Guidance to organisations on recruitment and preparation of patient assessors

PLACE aims to improve standards across all NHS trusts, voluntary, independent and private healthcare providers. They put patient wishes at the centre of the assessment process, and they use information gleaned directly from patient assessors to report how well a site/organisation is performing – in terms of national standards and against other similar organisations.

It is recommended that all NHS trusts, and all voluntary, independent, and private healthcare providers undertake an annual PLACE assessment of the quality of non-clinical services and the condition of their buildings. 

They look at:

• how clean the environments are
• the condition – inside and outside – the building(s), fixtures and fittings
• how well the building meets the needs of those who use it, for example through signs and car parking facilities
• the quality and availability of food and drinks
• how well the environment supports people’s privacy, dignity and wellbeing
• how well the environment supports people with dementia
• how well the environment supports people with a disability.

The assessments apply to all healthcare sites/premises of all types. This includes acute, specialist, children’s, mental health, learning disabilities, community, voluntary, independent and private healthcare providers.

Who

A crucial component of the assessment process is the involvement of patient assessors. This term covers all people whose experience of the site/organisation would be as a user rather than as a provider, and so encompasses relatives, carers, friends, patient advocates, volunteers, trust/organisation membership and trust/organisation governors as long as they have the patient’s view as their focus. Organisations can determine locally how patient representation will be made up; however, the entire representation should not be drawn from the board of governors and representation should be balanced.

Current or recent members of staff (that is, who have left the organisation within the previous 2 years) should not act as patient assessors at their own organisation, even when they are also patients.  Patient assessors should, as far as possible, reflect the patient population. They can act as staff assessors or can be patient assessors at other organisations. Teams should be a mix of people who use the building/site and broadly reflect the local population using the service. Existing patient assessors should be encouraged to do talks and videos to encourage other patients/services users of the value of the role and how they can also support by becoming a patient assessor.  

How many

There is no maximum number of patient assessors in a PLACE team. As a minimum, patient assessors should make up 50% of the team (including any sub-teams). There should always be at least 2 patient assessors, even in smaller sub-teams. 

Contingency plans should be in place so that assessments can still go ahead if a patient assessor is not available. The exact number you need depends on how you want to organise your assessment – for example, if you want several smaller teams or one large one. It may be easier to split into small teams, each checking two or three wards or departments. This also allows the use of a wider range of patient assessors, including those who might not be physically fit enough to assess a whole site. In all cases the minimum number of patient assessors required within a team should be met.

What skills

Anyone can be a patient assessor. Organisations are encouraged to recruit a broad range of people to address the need to have diversity by focusing on recruiting patient assessors with protected characteristics.  

The process has been designed to be as inclusive as possible. It is important that the assessment process is flexible to consider the needs of the patient assessors, and the site/organisation should be flexible in making their arrangements so that patient assessors are able to be fully involved.

For example, this may include:

• on large sites, undertaking the assessment on more than one day so that patient representatives, particularly more elderly people, are not unduly burdened
• establishing several small teams who can share the burden of a large assessment, with each team assessing just a few wards or departments
• inviting specific patient representatives to take part in the aspects of the assessment for which they are most suited, without having to undertake the full assessment (for example, children may be involved in assessing children’s services, sight-impaired people may have a particularly useful role to play in assessing wayfinding)

Where from

Organisations will make decisions on patient representation. Consideration should be given to working with the local Healthwatch if possible. Organisations may also need to recruit additional patient assessors. This may be via trust/organisation members, patient committees, NHS Youth Forum members, community engagement networks, local charities, education institutions or other existing links.

Alternatively, organisations may choose to recruit patients with no previous assessment experience, selecting patient assessors specifically to undertake PLACE assessments. Also consider contacting volunteer teams within your organisation; they can reach out to their contacts to encourage participation in PLACE.  

It is strongly advisable to commence early engagement with the relevant patient user groups and organisations that you plan to work with in order to keep them well informed and updated.

Depending on your organisation’s processes for patient/staff assessor, training this might also be a good opportunity to arrange training/update sessions with those organisations/ individuals.

Patient assessors should broadly reflect the patient population. Factors such as age, disability or ethnicity should be actively considered – children’s healthcare site/premises, for instance, might wish to consider how young people can be involved, and it is always good practice to include the views of those with mobility or sensory impairments.

Organisations should consider linking with neighbouring organisations that are participating in the PLACE programme, to form pools of patient assessors that can be called on locally as a shared resource. 

Additionally, there are many national and local organisations that could be approached. These are too numerous to list individually, but the following organisations have agreed to direct organisations to useful guidance or other support systems:

• The National Children’s Bureau has a network of trained young assessors – organisations providing children’s services may find this model useful
• The National Council for Palliative Care has contact with a wide network of people who have personal experience of palliative and end of-life care, who are keen to improve care for others
• The Royal National Institute for Blind People – sight impairment should be no barrier to involvement in this process

In addition, other major patient representative organisations such as Age UK, The Patients Association and MIND, are aware of PLACE and have extensive experience in supporting assessments/inspections of all types.

NHS England have produced guidance and information for patient assessors for anyone thinking of becoming a patient assessor which is part of the suite of PLACE guidance documents available on the PLACE collection website. Organisations may wish to make this available through their local networks.

Appendix A provides examples of adverts for patient assessors that organisations may wish to refer to these when recruiting patient assessors. These can be adapted to suit organisational needs.

Patient assessors are the focus of the PLACE process, so it is important that organisations demonstrate that they value their services. For effective involvement, people need to feel supported and recognised, and there are many ways this can be achieved. Often, the major motivator is seeing improvements made as a result of involvement.

The PLACE system has been designed specifically to promote this by the level of engagement with patient assessors, encouraging openness and providing assessors with the opportunity to share views not just during the process but beyond. It is good practice to report back to assessors on the content of the action plan and progress during the year towards achieving those actions. Other methods are important too, including being thanked, receiving acknowledgement or participating in training. 

Organisations that take the development of patient assessors seriously should find that they benefit well beyond the PLACE process, by building a cadre of committed volunteers.

Support from existing patient assessors to provide peer support should be encouraged to demonstrate the value of the role and how they can also support by becoming a patient assessor.

Organisations carry a duty of care for patients, staff and other volunteers’ wellbeing, and safeguarding their welfare should be paramount.

Organisations should have local arrangements and practices in place for the safe recruitment and continued monitoring of patient volunteers. These arrangements will include steps organisations need to take to assure themselves that volunteers are ‘fit and proper’ to become PLACE patient assessors. These steps may include a Disclosure Barring Service check (see note below), references or group interview.

Organisations should also ensure that local safeguarding arrangements are up to date and embedded within the organisation so that all staff are familiar with and understand them.

PLACE patient assessors will not be undertaking a regulated activity as defined by the Safeguarding Vulnerable Groups Act 2006. They are therefore not eligible to apply for enhanced disclosure and barring checks, and organisations are not entitled to ask a volunteer to apply for this type of check.

Organisations could ask volunteers to apply for a standard disclosure and barring check if individual volunteers are eligible, but they should consider the activities and the supervision of their patient assessors when making that decision.

Organisations should make a risk-based assessment of whether it is proportionate and necessary to request such a check. Patient assessors should be accompanied at all times by staff.

More information on disclosure and barring checks, and the eligibility of volunteers is available. 

Organisations and patient associations should follow their own local policies for reimbursement. Most organisations reimburse travel expenses and provide appropriate refreshments, whilst some also offer a small honorarium. For more information on remuneration of volunteers please contact your local PLACE programme lead for details on how your travel expenses will be reimbursed. Find out more about volunteer's rights.

The quality of local training and preparation is fundamental to the success of PLACE. It not only ensures good assessors, it also demonstrates that you value your volunteers and intend to take their views seriously.

In general, training and preparation for both staff and patient assessors will be carried out locally. Organisations may provide the training and preparation themselves or in partnership with others (for example local Healthwatch).

Training and preparation may take place at any time either before the assessment or on the day. It should not happen too far in advance, since the information needs to be fresh in the minds of the assessment team. The precise format of any training provided should be determined locally but should include as a minimum:

• housekeeping (such as fire evacuations and fire procedures)
• role of the team members (for example, the PLACE/team lead)
• the process and principles of food tasting and assessment, including the principles of sampling
• patient confidentiality and expected standards of behaviour during the assessment
• aspects of hand hygiene, infection control and procedures on entering side rooms
• the content of the assessment and the supporting guidance
• the scoring methodology and supporting guidance including the process for issue/ dispute resolution
• information about the site/organisation and its services, particularly where there is specific additional guidance to be applied (for example, wards for those with dementia, healthcare site/ premises providing mental health and/or learning disabilities services)
• the role of patient and staff assessors and how the assessment will be organised, (for example the areas to be assessed, and the aspects to be covered). On a large site, teams may be split to cover the full range of services
• the specific functions of patient assessors in completing the patient assessment summary sheet

• utilise patient assessor training slides; these are available within the suite of guidance documents available on the PLACE collection website
• provide support for patient assessors by providing training on equality and diversity
• provide top tips for patients, assessors and staff who are involved in conducting the assessment
• introduce buddies from existing patient assessors to support new assessors
• consider linking with local trusts/organisations to form regional workshops with assessors from different trusts/organisations to meet up to discuss scoring processes and best practice
• consider the local option of certification and for staff accreditation as part of the CPD process
• send ‘thank you’ letters to patient assessors for their support to conducting the assessment
• provide ongoing feedback on progress towards delivering the actions outlined in the action plan

Training and preparation should also cover such topics as what to do in an emergency (for example cardiac arrest) and any limits on the assessment process (for example, ensuring that the process does not intrude unreasonably on patient privacy or staff activities).

The assessment process has been designed to be self-explanatory, and so providing training should not be unduly burdensome. Patient assessors can do much of the preparation at home, simply by reading the assessment forms and guidance.

This depends very much on your patient assessors and their previous experience. All assessors (staff and patients) will need some preparation, but people who were previously involved in PLACE may require a different approach from those who are assessing for the first time.

You may wish to deliver joint training/preparation with staff. This has the advantage of building strong relationships before the assessment, though it can be repetitive for some team members. Even if you don’t include staff assessors in the full training/preparation, it can be helpful to invite them to meet their team-mates prior to the assessment.

The time needed will vary locally. You will need to take the following into account.

Who your patient assessors are, including:

• any previous experience
• any particular skills or knowledge gaps
• any special training/preparation needs (for example disabilities)

The amount of time patient assessors can reasonably be expected to give:

• at home (reading the documentation plus any local guidance you produce)
• in advance of the assessment (in a training/preparation session at the site)
• on the day of the assessment (before or during the assessment)

Any particular features of the site being assessed:

• infection prevention and control
• what to do in an emergency
• patient population and how to interact with them
• specific areas for assessment
• who will be delivering the training/preparation the organisation or with other bodies such as local Healthwatch

For multisite organisations, you will need to decide how to cover general, trust/organisation-wide issues and specific, site-related ones. You may wish to hold a single training/preparation session in advance for all the general issues, with short, site-specific information on the day of the assessment.

Again, it’s up to you. Arranging joint training/preparation with local Healthwatch or other organisations participating in PLACE can be a good way of developing strong relationships, but others can also contribute (for example, trust volunteer co-ordinators, infection prevention staff or local patient representative organisations). Arranging for an executive or non-executive director to call in for a few minutes to open the session and thank patients for attending is an excellent way of demonstrating how much your organisation values their input.

Many patient assessors are not in full-time work and may be unaccustomed to spending long periods of time in a classroom. Training/preparation can be very tiring. The following tips may help:

• don’t spend more than 30 minutes on any single ‘chalk-and-talk’ session
• don’t run 2 ‘chalk-and-talk’ sessions together – split them up with questions or an activity
• the longer the event, the more interactive work you should include (for example, table discussions or mock assessments)
• build in plenty of breaks
• make sure no-one is isolated. Consider inviting other staff to join in at lunch to meet patient assessors and introduce them to others
• provide handouts or notes to back up the sessions

It’s important to ensure that patient assessors have fully understood the training/preparation and are aware of their roles. Formal testing is inappropriate, but try to build in enough question and answer sessions to clear up any areas of confusion. 

Many people are reluctant to ask questions in a large group, for fear of looking foolish. Make sure you offer plenty of chances for one-to-one discussions with experienced assessors (staff or patient), for example over coffee breaks or during table discussions. Alternatively, ask participants to jot down on paper the things that are worrying them and drop them in a box. These can then be addressed anonymously with the whole group –  chance are that more than one person has the same concern.

Sending out further information after the event helps people feel fully involved and offers an opportunity for them to refresh what they have learned. Some handouts need to be given out on the day, but think about whether there is anything you can send separately, between the training/preparation and the assessment visit.

Patient assessment summary sheets for completion solely by patient assessors are available alongside the assessment forms.

Patient assessors will decide whether they wish staff to be present at this time of completing the patient assessment summary sheet. As well as deciding whether they want to complete individual forms or they may wish to complete a consolidated form together.

Patient assessors may choose to complete more than one patient assessment summary sheet (for example, if the assessment has taken place over more than one day, with different assessing teams, each team may wish to complete a separate form based on the areas they assessed).

Read the PLACE guidance on the organisation of assessments for further details. 

Example adverts / role descriptions for patient assessors, these can be adapted to suit the needs of organisations.

Example 1

Role Summary/Purpose

PLACE stands for Patient-Led Assessments of the Care Environment. A PLACE assessment focuses entirely on the care environment and does not assess clinical care provision.

There are 6 areas that are assessed during the inspection:

1. Access to privacy for patients and respect for their dignity
2. Food and hydration
3. Cleanliness
4. General building condition and appearance / maintenance
5. Support to people with dementia
6. Support to people with a disability

Assessment teams are made up of 50% staff and 50% current service users and their supporters (family, friends, partners, carers).

The inspections happen over a 10-week period (starting in September) and the commitment we require from service users and their supporters depends on availability and the amount of interest the role attracts. We will keep you updated about how many inspections you can attend. However, we completely understand if you would like to do just the one. Your input will be invaluable, no matter how many inspections you can commit to. As a service user/carer, we would like you to participate in the full assessment process.

You will also be asked to complete a separate assessment sheet, which highlights any issues that you want to raise about your involvement in the process and any additional comments about the care environment.

Main duties and responsibilities

Thank you for your interest in this role. As part of the role, we would like you to:

• attend the pre-inspection training provided by a facilities manager
• familiarise yourself with the standards for the PLACE inspection
• follow the inspection process - with support from the team
• be an active member of the inspection team, present, and record your views when asked to do so
• show consideration and respect for the other members of the inspection team by actively listening and engaging in discussions and putting your points across in a professional manner
• help the group make recommendations that will lead to service improvements
• complete the service user assessment sheet and highlight any issues that you want to raise about your involvement in the process and any additional comments about the care environment
• understand and comply with all trust policies, procedures, protocols and guidelines relevant to this role
• take responsibility for your own learning and attend supervision as and when required

Requirements for the role

To fulfil the duties of this role we ask that you:

• have experience of being a service user this can include, for example, a patient or relative, friend or carer

• have an interest in improving the environment and facilities for patients

• attend local PLACE training
• have good oral and written communication skills
• have a positive regard for service users and their families

Volunteer PLACE (Patient Led Assessment of the Care Environment) Assessor

Purpose

Alongside patient involvement participants you will volunteer to undertake a series of PLACE assessments within healthcare organisation environments.

Base

Add name of Healthcare organisation /facility.

Background

PLACE is a system for assessing the quality of the patient environment. It is a voluntary self-assessment which takes place annually.  The aim is to improve standards across all NHS trusts, voluntary, independent, and private healthcare providers.

As a volunteer you would undertake PLACE assessments across a 1–4-day period depending on the size of the organisation. You will follow the survey protocol to assess the built environment, the provisions made for patients (for example meals, refreshments) and verbally survey the experiences of patients you encounter, making notes as you go.

As part of the PLACE team, you will have a named point of contact in the staff team and clear routes to escalate any concerns or complements.

Tasks

• carefully follow the PLACE assessment protocols to evaluate aspects of hospital life against set criteria
• approach your tasks with courtesy and professionalism to staff, visitors, and patients.
• you may be entering busy environments, speaking to people who are very unwell and asking questions which people may find unnerving. You must therefore be tactful, respectful and leave if it is an inappropriate time to be surveying
• document only factual information in a succinct, evidence based and unbiased manner
• clearly explain to those you encounter the benefits of PLACE in terms of quality improvement and accountability
• refer any challenges to your named point of contact
• attend a debriefing session after the assessments are complete

Exclusions

Volunteers are not expected to be involved in any of the following:

• dealing with challenging or aggressive behaviour from anyone. Simply withdraw and call your named point of contact
• investigating anything said to you which you cannot see evidence of
• keeping secrets – you must always report what someone says to you if it relates to harm, mistreatment, or risk (even if it is not relevant to your survey)

Person specification and requirements

• a methodical and logical approach to tasks
• good written and verbal English skills to be able to make clear entries into the survey and engage positively with those you meet. Additional language skills may also be of value in conversing with patients who do not have English as a first language
• tact and diplomacy
• professionalism and the ability to maintain boundaries
• a commitment to safeguarding and patient welfare
• ability to commit to XXX dates for participating in this volunteering opportunity (Note: Organisation to specify local requirements)

Training and support

• you will receive a full briefing and debrief for this volunteering activity
• you will have a consistent named point of contact throughout the PLACE assessments and access to them via a muster point and/or telephone communication as you travel round a site