PEN is 6!

PEN is 6 today!

PEN is 6 years old – and like many 6 year olds we are growing more independent, flexing new-found skills and abilities although appearing a little gawky and uncoordinated at times; we  want it all and sometimes have difficulty making choices and on occasion, perhaps, we are a little bit too rigid and demanding  ….and of course we are worried about the monsters under the bed!

Growing and independent
But joking aside we have indeed grown significantly over our first 6 years to a network of almost 8,000 likeminded people wanting to improve the experience of care for all involved; we have developed new resources and approaches to support teams who wish to implement change (these can be found on our website under Resources); and because we know our website is still a little bit gawky and difficult to navigate we plan to re-launch this over the coming months!

We want it all
Yes – we want it all!  We want to ensure we support organisations to recognise, share and celebrate their good work and then help them get better at measuring, embedding and sustaining this – and of course we want to do it now!  This year saw our best ever PENNAwards with more categories, more entries, more judges, more finalists and ultimately more brilliant examples of what is working well.

We need your feedback
We are though still growing and developing and to help us be a little less rigid and demanding please let us know how it is going – we love to hear your views but a word of warning, be kind with your feedback – as a 6 year old, we can be hurt by criticism, but we always listen and take on board your views.

There are monsters under the bed
As a not for profit organisation we are self-funding and every now and then there really are monsters under the bed but together we can vanquish those monsters and make the world a better place.  We would be delighted to work with you, to welcome more associate or partner members, to support you on your own experience improvement journeys – just let us know how we can help.

Our last 12 months
Here are just some of the areas we have had the privilege to work in over the last 12 months:

  • CYP Experience
  • Transition
  • Maternity Experience
  • Learning Disabilities
  • Complaints and Compliments
  • MRI and Mammography
  • Leadership – board reviews
  • Strategy/ values development
  • Benchmarking organisations
  • Winning Principles for Patient Experience

Our partners
We have been delighted to work alongside NHS Improving Quality, the Picker Institute, NHS England, West Midlands SCN and CHANGE People amongst so many others with a very special thank you to Andrew Hasler, Phil Stylianides, Catherine Carter and of course Kath Evans.

What’s ours is yours
We now have over 500 case studies and will be making sure these are fully accessible on our new website, together with a series of best practice webinars, videos of the our category winners and others, plus articles and news items from our monthly newsletter.

Thank you for your support.  We have had a wonderful year – our best yet, and are grateful for everyone’s support.

So with a final word from AA Milne

“But now I am six, I’m as clever as clever.
So I think I’ll be six now for ever and ever.”
All the best
Ruth

Wrightington, Wigan and Leigh NHS Foundation Trust

Staff Engagement the WWL Way

 

Organisation

Wrightington, Wigan and Leigh NHS Foundation Trust is a major acute trust serving the people of Wigan and Leigh. Innovative and forward thinking, the trust is dedicated to providing the best possible healthcare for the local population in the Wigan Borough and surrounding areas. The Trust aims to continuously provide safe and good quality care to all patients. Over £220 million is spent each year on a diverse range of reputable general and specialist acute services.

The Trust has three hospital sites, a state-of-the-art outpatient’s centre, a dedicated Ophthalmology centre and offices located at Buckingham Row in Wigan town centre. The Trust employs approximately 5000 staff.

 

Summary

The “WWL Way” is a vision for understanding, implementing and embedding sustainable staff engagement in Wrightington, Wigan and Leigh NHS Foundation Trust (WWL). It has grown out of a long history of successful staff engagement initiatives that have delivered positive outcomes to staff and patient care, and has developed into an evidence-based measurable pathway model and robust strategy for staff engagement.

Our long term objective is to embed a sustainable positive organisational culture, through strong leadership and by giving staff at all levels the information, tools and encouragement they need to self-sufficiently enhance engagement throughout WWL. Our forward-thinking approach to staff engagement has already received national attention because of our “gold standard example of a systemic and sustainable programme to improve staff engagement and satisfaction” (HPMA). We believe our approach has the transferability to make a huge impact on the wider NHS.

The WWL Way has created a framework to continuously measure and improve engagement, identifying specifically the factors that are enabling engagement at Trust level or at a team level. Not only that, it directs staff and the Trust towards the right tools to address specific staff engagement needs, creating a bespoke solution as opposed to “one size fits all”. In addition, strong leadership and staff side sponsorship and consistent communication has ensured the WWL Way has become “the way we do things” and an authentic approach as opposed to a tick box exercise. The difference the WWL Way has made to patient care, quality and experience has been extremely encouraging.

 

Rationale

Our staff engagement journey evolved over 15 years and included the following three distinct initiatives:

  • Staff Involvement Delivers (SID) – a partnership between Human Resources and Staff Side. “Conversations with” Directors events allowed staff to raise issues important to them and “walkabouts” gave Directors the opportunity to integrate with staff at the front line.
  • Listening into Action (LiA) – In 2011 we undertook the NHS national staff survey, resulting in scores below average on 55.3% staff engagement measures and only above average on 21% of measures. LiA further energised staff engagement, giving a greater focus on making quick-win and bigger system changes, aligned to the needs of staff. LiA encouraged staff to run their own listening events and local level changes.
  • Our partnership with Unipart – Lean ways of working through team communication cells, visual management tools and a strong emphasis on metrics and devolved problem-solving.

 

Practical application of these tools can be observed at the following link: http://www.youtube.com/watch?v=lTNZCdfMKV4

 

We needed a joined up approach where all initiatives were accessible as tools to all staff, and used in the appropriate places. We also needed to understand how these tools were influencing the cultural conditions at WWL e.g. what was the cause and effect? By knowing this we could understand and regularly measure their impact, to create a continuous improvement approach to staff engagement.

 

Developing “the WWL Way”

Staff Engagement at Wrightington, Wigan and Leigh NHS Foundation Trust

In mid-2013 we combined the three initiatives to create our own unique brand of staff engagement – “the WWL Way”. We created a new “Staff Engagement Pathway” model underpinned by research/theory – a framework for understanding staff engagement more deeply, by gauging levels of staff engagement, and identifying several factors that help us better understand what enables improved staff engagement. The framework focuses on nine staff engagement enablers as well as staff engagement feelings and behaviours.

 

Practical Application

9 Enablers of Staff Engagement at Wrightington, Wigan and Leigh NHS Foundation Trust

Our validated ‘WWL Way’ quarterly diagnostic survey and extensive engagement toolkit are now used together both at Trust and Team level, to measure, track and continuously improve the enablers of staff engagement and ultimately our organisation’s performance.

Our Staff Engagement Pioneer Teams 26 week Programme allows teams to use the survey to identify their specific engagement needs. Our new “WWL Way toolkit” integrates our initial trio of initiatives into eight staff engagement tools. It offers a choice of solutions to apply locally, avoiding a “one size fits all” approach. The Programme helps teams feel empowered to engage in, and offer up, service improvements through their own initiative.

 

Who Made it Happen?

  • Chief Executive and Directors – Acted as “Engagement Sponsors”, there to build excitement, be authentic, harness the WWL community and emphasise the significance of staff engagement.
  • Staff Side – worked in partnership to bring honesty and openness to staff engagement and also encourage and mobilise staff engagement activity at all levels.
  • Staff Engagement Team – Develop and Deliver the WWL pathway framework, diagnostics, staff engagement toolkit and Trust Wide Engagement Activities.
  • Staff Engagement Champions – Advocates and sponsors of staff engagement activities, guiding and supporting staff engagement teams at every step.

The following video explains more: http://www.youtube.com/watch?v=Zrq0m2nY1Q4&feature=youtu.be

 

Impact & Results

Impact and results of staff engagement at Wrightington, Wigan and Leigh NHS Foundation Trust

In 2012 we saw major improvements in our national staff survey results. Above average scores increased by 64% from 2011, and increased again by another 15% in 2013. During this period we saw significant reductions in sickness absence (down from 4.62% in April 2012 to 4.17% in Dec 2013) and expenditure of temporary staffing (down from £15 million in 2011/2012 to £12 million in 2012/2013).

In 2014 we have seen continued improvement in our Trust-wide engagement scores as a result of a range of organisational activities aimed at addressing development needs identified through our quarterly staff engagement survey. We have seen significant improvement in two particular engagement enablers: Trust (staff feeling trusted and empowered) and Working Relationships (staff feeling supported). These improvements have been supported by proactive work to develop our leadership skills, extending the use of communication cells and listening to staff. As a result we have seen significant improvements in staff advocacy (staff recommending the Trust as a place to work and a place to be treated) which has risen by 14% since January 14. We have also ranked 22nd out of 241 Trusts in the 2014 Staff Friends and Family test results (released November 14), compared to 54th place in 2013.

We have seen a 7% overall improvement in engagement collectively amongst teams, one of which improved by 25% over six months. This was all measured and achieved through our staff engagement pathway framework, and the hard work of our own staff to take ownership and action.

 

Staff engagement has also enabled us to achieve Quality and Safety Improvement between 2007/08 and 2013/14:

  • Reducing mortality rates (HSRM) – 126 to 87
  • (annual actual deaths in hospital falling by 30% in the same period)
  • C-DIFF incidences – 373 to 26
  • MRSA reduction – 39 to 1

Staff engagement has also influenced our patient experience:

  • Top 25% in the annual patient survey.
  • Friends and Family Test: Consistently the highest scoring A&E Department in Greater Manchester, Second in Greater Manchester for our inpatient quality.
  • WWL received recent national notoriety when our bereavement staff went the extra mile to enable a dying patient to see her horse for the last time. This was an example of engaged staff going above and beyond to enhance patient experience and deliver compassionate care.

 

Key Learning Points

  • Buy-in. We ensured strong visibility and promotion of our staff engagement the WWL Way and its initiatives –gaining senior leaders’ commitment and sponsorship, and acting “at scale”.
  • We established a partnership approach between staff side and management, working together towards mutual staff engagement goals.
  • We acted and communicated quickly following listening events, providing regular feedback through a “You Said – We Did” approach.
  • We acknowledged that staff engagement can be enabled in many ways, from how we recognise and value staff, to the way we involve staff in decisions, to the way we build motivation and morale.
  • Every Day Enactment. We always ask the question “have we asked our staff?” We are seeing a cultural shift from our leadership, in that they are beginning to make more informed and collaborative decisions with greater staff involvement.

 

Creative Minds – South West Yorkshire Partnership NHS Foundation Trust

Creative Minds – South West Yorkshire Partnership NHS Foundation Trust
Category – Strengthening the Foundation

Introduction / Overview

South West Yorkshire Partnerships NHS Foundation Trust (SWYPFT) provides general community, mental health, learning disability and substance misuse services to the people of Barnsley, Calderdale, Kirklees and Wakefield, and forensic services to Yorkshire and the Humber. Our mission, which was developed from the ideas and opinions of all our stakeholders, is “enabling people to reach their potential and live well in their community”.

Summary

Creative Minds is an award-winning strategy that develops community partnerships and co-funds creative projects across South West Yorkshire Partnership NHS Foundation Trust’s localities in Barnsley, Calderdale, Kirklees, Wakefield, and in the Trust’s forensic services. It utilises creative activities such as arts, sports, recreation and leisure, delivered in partnership with over 70 local community organisations to increase the confidence, develop the social skills, and improve the lives of thousands of local people.

Creative Minds was launched in November 2011 in response to patients and carers expressing their desire for more creative approaches to understanding and supporting their health and wellbeing. The strategy was co-produced through a series of workshops which focused on working with and listening to the views of patients, carers, Trust staff and community organisations and groups, ensuring the Trust put the patient at the centre of the development of the initiative.

Where individuals have low expectations and poor self-image, the sense of achievement found in creativity gives them a chance to move away from negative and self-destructive patterns and habits, and start to write a new story of recovery.

An important element of Creative Minds is how it supports the Trust’s mission to help people to live well in their community through accessing local services that enable them to reach their full potential.

The main reason for developing the Creative Minds strategy was to meet a continued desire from patients and carers to be able to use more creative approaches to support their wellbeing. Workshops were held across the Trust to brought patients/carers, staff and community partners together to develop the strategy.

Creative engagement was seen as an opportunity for people to engage as equals, to shift the power imbalance between care providers and the cared for, and for people to progress towards personal autonomy. Many participants find that they discover a passion for a particular activity or talent they never knew they had, which gives them the means to maintain their health and wellbeing through finding a hobby they can continue to enjoy for the rest of their lives.

What Was Done?

A major aim of Creative Minds was to build a strong infrastructure of community and voluntary organisations able to work with the Trust providing excellent creative projects for all who access our services.

Partnerships and co-production was at the core of the conception and development of Creative Minds. It not only shows our commitment as an organisation to having a creative approach to service delivery but also showcases our passion for working in partnership with our communities.

Creative Minds has provided a way to build on existing good practice in our services, and to work more closely with a wide range of community organisations enhancing our service provision by delivering innovative, transformative and meaningful health and wellbeing projects. We have a network of internal and external champions whose passion and commitment to creative approaches has helped to bring Creative Minds to life.

We are now using this infrastructure to help embed this different way of working in all that we do.

Impacts / Outcomes

To date, Creative Minds has delivered almost 200 creative projects in partnership with over 70 community organisations and groups, benefitting over 4,000 participants.

Currently, most projects carry out their own internal evaluation. Two of our projects have also carried out their own social return on investment reports, and these show that for every £100 invested we get a £700 social return on investment. Work is underway to use our mental health clinical system to identify the pathway and package an individual is on prior to a Creative Minds project, then to re-evaluate once they have experienced the project in order to capture any decrease in need for services.

Creative Minds was chosen as the winner in the ‘compassionate patient care’ category at 2014’s Health Service Journal Awards – an accolade that proves its worth among healthcare professionals.

However, the most revealing and striking feedback comes from the participants themselves. The way they talk about themselves and their new lives with a new-found confidence and self-assuredness speaks volumes about the impact Creative Minds is having. A series of films featuring personal testimonies were created to show the success of the strategy first-hand.

Key Elements

The principles and philosophy of Creative Minds seemed to strike a chord with many people. We have initiated a genuine social movement of which people want to be part, and for which people feel a sense of ownership. A key component of the popularity of Creative Minds is the fact that it holds such a broad definition of ‘creativity’. Arts, sports, recreation and leisure activities are just some of the types of projects that Creative Minds co-funds, giving participants the opportunity to take control of their own care and recovery through feeling empowered to make their own choices – just one of the reasons why 4,000 people have been able to benefit from the initiative.

Participating creatively as a means of self-expression tackles social exclusion, promotes self-acceptance and raises aspirations through allowing the individual to discover talents, skills and abilities that combat the feelings of negativity surrounding their mental health. All of these things can help people to develop feelings of pride and satisfaction, enabling them to feel worthwhile. Finding an activity that they enjoy challenges negative self-images and where people have low expectations of themselves, the sense of achievement that can be found in creativity is unrivalled.

Our Creative Minds approach recognises that successful interventions which have an impact on mental health conditions through timely, targeted support will have substantial social and cost benefits.  In relation to meeting current needs, Local authority joint strategic needs assessments identify the importance of finding ways of bringing key partners together from across the sectors to understand how their actions can impact on health and wellbeing, and how by working collaboratively and adopting models of good practice, they can play an important role in maintaining and improving health and wellbeing.

Although Creative Minds has mainly provided for mental health patients, we have also projects specifically for people with learning disabilities, health and wellbeing teams and substance misuse services. Creative Minds is also starting to deliver benefits to people with long term physical health conditions and hidden impairments. Creative approaches offer a different way of engaging with communities and have worked especially well with people who have traditionally been more difficult to engage. Projects sensitive to different cultures and faiths have been developed, promoting a sense of inclusion.

Learning Points

  • Reducing stigma: Showcasing positive artistic achievement challenges negative stereotypes and celebrates participants’ talents and abilities.
  • Recovery: Creative activities have made a difference to participants’ wellbeing as well as helping them to feel as though they are a part of a community.
  • Prevention: Creative programmes have been shown to promote better health and wellbeing in vulnerable individuals and to foster social integration, community strength and cohesion.
  • Early intervention: Early engagement with ‘softer’ techniques avoids deterioration of health needs and the need for more expensive and intrusive interventions.
  • Personalised care: Offer real choice to individuals to develop self-determined packages of care.
  • Multi-agency working: Real opportunities for partnerships with creative groups and agencies, increasing the range of creative resources and approaches available to patients.
  • Innovation: The creativity agenda can be used at all levels within the organisation to seek innovative approaches to client care, team development, service development and organisational management.
  • Value for money: There are opportunities to lever additional funds through partnership working with external arts/health agencies.
  • Strengthening transition: New opportunities in the wider community, supporting progress away from acute services towards greater autonomy and independence.
  • Resilience: Creative approaches have been shown to be effective in building cohesion and strength in vulnerable communities and providing significant gains in personal resilience.

Bringing Safer Care Closer to Tanzania – Northumbria Healthcare NHS Foundation Trust

Category – Bringing Patient Care Closer to Home

Introduction / Overview

Northumbria delivers integrated acute and community health and social care to the residents of Northumberland and North Tyneside. It is the largest geographical Trust in the UK covering 2000+ square miles.

Employing over 9000 staff – together each year we:-

  • Care for over 73,000 patients and families on our wards.
  • Provide treatment to around 167,000 patients in our A&E departments and minor injuries units.
  • Perform almost 27,000 operations.
  • See more than 45,000 people for day-case procedures.
  • Carry out around 1.3 million appointments with patients outside of hospital.
  • Provide adult social care support during 70,000 home visits.

Summary

1

This project describes a unique partnership and global collaboration that has brought care closer to home by introducing laparoscopic surgery as a new service to Tanzania.

Northumbria, with full support from our Board and Charity Development Group, approached this as a long term training development programme. Successful implementation required the total commitment of a dedicated team to see it through over a decade.

People may say that laparoscopic surgery is not an obvious choice for implementation in a less developed country due to the high-tech nature of the equipment and the high-level skills required of the surgical team.

The real challenge was to be able to develop the new service from Northumberland, UK, 7000 kilometres away!

The ambitious programme required a team effort over a sustained period of time, working within a challenging environment, with few resources and frequently without electricity! Each year new procedures have been introduced and keyhole techniques are now routinely used for diagnostics and biopsy, improving the health outcomes for hundreds of patients.

Recently secured AHSN monies will enable the learning from this project to be shared across the UK, as well as promote the innovation that can result from volunteering in less developed healthcare systems.

The benefits of laparoscopic surgery are numerous. For the patient: less invasive surgery and less anaesthesia, much reduced chance of haemorrhage requiring transfusion (HIV risk), fewer days in hospital, reduced incidence of infection, less chance of complications, less requirement for post-operative medication and nursing care, reduced need for outpatient visits or district nurse follow up, return to work quickly and, most important, less overall cost to the patient for the healthcare intervention.

For the hospital: reduced theatre time , ability to manage day case elective surgery to ease congestion on surgical wards, less patient aftercare required and lower costs of service delivery.

In 2002, Northumbria was approached by the Chief Executive of Kilimanjaro Christian Medical Centre (Tanzania) to explore the possibility of introducing this service to address the backlog of patients on surgical wards. With an average occupancy of 116%, the hospital needed to be able to process more patients each month and discharge them quickly.


What Was Done?

Surgeon Liam Horgan, sister Lillian Broatch and sister Sue Colley provided dedicated support to the developing Tanzanian laparoscopic team through annual training visits to KCMC. In between, Tanzanian surgeons and senior theatre nurses visited Northumbria for specialist training. The project gained further momentum with the donation of two laparoscopic stacks from sponsors.

The development of a new service is a challenge and there are many stages in the acquirement of new knowledge and skills before competency is assured. With the full support of the KCMC Surgery Department, Northumbria was able to develop and implement innovative training methods to fast-track the creation of a new laparoscopic service for Tanzania.

Furthermore, since 2008 the Northumbria team has supported KCMC to deliver annual laparoscopic surgery training courses for surgeons and nurses from across Tanzania. This was followed in 2011 by the development of a laparoscopic surgery module within the medicine undergraduate course at Tumaini University.

With the UK training team so far away, thoughts turned to distance learning possibilities but an internet msn/skype link would not be sufficiently reliable and a dedicated satellite connection proved to be too costly. The team developed a dedicated audio-visual link between Theatre 1 at KCMC and Hexham General Hospital to support training. UK surgeons could view images from the laparoscopic endoscopy camera beamed from Tanzania and guide the surgeons while the surgery actually took place.

The innovative surgical tele-mentoring link gave the Tanzanian surgeons the opportunity to gain greater experience and confidence with each transmission. Within Tanzania, images from the endoscopic camera were also linked to the seminar room so that the surgeon could talk to students and answer questions throughout each procedure. Previously up to 20 medical students would be crammed into the operating theatre to observe.

2


Impacts / Outcomes

Before the introduction of laparoscopic surgery at KCMC, open surgery was performed on all patients. This led to a higher possibility of post-operative infection due to overcrowding on the wards and patients needed a longer stay in hospital to recover. Laparoscopic surgery offered an alternative for patients which significantly improved their health outcomes.

Following two years of intensive training, a regular weekly laparoscopic cholecystectomy list was established at KCMC during 2005, the first hospital in Tanzania to do so. Dozens of patients were treated with improved laparoscopic techniques within the first few months.

Further advanced training took place over successive years and as KCMC established itself as the only government hospital to offer a laparoscopic service, people began to travel from across Tanzania, and further afield from Kenya, to book laparoscopic interventions for gall bladder removal, removal of the appendix and inguinal hernia repair.

By 2013 keyhole surgery was also being used more widely for diagnostic procedures, reducing the number of multiple-site open incisions which may be required during emergency surgery, especially when high quality diagnostics may not be readily available.

Now all gall bladder and appendix removal is undertaken laparoscopically.

Keyhole surgery is also now being used in terms of diagnosis of potentially terminal conditions, providing a better chance of the patient being able to return home to their loved ones for their final days rather than remaining in hospital for post-operative care following conventional open surgery.

Key Elements

The project has been able to contribute to the development of Tanzania’s health service through the introduction of laparoscopic surgery as a new service for the population of Tanzania.  KCMC has prospective audit data for over 400 procedures. When, in future, laparoscopic surgery is available at all Tanzanian consultant-referral hospitals, the numbers of beneficiaries will be in the thousands.

Other factors contributing to the success of the project:-

  • Determination of the team to find innovative solutions despite the obvious and significant geographical, and financial barriers.
  • A shared vision, friendship and strong partnership between two organisations that has developed over more than 10 years now.
  • The support from Northumbria Trust Board and commitment to a long term partnership with Tanzania, from which everyone benefits.
  • The governance arrangements developed for this work are cited as best practice in government reports, including the recent All Party Parliamentary Group report on Global Health

Northumbria has launched a Global Health Fellowship as part of its leadership programme in acknowledgement of the unique developmental opportunities provided by international work.

There has been money secured from the North East Academic Health Science Network to continue the work
http://www.northumberlandgazette.co.uk/news/local-news/nhs-trust-putting-itself-at-forefront-of-global-volunteering-1-7027683


Learning Points

  • Firstly remember ‘Pamoja Tunaweza’, which in English means ‘together we can’.
  • This unique project brought together teams of engineers, surgeons, theatre nurses, operational managers and external stakeholders to work together over a number of years to advance surgical teaching and training in Tanzania and launch a new surgical service and bring vital care closer to home.. 
  • The shared vision and strong partnership working of the UK and Tanzanian teams gave the momentum needed to struggle through new uncharted territory and succeed on two levels: service development and innovative workforce development.
  • That while the benefits for Tanzania are obvious, Northumbria, as a well resourced organisation, has gained just as much from this partnership as Kilimanjaro Christian Medical Centre.

The value of patient information

A new report from PiF (the Patient Information Forum) and MHP Communications investigates patient experiences of health information and support. The report is based on a ComRes Poll carried out in February 2015 with 1,567 people living with long term conditions.

The findings included:

  • 36% of people disagreed that they were given helpful information when they were first diagnosed
  • 30% felt their views and opinions on care and treatment are not taken seriously by their doctor
  • 20% didn’t feel they had enough information to feel confident in discussing treatment options with their doctor

In the report PiF and MHP Communications call for health information and support to be better integrated into the treatment and care that is provided by health services. Information needs to be recognised as a key intervention for improving outcomes. This should be seen as a core part of a patient’s care, should be personalised and delivered as a standard part of engagement. Information should be accompanied by appropriate support structures to ensure it can be used effectively.

PiF is a non-profit organisation that seeks to champion the role of health information in improving patient outcomes and experiences, and provide support to organisations and individuals to help ensure the health information they produce is high quality and accessible.

Previous research from the organisation bought together evidence on the value of information, highlighting the central role it can play in improving experiences of care and patient outcomes.

PiF have recently launched a Toolkit for creating health information that works, including best practice guidance and links to practical tools and resources. In July they are holding their 10th anniversary conference that will focus on the role health information and support can play in empowering patients and the public to play an active role in their health and care.

You can find out more information at www.pifonline.org.uk .