Patient Led Assessment of Care Environments (PLACE)

It is vitally important for the development of any service, public or private to obtain feedback concerning quality and performance of that service from the service user. The National Health Service is no different and the collection of patient experience feedback is considered a valued addition to any audit/assessment process. I first became aware of and took part in patient led assessments of NHS Dorchester County Hospital as part of my duties as a publicly elected DCHFT Governor in 2012. PLACE, which is the system for assessing the quality of the patient environment was introduced in April 2013, replacing the old Patient Environment Action Team (PEAT) inspections.

Good environments matter. Every NHS patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced” NHS Website.

The annual assessments primarily apply to hospitals and hospices providing NHS-funded care in both the NHS and private/independent sectors, but others are also encouraged and helped to participate in the programme. I recently took part in two local hospital PLACE assessments as a Healthwatch trained volunteer Assessor*. The aim of PLACE is to provide data to inform improvements from a patient perspective. The role of the assessor is to visit and assess how the environment supports the provision of clinical care, assessing such things as patient privacy and dignity, food, cleanliness and general building  maintenance and, more recently, the extent to which the environment is able to support the care of those with dementia or with a disability. The scope of the assessment does not cover clinical care provision or how well staff are doing their job as PLACE is the responsibility of NHS hospitals estates and facilities. PLACE  is carried out by groups of three or four assessors covering areas of the hospital on a specific date taking into account lunchtime meal distribution. Once collected the data is fed into a national data base and the results published showing how hospitals are performing both nationally and in relation to other hospitals. In 2022 1,046 assessments took place and the highest national average domain score was for cleanliness at 98%. As a Nutritional Therapist I have a particular interest in the food domain which includes food & hydration organisation and ward food. The box’s that need to be ticked in this domain are answers to questions such as, is there a range of menus that are simple and easy to understand? (words, pictures, language). If meals consist of more than one course does each course meet the needs of the patient? Are patient areas made ready for meal service, tables de-cluttered and wiped clean? Are patients made ready for meal service, helped to sit up in bed or sit out, moved to dining table? If appropriate were napkins provided? Were packaged foods unwrapped for patients needing help? Were there discussions with staff concerning processes to ensure mealtimes are protected? Was this evidenced during mealtimes? Were staff actively involved in the delivery of food and associated service? Was the crockery and cutlery suitable and contrasts between tables and trays?  Was food attractively presented and appealing? Was drinking water available at all times? Were hot drinks made available where appropriate? Meals are tasted on the day by the assessors and results recorded. I was pleasantly surprised by the variety and choice of food served to patients. It is important to aid recovery that patients are encouraged to eat well, that meals are nutritionally balanced and that they taste good and that patients are reminded and encouraged to drink water to remain hydrated. In carrying out these assessments as a patient representative and by observing and talking to staff during the delivery of a ward lunch service I gained insight of the variety of individual needs of patients and am pleased to say how staff cheerfully and willingly met those needs. It does not take extra time to show a little compassion or kindness and personal experience has taught me how important the quality of care is to patients and their loved ones.

*(Healthwatch is a national independent and impartial health and social care champion. Patient feedback is collected (good or bad) of services in hospitals, dentists, home care services, GP surgeries, mental health services, opticians, care homes, pharmacies and ambulance services. Collated feedback is then fed back to Dorset’s health and care decision makers ensuring the patient voice is heard helping to influence and shape the way services are run locally).