Getting the help you need – How PALS are supporting patients in Birmingham

December 18, 2019

People’s experiences of contacting NHS hospital and community Trust’s Patient Advice & Liaison Services (PALS)

Healthwatch Birmingham’s report highlights the importance of PALS as a tool for involving patients and the public in decisions about their care and as a means for Trusts to learn from patient’s experiences of using healthcare services to make improvements.

The experiences we heard from those who contact PALS in Birmingham are varied and there are inconsistencies between people in the service they receive. There is evidence that when PALS worked well, people’s needs were met, they felt understood and their voices heard. Where it did not work well, people were left feeling powerless, afraid that their treatment has been compromised and a belief that the service was incapable of acting in the service users’ interest. There are many examples in this report of good practice that should be replicated but also poor practice that needs to be improved.

Read the full report here

Independent champion Healthwatch Birmingham heard from patients, and their carers, from across the city about what it is like to contact NHS Trusts PALS departments in Birmingham. People told us that they value a personalised, inclusive service that is responsive to individual needs.

What do patients value?

People who shared their experiences said they want:

  • PALS to have a clear remit that is understood by patients, carers and families.
    • Better communications and information from PALS, based on comprehensive knowledge of the service, and keeping people updated on their enquiry
    • Better resourcing for PALS, especially staffing and opening hours
    • PALS to be more responsive and proactive in following up enquiries
    • PALS to be more accessible and visible to patients, carers and families
    • PALS to be impartial and even-handed when dealing with complaints
    • Better continuity of contact and consistency in handling enquiries
    • Better staff attitudes and understanding of health conditions, especially autism and similar conditions
    • PALS to have more influence to make changes in the trust
    • More involvement of service users in improving the service

The active participation of citizens, users and carers and their representatives in the development of healthcare services and as partners in their own healthcare has been an important principle for the NHS. The legal duty to involve patients and the public in a meaningful way to improve services has been encapsulated in many policy documents and formed the foundation for the development of Sustainability and Transformation Partnerships and Integrated Care Systems.

Recently (6 December, 2019) the NHS published the ‘NHS Oversight Framework for 2019/20’  which includes a Patient and Community Engagement Indicator for measuring compliance with statutory guidance on patient involvement PALS remains an important mechanism for involving patients and the public and identifying areas that need to improve. Indeed, this report finds that the existence of PALS is valued amongst those who contacted the service.

Improving people’s experiences of PALS

Following our investigation, Healthwatch Birmingham has asked NHS Trusts to develop actions to:

  • address the issues that led to dissatisfaction amongst those who contacted PALS,
  • to address the issues that they indicated needed to be improved to make PALS more effective
  • design a process that ensures that Trusts are hearing more feedback and are using that feedback to make improvements not only to patient experiences but to the PALS systems as well.

All seven NHS hospital, ambulance and community Trusts in Birmingham have responded and outlined the actions they intend to take to address the findings in this report.

Alison Last, Associate Director of Patient Experience and Freedom to Speak Up Guardian At Birmingham Community Healthcare NHS Foundation Trust said: 

“the Trust welcomes the Healthwatch Birmingham draft report following feedback from patients and carers on experiences of contacting PALS services in Birmingham.  The report is very timely, as we are about to review and update our current Advice and Liaison Service (Customer Service) Working Guidelines.  The feedback has been very useful to us in reflecting on how our service is doing and where we can make improvements.”


Marion Harris, Chief Nurse at Birmingham Women’s and Children’s NHS Foundation Trust said:

“Thank you for the recent PALS service report which we received. We are keen to offer an efficient and responsive PALS service so we were pleased to have the opportunity to reflect on the current ways of working and consider how we could improve. We are keen to learn from the report and especially from how our fellow PALS services operate locally. In reviewing the report we are seeking to introduce the following measures in the coming months (see report)”.


Mandy Green (Corporate Nursing) Head of Patient Experience at University Hospital Birmingham NHS Foundation Trust said:

“University Hospitals Birmingham NHS Foundation Trust (the Trust) welcomes Healthwatch Birmingham’s report into patient views on the quality of the Patient Advice and Liaison Service (PALS) and their experiences of using this service. The Trust is pleased to see that most patients, carers, and families were satisfied with their experience of the PALS service overall and that the service is valued by all individuals who contact the service. The Trust understands the importance and the value that survey respondents and the wider public have in the PALS service and is committed to ensuring that the service is appropriately resourced to ensure it can manage all concerns received quickly, effectively and with the sensitivity required”.


Caroline Burgin, Head of Complaints at Sandwell and West Birmingham Hospitals NHS Trust said:

The Trust will use the feedback in this report to make improvements to PALS/Customer Services in several areas. We plan to trial the use of Purple Point resolution method in our PALS service during 2020 to improve our timeliness and responsiveness to provide a faster service for patients and relatives.”


Christian Ward, Interim Deputy Director of Nursing at The Royal Orthopaedic Hospital NHS Trust said:

“We have reviewed the report and will be including this as an agenda item within our Patient Experience and Engagement Group, following this feedback our Patient Engagement Team will then provide a responsive action plan to address the issues raised. This will then be disseminated within the organisation via Trust Committees. We are very grateful to Healthwatch Birmingham for their insightful report and will be using it to support changes and improvements to our PALS service”.


Marie Capper, Head of Patient Experience at West Midlands Ambulance Service University NHS Foundation Trust (WMAS) said:

“West Midlands Ambulance Service University NHS Foundation Trust (WMAS welcomes the feedback provided by patients, carers, and members of the public in Birmingham and the report drafted by Healthwatch Birmingham. As a result of the report the ambulance service will be reviewing seven key points (see report)”


Shane Darby, Customer Relations Lead at Birmingham & Solihull Mental Health NHS Foundation Trust said:

Birmingham & Solihull Mental Health NHS Foundation Trust (BSMHFT) welcomes the Healthwatch Birmingham draft report following feedback from patients and carers on experiences of contacting PALS services in Birmingham. Thank you for this feedback, this has been very useful to us in reflecting on how our Trust is doing and where we can identify improvements for our service users, carers and families”.

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