practice and can help spread the work to other staff.
"To take this forward, West of England SLC developed and launched our vision awareness programme. The first session took place in October 2021 and monthly sessions followed. These were delivered by SLC volunteer member Anela and myself. We carried out formal evaluation which quickly demonstrated successful learning outcomes. We learnt that NBT volunteers were very enthusiastic, enjoyed the course and reported a significant increase in knowledge and confidence.
"As a result of the sessions, the NBT Volunteer Manager introduced a VI Champions system to ensure ongoing quality support for BPS people. NBT also implemented a system for BPS people to book assistance when arriving at the hospital.
Expanding our work to the Executive Team
"A few staff, such as department and ward receptionists, started to join the training and the word spread quite quickly. The next step was to engage clinical staff.
"With this in mind, I met with the Chief Nursing Officer (CNO). From this meeting, he agreed to champion our work, encouraging clinical staff to engage with training.
"As a result of this significant development, some of the Trust’s Executive Team and an increasing number of clinical staff attended our vision awareness sessions. One senior nurse who attended a session also initiated a system of VI Champions in her own division to further embed the learning for BPS patients.
We continued to build our programme
"Our work continues to progress. Examples include that we:
- developed a handover pack for hospital ward staff for when there is a BPS patient on the ward
- created a short video which is now shown at Trust induction programmes
- worked with NBT to embed vision awareness sessions four times a year for new staff following an induction
- arranged with NBT that Medical Students from The University of Bristol Medical School (who have clinical training at NBT in their second year) now attend our vision awareness sessions.
Accessible Information Standard
"Running alongside this work, an equally important work programme to implement the Accessible Information Standard (AIS) is progressing well. The NHS Accessible Information Standard (AIS) was introduced by NHS England in 2016.
"NHS England describes how the AIS aims to:
- make sure that people who have a disability, impairment or sensory loss get information in a format that they can access and understand from healthcare services. Examples include braille, audio or large print.
- ensure they can get support from a communications professional if required.
"Without accessible healthcare information, people risk missing appointments, not understanding treatment and even taking the wrong medication. However, five years after the AIS was introduced, national research by Sight Loss Councils found that nationally 90 per cent of blind and partially sighted people still did not receive healthcare information that they could read.
"So, the SLC supported the development of two business cases at NBT to create two posts to embed the AIS at NBT. Funding was secured.
"NBT then invited me to join the Communications Assistant Director and the Head of Patient Experience in the interview and selection process for the Patient Communications and Engagement AIS Lead. The post was filled from December 2021.
"Since this appointment, much progress has been made as part of our joint partnership to make health accessible. We have:
- become active members of the Trust AIS Steering Group
- informed the development of NBT’s AIS Policy
- advised on NBT alerts going onto the Patient Record and booking systems that raise awareness of an accessible information and communication need
- worked with NBT on a multi-sensory AIS campaign in partnership with the Trust and groups representing other sensory losses
- promoted the AIS throughout the Trust during Disability Week in 2022.
- developed an e-learning programme to complement the face-to-face vision awareness sessions.
- carried out work on digital accessibility which has resulted in changes on the Trust website.
Lessons learnt
"There has been some learning for West of England SLC along the way. Key points for success were:
- an approach that offers support rather than criticism
- forming good working relationships of mutual trust with key staff
- having an agreed plan with clear priorities and goals
- starting small, working up, demonstrating and building on successes
- constantly reinforcing how important it is to be involved in developments from the beginning
- engaging a Champion at senior level in the organisation.
Building on our success
"There is still much work to be done. This includes plans for:
- ongoing promotion of the AIS internally and externally so that BPS people know what they are entitled to and how to ask for it
- further work on digital accessibility, including a second E-Learning Programme on assistive technologies and communication support in collaboration with groups representing other sensory losses.
"However, we have developed an impetus for improvement and there is enthusiasm to drive things forward.
"This January 2023, the NBT Trust Board meeting invited the Patient Experience and AIS Leads and myself to report on progress. This was well received and West of England SLC was thanked for its work and assured of its value to the organisation. We feel that our support is now embedded in the Trust.
NBT feedback about our partnership
Professor Steve Hams, Chief Nursing Officer for North Bristol NHS Trust, said:
"Working with Sight Loss Councils has been an important part of our approach to truly understanding the lived experiences of patients with sight loss. Together, we have worked on a number of improvements as part of our commitment to delivering the Accessible Information Standards, and ensuring our patients receive the very best care. Whilst there is more for us to do, we remain committed to working with SLC and our local sight loss community to further our efforts in providing responsive, kind and safe care."
Kathryn Tudor, Volunteer Manager at NBT, said:
"Partnering with Sight Loss Councils has been an incredible opportunity to provide our volunteers and staff with meaningful and interactive visual impairment sessions. Attendees fed back that the content was excellent, and that their confidence and knowledge on the subject had improved by 60 per cent after attending. The input from the SLC has been crucial to shaping our patient experience improvement work."
Ann O'Malley, former Patient Communications and Engagement Lead (AIS), said: "Sight Loss Councils’ support for NBT has been invaluable. The volunteers have supported us in embedding the Accessible Information Standard and raising awareness across the Trust. Their commitment, passion and support has already led to significant change and we are looking forward to continuing the journey to improving access. Thank you, SLC!"
Heather Armstrong, 21.6.23.