Patient engagement is the way forward
Working with patients to design health and care services is the future, according to the person in charge of planning and buying health services for North East Hampshire and Farnham.
Dr Andy Whitfield, the Chair and Clinical Lead of NHS North East Hampshire and Farnham Clinical Commissioning Group (CCG), closed the organisation’s Annual General Meeting at Farnham Castle by telling the audience: “The powerful message from this evening is about patient engagement and designing services together.
“It is the way forward. It is the future of how health and social care should be designed.
“Our task is to improve healthcare locally and to improve quality in everything we offer to our patients.
“Traditionally services have been designed by the professionals. Actually people who use services have a more accurate idea of what services should be provided.”
During the evening Dr Whitfield and other leading CCG figures and partners outlined the organisation’s performance for the year 2014/15 and highlighted some of its main current activities.[i]
He said: “We have delivered a balanced budget for 2014/15. What that allows us to do is to plan for the future in a more innovative way.
“We have been successful and we fully intend to continue that into the future, involving local people more, working with them to shape the services they need.”
Dr Whitfield spoke of some of the CCG’s success stories, including the Hydrate in Care Homes and the Walk and Live Confidently (WALC) campaigns, both of which have contributed to a reduction in the incidence of fractured neck of femur – an injury associated with falls and a major contributor to premature death among elderly people.
He praised Frimley Park Hospital, saying he felt very privileged to be working with the first hospital rated by the Care Quality Commission as outstanding.
Audience members were shown a powerful video of the Safe Haven, at Aldershot’s Crisis Café, as seen through the eyes of a service user. She described the impact the service – designed by and for people experiencing mental health crisis – has had on her life. The service has been so successful that it was shortlisted for a national award and is being rolled out across Surrey.
Dr Jane Dempster, the CCG’s Clinical Director for Community Care and Integration, explained the Vanguard scheme, which the CCG and its area partners bid to join earlier in the year and which allows local projects to introduce new models of health and social care by supporting them with central funding and resources. For North East Hampshire and Farnham she said this is allowing health and social care partners to make the changes they were already making or planning but to do this much faster and with the resources to support them.
She said: “We want people who live locally to be happy, healthy and at home, when that is the best place for them to be.”
Dr Dempster added that the joined-up care would mean people would not have to repeat their story over and over again to medical and care staff as they would be treated by an integrated care team (ICT) made up of representatives of many different organisations, working as one.
“It won’t matter which provider is providing the services. It won’t matter which badge they are wearing and where they are coming from,” she said. “There won’t be any gaps.”
Her colleague Dr Edward Wernick, the CCG’s Clinical Director for Quality, Patient Experience and Patient Engagement, was joined by Steve Manley, the Community Engagement and Outreach Officer from Healthwatch Hampshire, to talk about meaningful patient engagement.
Dr Wernick urged members of the public to approach the CCG if they had ideas on how it could engage more with its community.
“Don’t commentate; Participate,” he said.
[i] For the CCG’s full annual report and accounts for 2014/15, visit: http://www.northeasthampshireandfarnhamccg.nhs.uk/documents/class-1-who-we-are-and-what-we-do/publications
Questions asked at the event.
Noting the importance of education – especially of the generations for whom we are planning – what opportunities does the CCG see for partnership working in schools (all levels) – through teachers, students and others in the children’s workforce?
The CCG believes that working with children and young people and hearing their views is very important.
The CCG has a number of examples where commissioners have engaged with young people to help shape service re-design. It is currently involved in re-tendering the Child and Adolescent Mental Health Service (CAMHS) and has ensured that young people were involved, both with the service and the tendering process.
The CAMHS provider has been commissioned to work with and in schools to train teachers to help them support children before they reach crisis point.
The CCG has also recently commissioned a pilot scheme in Rushmoor, working in four schools. This is around recognising that educational attainment can often be severely hampered by mental health difficulties – not just those of a child but within a child’s family. One element of this is looking to establish safe places within schools where children can go for help and support.
Throughout this the CCG and the collaborative Children and Maternity Team is looking to learn what it is that the children and young people themselves would like, and building that into the service.
a) What plans do the CCG have to prepare for and address winter pressures this year?
b) Will this include commissioning a minor ailment service from community pharmacy?
We are better prepared than last year. We have learned a great deal from last year’s winter pressure and how we were able to proactively plan and be on top of the situation from early on: using funding from the System Resilience Group and working with the acute and voluntary sectors, with community providers, with the Out of Hours service, with social care colleagues. Partners in the Frimley System have been talking to each other about this since June.
The integration hubs are up and running and will be looking after the vulnerable population. We will be looking at early intervention, at using pharmacies. We will be working with Frimley Park Hospital and social care colleagues on Discharge to Assess (when a person is ready to be discharged from acute hospital care but not yet ready to return to their own home and is placed temporarily in a care home for social care assessment and/or rehabilitation – this will be done in consultation and collaboration with the patient, their family and/or carer).
Additional funding is available for psychiatric liaison support. The falls/WALC (Walk and Live Confidently) campaign continues to work well to reduce injuries and hospital admissions. This involves identification of people at greatest risk, swifter access to falls treatment, self-referral, single point of access.
There is a new alcohol treatment service up and running and also a re-ablement service pilot being provided by Southern Health NHS Foundation Trust and Frimley Health NHS Foundation Trust, with beds at Fleet Hospital.
The CCG is keen to introduce Healthy Living pharmacies in our area following the success seen in Portsmouth. These pharmacies have seen an increase in access for patients to self-care and prevention services, such as smoking cessation, weight loss services and services to improve the use of medicines.
We are looking at the benefits of a minor ailments service and may commission in the future.
a) How is the NE Hants & Farnham CCG explaining to the public how they are improving health provision?
b) Who is selected to be involved and told?
While some communication is targeted, there is no process of exclusion when passing information to local people.
This question touches on how the CCG reaches people it currently does not engage with. At an event the day before the AGM it was observed that of the approx. 120 attendees, not many were of working or school age, as it was during the working day. The latter raises questions about how the CCG might better work with Parent Teacher Associations, for example. The CCG will also need to have a distinct approach when engaging with socially-deprived parts of the community, and so on.
The CCG is trying to build up a better picture of the voluntary sector, to be able to work more systematically and to better use the assets that are already out in the community.
The CCG will be working with its Community Ambassadors and it is also looking to use patient leaders.
The CCG invites anybody who has any ideas on how it might better communicate with local communities to get in touch.
“Don’t commentate, participate”
I believe NEHF CCG has become a type 2 Joint Co-Commissioning organisation. I understand that this entailed bringing together primary (GP) funding and secondary care funding. Is this a true or false perspective? I have seen little evidence so far.
This is not quite true. Co-commissioning is about NHS England and the CCG jointly working together regarding primary care services. This might include looking at premises, quality issues, workforce etc.
Co-commissioning increases our local voice to influence arrangements for local people based on the needs of the population.
There had been concern beforehand about conflicts of interest but the structure of the joint commissioning committee is such that no GP has a vote and the committee is chaired by a lay member.
What proportion of AGM attendees were members of the public?
A show of hands at the AGM revealed two people were members of the public. We were pleased to see a significant number of representatives of health and social care organisations and voluntary/community groups.
Attracting more members of the public to events and to meetings is something the CCG is keen to work on and would welcome any suggestions on how this situation can be improved and how CCG meetings can be made more relevant to ordinary members of the public.
As a mental health provider IAPT/TalkPlus, we have not been involved in recent Vanguard meetings (since July). Shouldn’t we be involved in some way?
Also we only found out about yesterday’s (Tuesday, Sept 22) meeting by accident. Is there a way where all parties can be involved to ensure full coverage of providers?
North Hampshire Urgent Care (the parent body of TalkPlus) is a member of the Vanguard Steering Group and is represented at this by Sue Paterson, its Chief Executive. North Hants Urgent Care is already involved in two of our workstreams (Prevention and Integrated Care Teams) and is about to become involved in a third project.
However, we have not yet brought primary care mental health services into these discussion and need to do so. We would be keen to have TalkPlus involved in our workstreams and projects and the best first step would be for the Clinical Director and General Manager of TalkPlus to meet with the Programme Lead and this is being arranged.
The co-production event on September 22 was designed to engage the third sector and patient participation/engagement groups rather than to engage with staff who work in health and social care. Vanguard steering group members were also invited to hear from these groups.
There will be many more opportunities for all kinds of organisations and their staff to input into the design and delivery of new models of care and we would hope TalkPlus would continue to work with us on this.
£1.3M MH (Mental Health) spend – what on?
(This was a reference to a section of the presentation by the Clinical Commissioning Group’s Chair, Dr Andy Whitfield.)
We have increased our funding in mental health from £27.3m in 2014/15 to £29.0m in 2015/15. Included within the in-year increase is £1.3m parity of esteem investment, the chart below shows how that investment has been used:
Is the federation of GPs simply a means of transforming services from the hospital sector to “private” GP practices?
Could key financial resources slides be provided to those attending please?
Are the presentations available on the CCG website?
The federation is about 24 GP practices working closely together. This may be to deliver new services but it is also about making existing services sustainable for the future.
Under the Vanguard programme we are aspiring to a provider model which will have acute trust, community care and GPs included, working within a pooled budget.
How do you see Technology changing the way NEHF patients receive better care outcomes in the future?
The main improvement that we can expect is improved access to quality data for all clinicians. At the moment the many organisations involved in patient care keep individual records, the most detailed of which is the GP record itself.
Although stringent systems are necessary to ensure that confidential medical information is shared, in accordance with the 7 Caldicott Principles respecting the individual's consent to share, many patients are surprised that we are not able to share their medical information more effectively. To this end we are working with Frimley Park Hospital, Royal Surrey County Hospital, community nursing providers, mental health, social and unscheduled care providers in order to enable them to have access to information recorded in GP records in order to improve continuity and efficiency of care.
In time as soon as technology allows we aim for the flow of information to be in both directions and for closer collaborative work to be possible. We are collaborating with neighbouring CCGs in order to co-ordinate this development work. The gradual migration of all practices within the CCG to using the same system will enable mutual support in the development of local tools optimised for our own population.
At the same time our GP clinical system continues to evolve with the aim to enable patients to have greater access to their own GP record, which will help them understand their care better, and even contribute to the record using approved health apps. The hope is that this will enable patients to use NHS resources responsibly and appropriately while firmly grounded in their ongoing care.
The experience of some of the members of Surrey Independent Living Council and myself is that when presenting at the GP surgery with an illness or ailment the default response can be to assume it is related to an existing long term condition or disability. For example when I go to the GP with my symptoms I always now say how would you treat this if I didn’t have cerebral palsy as it’s maybe not connected to it.
Are there any projects or programmes planned to address this please, so that people are treated by everyone in primary care (including nurses, practice managers, receptionists, etc.) as people and not first and foremost by their condition?’
There is no specific training planned to address the issue but the CCG would be happy to reconsider the matter if similar concerns were expressed by other patient comments and feedback. The CCG is planning to put in place a way of collating patient feedback from all Practices and we will be addressing training according to the broad number of issues raised. In the meantime we would suggest patients direct queries to their Practice Managers/Practice Patient Participation Groups either anonymously or otherwise so the issue is raised with the Practice concerned.