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Barking and Dagenham, Havering and

Redbridge

Clinical Commissioning Groups

Annual Report on Engagement

2015/16

Name CCG: Barking and Dagenham, Havering, Redbridge

Name person who completed this report: Andrew Strickland, Head of Communications

and Marie Price, Director of Corporate Services, BHR CCGs

Internal sign off obtained from: Marie Price, Director of Corporate Services

Healthwatch statements completed by: Manisha Modhvadia, Healthwatch Officer; Anne-

Marie Dean, Healthwatch Chair, Cathy Turland, Chief Executive Healthwatch

Date submitted to regional team: 31 October 2016

Please note the report covers the period- 1 April 2015 to 31 March 2016

Contents 1. Context Setting .............................................................................................................................. 5

1.1. Introduction ............................................................................................................................ 5

1.1.1 How we work and developments over the past year..................................................... 5

1.2. Demographics ....................................................................................................................... 5

1.3. Our collective demographic data and challenges across BHR ..................................... 7

1.4. Our vision for engagement and participation.................................................................. 13

1.4.1 Guiding principles for engagement .......................................................................... 13

1.5. Structure and resources .................................................................................................... 14

2. Developing the infrastructure for engagement and participation......................................... 15

2.1. Processes ............................................................................................................................ 15

2.2. Networks .............................................................................................................................. 17

2.2.1. Maternity Services Liaison Committee .................................................................... 17

2.2.2. Equality and diversity ................................................................................................. 17

2.2.3. Other networks and partnerships ............................................................................. 17

2.3. Structures ............................................................................................................................. 19

2.4 Social media ........................................................................................................................ 19

3. Engagement and participation activity ..................................................................................... 20

3.1. Introduction .......................................................................................................................... 20

3.2. CCG patient, carer and public engagement strategy .................................................... 20

3.3. BHR accountable care system engagement and research .......................................... 21

3.4. Urgent and emergency care engagement/research ...................................................... 23

3.5. Increasing uptake of psychological therapies ................................................................ 25

3.6. Changes to stroke rehabilitation services consultation ................................................. 27

3.7. Other engagement exercises – ongoing ......................................................................... 28

3.8. Procurements ...................................................................................................................... 28

4. Meeting the Individual Participation Duty ................................................................................ 29

4.1. Introduction .......................................................................................................................... 29

4.2 Specific activities................................................................................................................. 29

4.2.1 Continuing Healthcare (CHC) Survey ...................................................................... 29

4.2.2 Previous unassessed periods of care (PUPOC) .................................................... 30

4.2.3 Personal Health Budgets (PHBs) ............................................................................. 31

4.3. Implementation of new technology to support personalisation .................................... 31

4.4. Health 1000 - The Wellness Practice .............................................................................. 31

4.5. Holding our providers to account ..................................................................................... 32

5. Forward Plans for 2016-17 ........................................................................................................ 32

5.1. Our focus for the coming year .......................................................................................... 32

6. Healthwatch Statement .............................................................................................................. 40

6.1 Healthwatch Barking and Dagenham Statement ........................................................... 40

6.2 Healthwatch Havering Statement ..................................................................................... 40

6.3 Healthwatch Redbridge Statement .................................................................................. 41

1. Context Setting

1.1. Introduction

The Barking and Dagenham, Havering and Redbridge (BHR) CCGs work as a collaborative.

We are committed to engaging with patients, carers and the public in all that we do. This

year we reflected on what we’d achieved since 2013 and through a participatory process

developed our new engagement strategy for 2016-2019. This report outlines our local and

collective arrangements, what we have achieved over the past year and our plans for the

coming year.

1.1.1 How we work and developments over the past year

We have a dedicated borough team and a shared management team that works across the

three boroughs.

Locally we enjoy good relationships with our borough partners and organisations that work

across the BHR patch. Our approach enables us to retain a borough focus on our

populations, but by sharing resources, good practice and by working together we also gain

significant benefits. We are also able to hold our common providers to account and ensure

that they are responsive to patient needs and wishes.

Over the past year there have been a number of developments, with the creation of the

sustainability and transformation plan (STP) footprint across the eight north east London

boroughs and our successful bids in BHR to be an urgent and emergency care vanguard and

devolution pilot, exploring the benefits of becoming an accountable care system (ACS).

Involving patients and local organisations has been key to these strategic developments, and

we talk more about this later in the report. Our new engagement strategy, which we involved

a wide range of colleagues in developing, provides us with a sound foundation and action

plan to take engagement to the next level, as we move to greater integration of the CCGs

and with our local health and social care partners.

In this section we outline the demographics of each borough and the overall BHR patch,

including our common challenges.

1.2. Demographics

Barking and Dagenham

The overall population of Barking and Dagenham is currently 190,560 people (based on 2012 ONS figures).

Since 2001, Barking and Dagenham has seen rapid population growth, linked to both to new

housing development and birth rate changes. The population structure has changed

significantly with particularly large increases in the numbers of younger people living in the

borough. The main component of population change across the London boroughs over the

last decade has been and remains natural increase which is the result of having more births

than deaths.

There has also been a rapid shift in the proportions of various ethnic groups, with a large

decrease in the white British ethnic group and a large increase in the black African ethnic

group. Our population faces a range of major health challenges and health outcomes are

poor for many local people because of a combination of poverty, deprivation and lifestyle. We

have higher numbers of deaths from the major diseases (heart disease, stroke, cancer,

diabetes and chronic lung disease) compared with the London average. Our residents also

experience more ill health and disability during their lifetimes.

There is a strong correlation between poverty/deprivation and poor health, for many reasons

that include poor diet/nutrition and unhealthy living and working conditions. In general, those

who live in areas of high deprivation suffer the most from poor health and wellbeing.

You can read the Barking and Dagenham joint strategic needs assessment for more

information.

Havering

There are 245,974 people living in Havering and 261,867 people registered with a Havering GP. The people of Havering are generally fairly healthy. Life expectancy is long and residents and visitors to the borough benefit from plenty of high quality parks and open spaces.

As well as increases in the number of births, there has been an increase in the general

fertility rate from 54 (per 1,000 women aged 15-44) in 2003 to 66 in 2014. From 2009 to

2014, Havering experienced the largest net inflow of children across all London boroughs,

with 4,606 children settling here from another London borough.

The life expectancy at age 65 years is 19.0 years for males and 21.7 years for females.

About 18% of working age people disclosed that they have a disability or long term illness

Havering is one of the most ethnically homogenous places in London, with 83% of its

residents recorded as White British, higher than both London and England. About 90% of the

population were born in the United Kingdom. It is projected that the Black African population

will increase from 3.8% (2015) to 5.2% in 2030.

There are 97,200 households with at least one usual resident in Havering. Households are

mainly composed of pensioners and married couples with dependent children. All adults in

52% of households (40,722 households) are working and no adults are working in 16% of

households (12,256 households). In 2011, there were 7,224 one-adult households with

children under 16 in Havering. This is an increase from 2001 when there were 4,005 lone

parent households. There has also been an increase in the number of one-adult households

with no children.

About 70% of the population in Havering are home owners. This is one of the highest

proportions across London boroughs. Housing in the borough is mainly Victorian and

Edwardian. Houses are generally large with an average of 2.8 bedrooms per household

(higher than both London and England). The rate of statutory homeless households in

Havering (1.9 per 1,000 households), in 2014/15, is significantly lower than London (5.1 per

1,000) and England (2.4 per 1,000). The rate of homeless households in temporary

accommodation (6.5 per 1,000 households) is lower than London (14.0 per 1,000) but higher

than England (2.8 per 1,000).

The borough has a rate of short-term international migrants of 77 per 100,000 population, the

lowest of all London local authorities. About 83% of the traveller caravans in Havering were

on unauthorised sites, as at July 2015.

https://www.lbbd.gov.uk/council/statistics-and-data/jsna/overview/

Thirty two percent (13,449) of the population aged 65 years and above are living in one-

person households. Almost half (48%) of all one person households in Havering are

occupied by persons aged 65 years and over, which is the highest proportion in London

The results of the 2011 Your Council, Your Say survey indicated that health services are the

top priority for local people in making the Borough a good place to live, followed by clean

streets and the level of crime.

You can read the Havering joint strategic needs assessment for more information.

Redbridge

Redbridge has a growing and mobile population. In 2014 the population was estimated to be 293,055 (ONS mid-year estimate). It is predicted that the population will grow by another 40,000 (13.5%) by 2021, with the greatest growth being in numbers of children. By 2021 it is predicted that 28% of the population will be aged under 20 years.

There was a 34% increase in births between 2004 and 2014 although the rate of increase

appears to be levelling off. There is projected to be a 19% increase in the numbers of people

aged over 85 years by 2021, with a consequent effect on demand for services for this age

group.

The population is very ethnically diverse: a majority (63%) of the population is from black and

ethnic minority backgrounds with the largest group being of South Asian origin.

Redbridge ranks 138th out of 326 local authorities on 2015 Index of Multiple Deprivation

(with 1 being the most deprived), but there is wide variation across the borough with some

wards predominantly in the lowest two quintiles for deprivation and some in the highest two

quintiles.

You can read the Redbridge joint strategic needs assessment for more information.

1.3. Our collective demographic data and challenges across BHR

This following picture summarises the key demographic challenges for the boroughs within

our collaborative. It also includes details of the main providers. Barts Health is also a key

provider for Redbridge given a third of the population use Whipps Cross Hospital and

approximately 10% of Barking and Dagenham residents use Newham Hospital. We are an

associate to the contract which is led by Newham CCG.

https://www3.havering.gov.uk/Pages/ServiceChild/Joint-Strategic-Needs-Assessment.aspx

http://www2.redbridge.gov.uk/cms/care_and_health/health/joint_strategic_needs.aspx

The table below summarises the health, wellbeing, care, quality and financial challenges for our wider BHR population.

We have a diverse population in BHR and the chart below outlines the make-up of the people that live in our borough and wider patch.

The following pictures illustrate how while we have a rapidly increasing younger population, that we also have an increase in the numbers of older

people, and particularly those with multiple co-morbidities and long term conditions.

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1.4. Our vision for engagement and participation

Our vision for community engagement is for local people and stakeholders to

genuinely feel that we are open, transparent and responsive to their needs.

We do this by:

Identifying how people can get involved and what skills and support they need to

do this.

Working out how to engage with different groups of people so we can gather a

wide range of views.

Proactively engaging with patients, public and communities whose views are

often under-represented (these are often referred to as hard to reach groups).

Making use of the information available to make robust and informed decisions

about commissioning local health services.

We recognise there are a range of factors that have a direct impact on people’s

health and their health needs, such as whether they are in work, how much they

earn, where they live and their family background.

Community engagement should provide the opportunity to develop the voice and

capability of local people to help them proactively engage and influence change.

To commission services that equally meet the needs of all groups and engage with

people whose views are often not sought, we need to be creative in our approach.

We know that local groups such as Healthwatch and the borough umbrella

organisations for the community and voluntary sector have a good track record and

connections to the wider community. We will work with these bodies and existing

community and voluntary groups to reach these communities. This will help us to:

Make sure we are effectively meeting the health needs of local people.

Plan services for the future that reflect what local people need and want.

1.4.1 Guiding principles for engagement

To help us make sure we approach the way we do patient, carer and public

engagement in the right way, we undertook some work to find out what principles

people thought were important to guide the CCGs.

We started with a list of 20 principles and asked people to tell us the ones they

thought were most important. Whilst all of the principles were seen as important

there were some that stood out from the crowd. With additional help from those who

attended the event, the following list emerged as the most popular. They are a

helpful addition to help us make sure we do a good, high quality job of engaging our

patients, carers and the public.

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Be open and honest about what is possible and what is not possible

Involve people as early as possible, listen and act on patients and carer feedback

every step of the way and tell people how their involvement made a difference

throughout the process and at the end

Be accessible, the way you engage people should be tailored to the people you are

trying to engage, ask people what will work best for them

Communicate clearly in easy to understand, plain English

Allocate appropriate resources and support so that engagement can be effective

Work hard to seek the views of people and communities who experience the highest

health inequalities and the poorest health outcomes

Base relationships on equality and respect, patients, carers and the public have an

equal voice to professionals

Work with relevant partner organisations

It is not our intention that this is a definitive or ‘tokenistic’ list for us to follow, but a set of

principles to guide us on our way.

1.5. Structure and resources

Engagement is everyone’s business in the CCGs, but to ensure that this happens, a number

of people have specific responsibilities.

The three CCGs in BHR work collaboratively and operate a single management team, which

provides a range of shared support functions working alongside our local borough teams. We

talk about ourselves as BHR CCGs when we are working together.

Within this team, there is a dedicated patient and public engagement adviser, reporting to the

head of communications and with direct access to the director of corporate services. The adviser

works closely with the staff, chief operating officers and the lay members for public and patient

engagement in each CCG. Each CCG also has a clinical director lead for patient and public

engagement. The nurse director and the directors for innovation and primary care transformation

also have particular engagement responsibilities and these are reflected later in this report. The

CCG’s chief operating officer, lay member and chair regularly meet to track progress and ensure

that the patient voice is being heard and reflected in commissioning decisions.

The CCG has a service level agreement (SLA) with NEL Commissioning Support Unit (CSU) to

provide a full communications service. Under the SLA the CSU will provide the CCG with

whatever support is required at any particular time, including support for consultation and

engagement. This includes patient focused research through to implementation and evaluation

of marketing campaigns, formal consultation on service change and social media activity. The

NEL CSU is.embedded in the work of the CCG and for example worked intensively on the three

borough stroke rehabilitation consultation and campaign to increase uptake of psychological

therapies, both reported on in section 3.2.

The CCGs funds NEL CSU approximately £400k per annum for communications support and

approximately half of this relates directly to engagement and consultation.

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The director of corporate services and head of communications meet with the CSU BHR CCGs’

business partner and senior manager for the service on a monthly basis. We review

performance against key performance indicators (KPIs), run-rate against budget and plan for

future activities. The service performs well and we enjoy positive relationships with the team.

The CCGs generally spend approximately £80k in addition to staffing costs on engagement and

consultation throughout the year. We also spent additional funds on research and engagement

on the UEC vanguard and ACS devolution, which were covered through funds gained from our

successful bids. We also committed expenditure on securing an independent and leading patient

participation organisation to work with us in developing our new engagement strategy.

2. Developing the infrastructure for engagement and participation

2.1. Processes

Each CCG has an active patient engagement forum which meets every other month (or

more frequently if required). It is called a patient engagement reference forum in Havering.

Forum members invite speakers, such as local provider representatives, to attend and

discuss topics of interest. For example last year senior representatives from BHRUT

attended for extended sessions to discuss concerns about quality and the hospital’s special

measures status and to share information about the improvements being made. Senior

representatives from Barts Health also attend Redbridge meetings to discuss similar quality

concerns and specific issues such as patient transport, hearing feedback and taking back our

views.

Forum members also discussed issues ranging from primary care improvement, mental

health, stroke rehabilitation consultation and annual commissioning intentions.

The forum meeting is the place where patients and the public can influence decisions about

local healthcare, bring any issues, concerns, or good news stories, to the group. The forum

also gives GPs and their supporting teams the opportunity to receive direct feedback about

people’s experiences of local health services. Individual members are also involved in

representing the public and patient voice on a number of steering groups.

The three patient forum groups include members from Healthwatch, the voluntary and

community sector, youth organisations and have carer, mental health and learning disabled

service user representatives.

Training for forum members: We welcome the input that our members bring to the CCGs,

but recognise that we have a responsibility to support and help develop their skills and

knowledge. As part of this commitment we commissioned Patient and Public Involvement

(PPI) Solutions to run a programme of training for patient representatives from the PEFs and

PERF in BHR during September to October 2015. The training covered a range of topics

and was interactive in format. Colleagues welcomed the opportunity to network with

members from across the patch and rated the training highly.

Minutes from forum meetings are also placed on the agenda for governing body (GB)

meetings and contribute to the standard lay member reports to each GB meeting. Any

quality concerns identified at meetings or through community events are raised through the

lay member’s report (as well as directly with the appropriate officer in the CCG).

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The CCG’s website offers information from the homepage about the forum and patient

participation groups and gives details about how to get involved with the work of the CCG.

We engage online with local people via Twitter (with a Twitter feed on the website

homepage) and local patient and campaign group blogs. We monitor the local Streetlife

website – a community website hosted by the local newspaper group – and answer any

patient queries. We also monitor local blogs and engage when questions are posed or issues

raised relating to the services that we commission.

If we carry out particular formal engagement exercises, such as the stroke rehabilitation

consultation, we create space on the website for people to access information and to feed

back via online questionnaires. We talk more about our online engagement arrangements

later in this report.

The borough, primary care and engagement team members work together to support our

member practices to develop patient participation/reference groups (PPGs/PRGs). We

have encouraged patients to join through outreach at community events using our newly

developed marketing materials. Through our support we have increased the number of

groups in existence, and have encouraged new members to send a representative to the

PE(R)F meetings. PPG members have seen their contributions celebrated through awards

at the CCG’s annual awards ceremony, following the annual general meeting (AGM). Each

June as part of PPG Awareness Week, we celebrate the contribution of PPG members and

use the opportunity to encourage the recruitment of new members.

We hold public meetings as part of consultation exercises, where clinicians and senior

managers present potential plans to local people, discussing issues and receiving feedback.

We also attend meetings of local community groups (e.g. faith, BME, those with one or

more long term conditions) to discuss plans and hear views. Our lay members and patient

engagement adviser regularly meet new groups, and our senior officers and clinicians often

present at community group meetings when invited and bring any feedback to the CCG.

We use experience-based co-design and focus groups to explore specific issues in more

depth. In developing the engagement strategy we took this approach to ensure that we

secured broad range of views.

In Barking and Dagenham we link up with our local Healthwatch on their information days

where local people are encouraged to become involved, including through PPGs and our

CCG patient forum meetings. Our CCG Chair, Dr Waseem Mohi, has a monthly column in

the local newspaper, which provides an opportunity to reach readers with information about

what the CCG is doing and to encourage them to get involved. The column is well read and

we also include copies on our CCG website. Read more here.

In Havering we hold end of life cafés – sometimes called ‘death cafés’ which are discussion

and planning sessions with patients nearing the end of their lives to talk about death,

breaking the taboo and leading to productive planning of their care with their family and

clinicians. This open approach has enabled the CCG to get an insight into what patients want

at the end of their life and preferences for their care such as dying at home and ‘do not

attempt to resuscitate’ orders.

http://www.barkingdagenhamccg.nhs.uk/News-and-publications/chairs-column.htm

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2.2. Networks

2.2.1. Maternity Services Liaison Committee

The BHR CCGs fund the BHRUT Maternity Services Liaison Committee (MSLC). It is made

up of local women and their families who have recent experience of maternity services.

Members meet regularly with senior midwifery and commissioning staff to provide feedback

on plans and the quality of services. Some MSLC members also ‘walk the floor’ to speak to

those currently receiving services to seek their views and provide instant feedback to

leaders, helping to ensure that services are of a high quality.

The group has an active Facebook page and posts regular updates on Twitter

@MSLC_queens where they encourage women to join up, or share useful information about

birthing options and provide general support for prospective and new mums/families. They

have offered particular support to encourage breastfeeding; a borough priority given the

benefits to mother and child. The group has an action plan and plays an active role in the

commissioning and monitoring process. We are providing a small amount of additional

funding to the MLSC to help them promote their activities and encourage participation from

expectant or new mums.

2.2.2. Equality and diversity

We are members of the outer north east London Equality Delivery System (mark 2) Group

which is led by our local community and mental health provider, NELFT. Some of our patient

representatives across BHR are also actively engaged in the work and outputs of this group.

Earlier this year we worked with Redbridge Healthwatch to organise a workshop on the

accessible information standard (AIS) for practice staff. The aim of the workshop was to

provide information, support and guidance for practices on how practices could achieve

successful and effective implementation of the AIS. The workshop was attended by 57

practices across BHR. Following the workshop Healthwatch advised that they will be working

with patients and carers to promote their rights and will also be doing enter and view visits to

practices to review what resources are available, ensuring that they are complying with the

standard.

2.2.3. Other networks and partnerships

As a CCG collaborative we often and increasingly carry out engagement exercises together

where the work crosses borough boundaries.

We also work in partnership with other local CCGs, in particular our north east London

(STP) partner CCGs in City and Hackney, Newham, Tower Hamlets and Waltham Forest,

and with local NHS providers such as the local acute hospital and foundation trusts, with

local councils, Healthwatch and local community and voluntary organisations.

The success of our local partnerships has been demonstrated over the past year by our

successful vanguard and devolution bids – all supported by statutory health and social care

partners in BHR, and all with significant elements of engagement.

We have also worked with Newham, Tower Hamlets and Waltham Forest CCGs on the

Transforming Services Together programme, looking at whole-system, transformational

change across the health economy in that area, which will affect our local population too.

Barking and Dagenham:

https://mobile.twitter.com/mslc_queens?max_id=585738107883925503

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The chief operating officer chairs the Children and Maternity Sub-Group of the Health and

Wellbeing Board which includes Healthwatch in its members. The group engages with wider

stakeholders in the development of plans and monitoring of local services.

We work closely with the local authority and community/voluntary sector colleagues

throughout the year and as part of specific groups set up to organise the International Day of

Disabled People and Carers’ annual events, which sees high attendance and engagement

with service users in the borough.

The Mental Health Sub-Group of the Health and Wellbeing Board is the forum where commissioners, providers, service-users, carers and other stakeholders including Healthwatch, the voluntary sector and the Police, come together to consider mental health needs and agree collaborative responses. Over the past year the group reviewed the mental health needs assessment, the crisis care concordat action plan and agreed priorities for mental health in the borough. Havering

With the local authority we jointly fund and coordinate a network of voluntary and community

organisations in the borough: the Voluntary and Community Sector Forum. Our lay member

for PPI chairs the meetings. More than 30 community groups are members and they meet on

a quarterly basis to discuss agreed specific topics. Over the past years these have included:

primary care transformation, mental health and the rebranded ‘talking therapies’ service, the

stroke rehabilitation consultation, as well as our usual discussion on commissioning

intentions.

We are also joint leads for a number of other formal boards, including the learning disability

partnership with Havering Council, on which there are user, carer and voluntary sector

representatives.

We have also worked closely with the local authority and voluntary sector colleagues in

developing the Compact for the borough, and which sets clear standards for engagement

and consultation.

Redbridge

In Redbridge we work closely with our CVS and fund a health community outreach worker

who acts as a link between the CCG and wider community and voluntary sector. She is able

to share our priorities and explain how to access the services we commission, as well as

hearing what people have to say about their experience and needs, and ensuring that this is

fed back to us so that we can take appropriate action.

Our lay member for PPI is the CCG’s representative on the Public and Voluntary Sector

Partnership (PSVP). The Partnership is made up of elected Members from the Council,

elected representatives from the voluntary and community sector, and nominees from

ourselves, the Redbridge Police Service and the Redbridge Fire Service.

Redbridge CVS hosts the meetings and supports the voluntary sector representatives. The

key role of the Partnership is to develop effective working relationships between the

voluntary and public sectors in a range of areas and provides a useful vehicle to raise issues

of common concern and authorises further work to address these issues. The group also

oversees the development and partnership sign off of the local Compact ‘Good Practice for

Working Together’ between the public and voluntary sector.

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Voices of Experience: the CCG funds Age UK to provide a face to face and virtual forum for

over 200 older people to share views, be engaged in and consulted on health and social care

issues. The service enables older people who regularly use health and social care services

to influence a range of service providers through genuine consultation.

There are two groups - the Questionnaire Group and the Citizens’ Panel. Each works in

different ways to ensure seniors' opinions are represented and their voices heard. Age UK

host many discussion groups at their bases and sheltered accommodation in the borough.

The group also takes their questionnaires with translators to a number of black and minority

ethnic (BME) community groups.

The Panel of 15 older people is drawn from the wider group who represent the Voices of

Experience at meetings with representatives from the CCG and other NHS organisations, as

well as social services and other local bodies. Training, support and transport is provided to

enable members to participate.

2.3. Structures

Our CCG patient forum meetings are a critical part of our engagement structure. Each has a

two way feedback arrangement - to the PPGs/locality that the members come from, through

to the governing body.

The lay member for patient and public involvement (PPI) sits on the patient forum and

provides a formal link between the group and the governing body. At each meeting the lay

member for PPI presents a report feeding back to the governing body issues that the group

has raised and feeds back to the PERF any actions taken as a result of their feedback.

Redbridge governing body has a Healthwatch representative as a non-voting member of the

governing body with a seat at the table. The other Healthwatch organisations are welcome

to join should they wish to and are also involved in other strategic meetings, such as the A&E

Delivery Board (formerly system resilience group).

Because we work in a collaborative, the three lay members, patient forum chairs, vice chairs

and relevant officers meet on a quarterly basis to discuss common themes across the BHR

patch and share best practice. The chairing and location of the meeting rotates between the

three CCGs.

2.4 Social media

This year we have continued to increase the use of online and social media when engaging

with patients and the public. Our CCG website has been refreshed to delete outdated content

and reduce the number of ‘click throughs’ to content. Our GPs own intranets have also been

redesigned with input from GPs and clinical directors.

Our Twitter account continues to deliver the most comprehensive patient/public facing

information in the local health and social care system. Health care information, news and

updates are delivered every day of the week, including weekends and bank holidays,

providing both localised information and the promotion of wider, partner and national

campaign messages as appropriate.

It was used widely to help promote the establishment of late evening and weekend GP ‘hubs’

and a new mental health service, #Talking Therapies. We also tweeted about the opportunity

for the public to take part in the biggest single NHS engagement exercise carried out in our

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area, resulting in 3,000 individual interviews regarding urgent and emergency care carried

out across the CCGs.

We also use our twitter feed as a way of responding to queries and concerns raised on social

media, responding quickly to issues raised.

We used an online survey tool to enable patients and public to feed directly into work to

update our engagement strategy – asking them which engagement principles they felt were

most important. We had more than a hundred responses and this is a tool that we have since

taken into engagement around wider proposed service changes.

3. Engagement and participation activity

3.1. Introduction

We have many examples of engagement and participation activities throughout the year and

have already referred to several of these in the previous section. Here we summarise the key

ones.

3.2. CCG patient, carer and public engagement strategy

Our objective was to develop a new engagement strategy for the three CGGs that took on

board what had worked to date, reflected the views and aspirations of local stakeholders and

which would help us to fully embed engagement in all that we do.

PPI Solutions were commissioned as independent experts to develop the strategy in

partnership with the CCGs.

Activity: the process, which took place across the BHR patch, involved listening to a wide

range of people through:

30+ one to one interviews

10+ small group discussions

A paper and online survey seeking views on the principles which should underpin our

strategy and which received approximately 100 responses

A stakeholder event with over 60 attendees

A draft strategy was then produced and shared with all the stakeholders involved in the

above activities, and wider colleagues, for their views. The strategy was then refined based

on their feedback and agreed by the governing bodies in May.

Who and how: we engaged all stakeholders, from CCG managers, GPs and governing body

members, to the PE(R)Fs, PPG members, community and voluntary sector group

colleagues, local authorities and the three Healthwatches across BHR. Colleagues were

contacted by the CCG and PPI Solutions and encouraged to involve others and share the

survey more widely.

Outputs, impact and outcome: We have a comprehensive strategy that is relevant to how

we operate now as CCGs. It has been developed with those it affects most and has helped

us to develop stronger relationships. One of the positive outcomes was a series of pledges

or ‘offers’ from local organisations about how they could help us reach wider groups – so

access through their meetings, newsletters, radio station were just some examples.

This engagement impacted on

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Procurement

Contract and service monitoring

Service planning and design

Commissioning intentions

Strategy development

Quality of service

3.3. BHR accountable care system engagement and research

Health and social care partners across BHR held a workshop in early 2016 facilitated by

Ipsos MORI. The purpose was to co-design a meaningful engagement and research

programme to make best use of some of the resource received from NHS England as part of

the announcement of BHR as a devolution pilot. The key objectives of this first phase of

engagement were to:

Gain an insight into what our population feels they need to support them to live

healthier lives; if they feel they receive enough information regarding the services

available to them; what their experiences of health and care currently are; and, how

they felt their experiences could be improved

Understand the experiences of health and care staff working across BHR to provide

an indication of the key areas of focus in relation to the barriers between services that

impede the delivery of good quality care; the ways in which clinical staff can be

helped to support our population to live longer, healthier lives; and, what staff feel that

they need to support themselves to live healthier lives

Explore with the community and Voluntary sector across BHR ways of working that

are mutually beneficial and discuss how health and care can work in a more cohesive

way with them

This phase one of the ACS engagement programme was designed alongside and aligned

with the urgent and emergency care vanguard engagement programme to give a detailed

insight into the behaviours and experiences of the BHR population as a whole.

Summary of approach:

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Activity: phase one involved:

3,007 Telephone interviews with the general BHR population - led by Ipsos MORI

‘All staff’ survey (for both local authority and NHS staff) with nearly 750 responses

received

A series of engagement workshops, with the voluntary sector across BHR.

Who and how:

Ipsos MORI led telephone survey of 3,007 residents aged 18+, designed to be

representative of the population of each borough; effectively three independent

samples using an identical questionnaire. Just over 1,000 interviews took place in

each borough.

Circa 750 responses to the survey were received from health and care organisations

from across BHR, the three local authorities, NELFT, BHRUT, London Ambulance

Service local staff , PELC (out of hours provider), and the CSU, along with GPs

working in BHR

Workshops open to all community and voluntary sector groups across BHR. This

method has been particularly useful in engaging with smaller groups and

organisations who are not linked to the wider umbrella organisations in each borough.

Fieldwork, led by Ipsos MORI, was undertaken by computer assisted telephone

interviewing between 30 March and 28 April 2016, with each interview lasting around

20 minutes. Specially trained interviewers talked residents through the survey

questions and recorded their answers. Demographic quotas were set according to

age, gender, work status and ethnicity to ensure that those who took part in the

research would be representative of each respective borough. A special method of

contacting interviewees was employed to ensure that homes without a landline (i.e.

those with only mobile phones) were still reached by this method of surveying

All staff online survey designed by communications leads alongside clinicians, in

collaboration with operational staff. The survey was live from 18 April – 3 May 2016

and was the first time that all health, local authority staff and GPs working in BHR

have been surveyed collectively.

Series of open workshops held across BHR to engage with the community and

voluntary sector; these were facilitated by the ACS Programme lead officer and

included presentations by the leads from the voluntary sector organisations in each

borough. Breakout sessions and table discussion ensured that the voices and

experiences of individual groups were heard and recorded.

Outputs, impact and outcome: key headlines from each element of the phase one

engagement programme include:

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The outputs of this engagement work have fed into the development of the BHR ACS

strategic outline case; work includes plans to test a locality delivery model of care which will

see seamless care delivered closer to people’s homes. This engagement programme has

fed directly into the development of this model of care. However, partners recognise that

each piece of engagement is valuable in its own right and the outputs from each will feed in

to the future development of services in BHR.

This engagement impacted on Procurement Contract and service monitoring Service planning and design



Quality of service

3.4. Urgent and emergency care engagement/research

Empowering patients and communities is a key element of the New Care Models

programme. Barking and Dagenham, Havering and Redbridge (BHR) were named as one of

eight urgent and emergency care (UEC)) vanguards in the country in 2015.

Our objective was to co-design the UEC care model and key elements of our UEC

transformation programme with local people: patients, carers, clinicians, staff and patient

representatives/voluntary organizations.

Building on work undertaken in summer 2015 to build our business case for the vanguard

bid, a stakeholder group (including Healthwatch) agreed that research was needed to

provide sound evidence of how well local people understand local UEC services, how they

currently use services and what drives behaviours.

Our co-design engagement approach has been cited an example of good practice by the

Coalition for Collaborative Care and showcased at a national Vanguard conference

Activity: following a tender process, we commissioned BMG Media to undertake a major

telephone survey – capturing views of 1,000 residents in each of our three boroughs. Our

24

three local Healthwatch organisations also joined forces to deliver more than 1,000 face-to-

face interviews and 10 focus groups in just under two weeks in March 2016.

Both research projects used the same questionnaire which was co-designed with our three

Healthwatch organisations. This is the largest market research study focused on urgent and

emergency care undertaken in BHR, and provides a significant evidence base for the local

UEC transformation programme.

Who and how: the telephone survey used randomly selected numbers for the three

boroughs (landlines and mobile numbers), and BMG ensured that the data collected for each

borough was representative of the individual borough. Interviewing targets were set by ward

to ensure geographical coverage and by age and gender. Ethnicity was also monitored on a

borough level. All the targets were based on the 2011 census data available for each of our

three boroughs.

We also asked BMG Research to record if participants were parents, carers and identified as

having long term health conditions, as we know from existing data that these residents tend

to attend A&E more frequently.

The community research also recorded demographic details, but focused on engaging with

those individuals whose voices were less heard. Examples include a focus group with people

with hearing loss in Redbridge, with young people in Barking and Dagenham, and with young

adults with learning disabilities in Havering. Demographic data was also captured to allow for

better analysis.

Interim findings were shared at a stakeholder co-design workshop on 17 March which saw

local people, patients, carers and local voluntary sector representatives work alongside

health and social care professionals to consider the research findings.

Outputs, impact and outcome: A report on the research, including analysis of how it

informs our UEC Transformation Strategy was shared with our local System Resilience

Group (now A&E Delivery Group) and is published on our local partnership website

(www.bhrpartnership.org.uk/documents.htm)

Key findings were:

People find the different UEC services confusing and difficult to navigate

http://www.bhrpartnership.org.uk/documents.htm

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A&E is seen as a reliable 24/7, same-day service for urgent care needs – long waits

are not a deterrent. People are prepared to wait for treatment in A&E because they

are guaranteed to be seen and get treatment as quickly as possible

39% of those who had visited A&E did not seek prior NHS/professional advice

37% of people said they had seen their GP with the same issue before going to A&E.

26% had been to A&E before with the same issue

Scenario questions showed people know the most “appropriate” services, but in

practice, they revert to A&E if their GP or a pharmacy can’t help

Anxious parents are just as aware of alternative services, but are more likely to go to

A&E if they are concerned about their child and want urgent advice.

The research has informed the next stages of our UEC programme, and directly shaped the

redirection pilot in summer 2016 at Queen’s Hospital Emergency Department (ED).This saw

adults assessed by a senior clinician on arrival the ED, and then directed to more appropriate

care options if they do not require emergency treatment.




Quality of service

3.5. Increasing uptake of psychological therapies

Earlier this year NEL CSU was commissioned by the BHR CCGs with the objective of

increasing self-referrals and awareness of the increasing access to psychological therapies

(IAPT) programme.

Activity: prior to a marketing and communications campaign, NEL CSU commissioned

Resonant (a research agency) to gain insight into residents’ behaviours and attitudes

towards mental health. Research focused on behaviours around accessing a mental health

services for low-level mental health issues, such as stress and identified key barriers which

prevented people accessing the service. These included:

People finding it difficult to recognise their own issues

Lack of awareness of support available

A complicated self-referral journey

Medicalisation of issues

Using the findings from co-creation workshops run with residents, the following were

developed: a new service name, vision, tone of voice and a new approach to language used

in communications.

A website for the newly branded service was designed which focused on making the user

journey easier to navigate and to self-refer.

A comprehensive marketing and communications campaign was implemented from mid-May

2016 until 31 August 2016 and included targeted door drops, email, community packs to GPs

26

and community centres, social media and web advertising, paid for digital search and media

coverage.

Example of one of the new posters to the right with updated service name and branding, and dedicated website with patient stories below:

Experian’s data marketing services were employed to identify groups of BHR residents

deemed to be under social or financial pressures. Examples of these groups include low

income families, elderly people living on their own and renters of social flats. These groups

were targeted using online (Facebook advertising and email) and offline channels (door

drops).

Who and how: the project involved: the BHR CCGs, NELFT – the service provider, NEL

CSU - commissioned by BHR CCGs to deliver the marketing and communications project,

Resonant – commissioned by NEL CSU to gain insight into residents’ behaviours and to

deliver co-creation workshops

Local residents, recruited by Resonant took part in workshops which provided valuable

insight into behaviours and helped shape the branding strategy and overall approach to

language used in communications. Workshops included BME, 65+ and working age (25-45)

from across the three boroughs. In addition to this service users and patients were sought

through NELFT’s user networks to take part in an online survey to provide feedback.

Outputs, impact and outcome: Early results are positive with over 600 self-referral

applications completed on the campaign website during the campaign period. 28,908

sessions were held on mytalkingtherapies.org.uk during the campaign period mid-May 2016

until 31 August 2016. Sponsored adverts on social media, google search and web

advertising generated 5.4 million impressions to BHR residents.

Facebook was a valuable tool in raising awareness of the service and driving visitors to the

website. Google Search also captured many residents who were online actively looking for

mental health or wellbeing information.

This engagement impacted on Procurement Contract and service monitoring

Service planning and design

27



Quality of service

3.6. Changes to stroke rehabilitation services consultation

Objective: It was identified that stroke rehabilitation services in BHR were not as good as

they could be. The rehab care provided depended on where people lived and was not flexible

enough to meet the individual rehabilitation needs of stroke survivors, meaning people were

not recovering from strokes as well as they could. BHR CCGs wanted to make stroke

rehabilitation services more joined up with each other and focused on what individual people

need, regardless of where people live. Doing this would mean people receive specialist care,

tailored to their needs that would help them to recover better and more quickly.

Activity: A 12 week public consultation took place from 8 January to 1 April 2016. Four

thousand eight hundred printed consultation documents were distributed throughout BHR,

including to GP practices, local libraries, hospitals and community groups and voluntary

services. There was also significant engagement with stroke survivors and their carers. The

consultation document, an easy read version, questionnaire and pre-consultation business

case were published on each CCG’s website. The consultation was also extensively

promoted through the CCGs’ Twitter accounts.

Four public engagement/drop-in sessions were held at libraries, supermarkets and at

Queen’s Hospital. GP stroke leads and CCG officers attended 27 meetings with groups of up

to 100 people to discuss the consultation proposals and answer questions. Staff engagement

sessions were also held at the two affected sites – Grays Court in Dagenham and Beech

ward at King George Hospital. Three hundred and thirty responses to the consultation were

received: 320 questionnaires and 10 letters/emails.

Who and how:

BHR CCGs – as commissioners

Barking, Havering and Redbridge University Hospitals NHS Trust – as provider of

stroke rehab services

NELFT Foundation Trust - as provider of stroke rehab services

Healthwatch – advising on how the consultation was run

LB of Barking and Dagenham -

Service users and members of the public – responding to the consultation

GP stroke leads and CCG officers attended 27 meetings to discuss the consultation

proposals and answer questions. These groups included residents’ forums, BME forums,

health scrutiny committees, health and wellbeing boards, local medical committee meetings,

patient engagement forums and Healthwatch meetings. There was a particular focus on

reaching stroke survivors, their families and carers, and this was achieved by presenting at

stroke clubs, carer’s groups, stroke exercise groups.

A total of 4800 consultation documents were printed - 3800 standard consultation documents

and 1000 easy read consultation documents – and were distributed across Barking and

Dagenham, Havering and Redbridge. Four public engagement/drop-in sessions were held at

libraries, supermarkets and at Queen’s Hospital. Staff engagement sessions were also held

at the two affected sites – Grays Court in Dagenham and Beech ward at King George

Hospital. Consultation documents were distributed at every event and meeting that the

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project team attended to discuss the consultation proposals. The consultation was also

promoted through local media, via the CCGs’ twitter accounts and through the drop-in

events.

Outputs, impact and outcome: The advice of Healthwatch colleagues and the local

authority colleagues proved invaluable in running a successful consultation, with their

comments incorporated to ensure the consultation was as accessible as possible to the

general public. Healthwatch representatives, the CCGs’ patient engagement forum chairs

and vice-chairs and governing body lay members were asked to review and comment on the

consultation document at first draft stage, and again with a designed version of the

consultation document, and their detailed comments were incorporated. On the advice of

Healthwatch, an easy-read version of the consultation document was also developed.

The consultation document was praised by one of our health scrutiny committees: The

Committee commends the CCGs for producing a comprehensive consultation document

which provides members of the public with clear information about stroke, the case for

changing the way stroke rehabilitation services are offered, the different options being

considered by the CCGs, and their potential impacts.

Following the end of the consultation, a report on the findings formed part of a decision-

making business case that was considered by the CCG governing bodies. The decision was

made to implement the changes proposed in the consultation, and the implementation is

currently underway.




Quality of service

3.7. Other engagement exercises – ongoing

Commissioning intentions: Each of the CCGs carries out a local engagement exercise with

their local stakeholders. This involves presentations with the CCG patient forum, voluntary

sector colleagues and the local Health and Wellbeing Boards.

Transforming Care Partnership (TCP) Plan: this was the first year that we were required to

produce a transforming care plan. We led an extensive engagement process, and

commissioned external expertise to gain the views of learning disabled service users placed

out of our boroughs. We have also established specific participation groups focussing on

children with autism, learning difficulties, mental health needs and their carers

Children and Young People’s Mental Health Transformation Plan: With our local

authority partners we engaged a wide range of young people and interested stakeholders

through the boroughs’ youth fora, children in care councils, local youth groups, specialist

groups for disabled people to develop a plan that would deliver genuine transformation for

mental health services for this vulnerable group. This work is ongoing.

3.8. Procurements

We have listed a number of examples above, but patients are routinely involved in

procurements that the CCG undertakes, sometimes in collaboration with our BHR CCG

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partners and sometimes just borough based. Over the past year these have included:

anticoagulation and elective care services.

4. Meeting the Individual Participation Duty

4.1. Introduction

We are committed to empowering patients as we believe that they are best placed to make

informed decisions about the health provision that they need. We have led the way in BHR

with innovative and new ways of putting patients more in control and ensuring that provision

is more responsive and tailored to their needs. This picture below, our ‘Rich Picture’, which

clearly puts patients at the centre, was developed several years ago with clinicians, staff and

local patients. It was included in our report last year, but is still relevant now, supported

locally and presents a clear illustration of what we want to achieve that all can easily

understand.

Since becoming CCGs we have focused on developing innovative solutions to meet patient

needs. We have a directorate of innovation across BHR, led by a director with a track record

in developing creative and patient centred systems and making use of new technologies. Our

continuing health care and personal health budgets, along with all personalisation schemes

are managed through this team.

4.2 Specific activities

4.2.1 Continuing Healthcare (CHC) Survey

In early 2016, the CHC service began implemented new feedback arrangements for the

service, building on the current channels open to families. A feedback survey is now sent out

with and attached to all eligibility and non-eligibility correspondence. The survey results help

us to understand the family’s reaction to the process and gives an overall outlook on the

30

development of the service. The objective of carrying out these surveys is to ensure that we

learn from patient’s experience to help us to continuously improve the service. .

Activity: a survey is sent out with the eligibility letter which confirms the type of funding for

the patient’s care needs. The results are then collated and anyalzed, with the necessary

improvements made.

Who and how: the CCG’s Quality Assurance Team send out the survey to patients/carers,

collate the results and analyse the findings.

Outputs, impact and outcome: the results to date indicate that the majority of respondents

report an excellent/very good experience of using the service. The comments show that

there is a good understanding of the information communicated to patients and families by

the clinicians and other CHC staff. Resources such as the public information leaflet provided

to families for further clarification were regarded as very helpful. Most importantly the overall

feedback concluded that families felt well informed of the processes throughout and were

aware of the need for the assessment.

Some comments received back from the surveys:

“I found the process very confusing but the CHC nurse guided me through the assessment

and I felt that the nurse was reassuring in answering my questions which made me feel at

ease”

“In my opinion the engagement prior to the meeting was professional and I felt that I was

kept updated up until the review. The CHC staff were kind and considerate and I felt that I

was really listened even when I had so much to discuss”

Where there were comments suggesting a need for improvement we responded where we

could, for example there was feedback suggesting that our letter was not easy to understand

and included complicated terminology. To address this we reviewed the letter and made

simpler and far more user friendly.

4.2.2 Previous unassessed periods of care (PUPOC)

The objective was to implement a more patient focused approach for families to understand

how decisions and plans were being made in relation to claims in relation to their family

member. We did this because there had been a significant number of claims/appeals, and

we felt that by introducing a more family and patient centred approach, that we could reduce

these.

Activity: we added in the additional step of a face to face meeting for the family with the lead

clinician to talk through the decision making process and how the outcome of the decision

was made.

Who and how: the PUPOC lead officer led the process with the wider team, and the

meetings were established between the lead clinician and the families of patients

Outputs, impact and outcome: There were a high number of claims to manage and

process and since establishing the new system we have had only one formal appeal. This

outcome has demonstrated the additional face to face meeting to guide and talk families

through the decision making process is likely to have had a positive impact. Families have

told us that they welcome this approach.

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4.2.3 Personal Health Budgets (PHBs)

We have been committed to the personalisation of healthcare for some time, evidenced

through our previous role as a pilot site for personal budgets. We rolled out the offer steadily

in BHR but have rapidly increased uptake during the past financial year, with approximately

400 patients now in receipt of PHBs.

Our key objectives were to increase the awareness and availability of personal health

budges (PHB) to continuing healthcare patients and simplifying a process that is patient /

family friendly service to enable them to apply and receive their budgets as appropriate.

Activity: development of a streamlined application process. Introduction of by weekly PHB

panels to ensure a speedy decision making process.

The CHC team visits the families of the patient at home to discuss how the PHB works and

the benefits of the option, including the more individually tailored approach to suit their health

needs.

Who and how: the senior CHC team and a dedicated personal health budget commissioner.

We have partnered charitable organisations to deliver the independence of support to

families.

How: to review visits as required. Ensure that patients have been informed and have been

made aware of the information provided to them.

Outputs, impact and outcome: to date we have a significant number of patients / families

now managing their own health budgets (over 40 this year), which increases their

involvement of care and thus has a positive outcome overall.

4.3. Implementation of new technology to support personalisation

We recognise that technology and effective use of data can support health professionals to

better understand and support patients. In BHR we have pioneered the development and

use of new systems that support health and social care staff to target and help patients who

require the most intensive support. The system has a simple, user-friendly interface that

enables staff to view a patient’s record with information from the key settings across

providers – such as urgent and emergency care use. This supports consistency of approach

to care and means that patients do not need to continuously repeat their story – something

which they have told us is frustrating.

4.4. Health 1000 - The Wellness Practice

Through our successful bid to the Prime Minister’s Challenge Fund, we established a pilot

new GP practice called Health 1000, for complex care patients who with five or more long

term conditions. We talked about this in our report last year. The Nuffield Trust has been

evaluating the impact of Health 1000 and our wider personalisation projects, with positive

progress demonstrated.

Patient feedback is continuous and there has been engagement of patients and staff from

the outset. Friends and Family surveys have delivered high response rates (60% in July

2015) and an 86% approval rating. Many comments were included in the responses to

surveys and the following themes emerged:

Good amount of time available with doctors and other professionals in the team

Staff being friendly, approachable, respectful, kind and listening

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Staff being proactive with phone calls and not just waiting for patients to contact them

Highly personal and tailored service

Other patient engagement events have been organised in partnership with Age UK and the

Redbridge Institute for Adult Learning – for patients to be introduced to a range of other

services such as IAPT, hearing impaired and carers’ groups to name a few. A separate care

plan group was set up for patients to feed into the development of a more bespoke care plan

system.

4.5. Holding our providers to account

We have responsive providers keen to innovate and try new approaches. However as

commissioners we have a responsibility on behalf of patients to review and hold our

providers to account for the services that we commission. We do this through Clinical Quality

Review Meetings (CQRM) every month with our providers, where results of surveys,

complaints etc are reviewed and further assurance or action is sought where required. We

also conduct unannounced visits, sometimes with our lay members, and also review the

findings of local Healthwatch enter and view visits.

Care plans – we have a long-established approach to integrated case management (ICM) in

BHR. To ensure that patients benefit from the multi-agency and joined up approach to

overseeing their health and care needs we have identified KPIs with incentives in the

contract for our community services provider, NELFT. We conduct an audit of care plans for

each BHR CCG regularly to check that they are complete and that it is clear that the patient

and/or carer has agreed the plan.

There are a number of examples of what we did in response to issues raised and

suggestions over the past year – see below:

Maternity: patients and staff were finding that opportunities to remind patients about test

results and other follow up activity were being missed, due to the fact that expectant mums

‘own’ and carry their notes. To address this, the team decided to introduce a sticker to add

to the front of the notes indicating whether urine or other test results were due – this meant

that health professionals and the expectant mother were able to speedily chase up and

receive results in a more timely way.

Dementia: there was feedback from patients and carers that staff at the local trust were not

always sensitive to the needs of dementia patients. To address this dedicated and trained

staff have been introduced to help improve the patient experience.

Mental health crisis: patients, GPs, organisations and carers told us that the arrangements

for access to rapid services were confusing. There were different names according to each

borough and the pathway/access was inconsistent. To address this a simple, standard ways

to respond to need and a common name was introduced across the service by the local

mental health provider.

5. Forward Plans for 2016-17

5.1. Our focus for the coming year

We are proud of the work that we have done in 2015/16 and have been building on what

we’ve put in place in this year, 2016/17.

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Our new patient, carer and public engagement strategy gives us a sound foundation on

which to build for the next three years. The plan includes a detailed action plan, setting out

the steps we need to take to deliver our objectives.

We will re-run our training programme for patient representatives across BHR. The

sessions cover a range of areas, such as the commissioning cycle, procurement and

quality improvement. The programme is intended to inform and empower members to

further understand and engage in the commissioning process.

Our annual CCG awards continue to recognise the contribution that patient representatives,

CVS colleagues and NHS staff make, with categories for patient champions, patient focus

and engagement.. The awards generate much interest and are a positive way to celebrate

achievement in effective engagement. We are exploring the opportunity for a wider BHR

awards, which will not only be more efficient, but which will better share the good practice

and contribution across all three boroughs.

6. Healthwatch Statement

The BHR CCGs maintain good relationships with our local Healthwatch organisations and we welcome the perspective that they bring. All were asked to contribute to the development of our engagement strategy over the past year, with some completing and forwarding on the online survey to members, taking part in some of the focus groups and/or attending the wider event open to all.

Our primary care team meet quarterly with the leaders of all three Healthwatch groups. During these meeting colleagues discuss what’s happening both nationally and locally, APMS procurements and the primary medical services (PMS) review. The primary care team have also started discussions with the three Healthwatches with regard to doing some joint work around customer care training for practice staff.

Statements from each of the local Healthwatch organisations are included within the section below.

Healthwatch Barking and Dagenham Statement6.1

CCGs’ engagement with Healthwatch Barking and Dagenham

The relationship between BHR CCGs and Healthwatch has strengthened this year. We have worked closely, in researching the needs of local people around some of the core services. This has either been commissioned work, working in collaboration or direct results of Healthwatch projects. There have been a number of steps BHR CCGs have taken to understand the needs of those accessing the services they commission.

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Examples of work include:

Urgent care research

Healthwatch Barking and Dagenham, Redbridge and Havering were commissioned to be a part of reviewing the urgent care services. The objective of the research was to gain a better insight into local people's understanding of what urgent and emergency care services are, what is available to them, and why they have chosen a specific service in the recent past. Working alongside BHR CCG each Healthwatch undertook engagement in their local boroughs and in total engaged with over 1000 people. This included one to one questionnaires and focus groups delivered to different groups. At the same time the CCG contacted 3000 people and undertook telephone interviews.

The main findings of research found that, there is confusion over where people should go to access urgent care, of those who sought advice from an NHS source, 87% said the advice was to go to A&E. A&E is seen as a reliable 24/7, same-day service for urgent care needs - long waits are not a deterrent.

The research has influenced the co design model of urgent care. It proved to be successful in making the voices of local people heard.

Phlebotomy project

Healthwatch Barking and Dagenham were shortlisted for a national award that celebrates the difference local Healthwatch have made to health and social care in the past year. They were shortlisted for the work undertaken on phlebotomy services. Recommendations were made to the CCG and BHRUT and NELFT.

The results worked well, due to the commissioners responding to the needs of the local community and implementing some changes and suggestions made by local people through Healthwatch Barking and Dagenham.

Meetings

A Healthwatch Officer has continued to attend the Patient Engagement Forum regularly. The forum is a base to share local intelligence with regard to patient experience and public opinion. Both the Healthwatch Contract Manager, Barking and Dagenham's Chief Operating Officer and CCG lay representative also continue to meet on a regularly basis.

Commissioning priorities

Healthwatch Barking and Dagenham hosted an event to give local people a say on the Clinical Commissioning Group's plans for 2016/2017. The event was informal, allowing people to learn about services that showcased the CCG's priorities for the coming year and tell the different services what they think. It was also an opportunity to seek views about CCG priorities and how the CCG can improve services offered in the borough.

Stroke rehab consultation

Healthwatch Barking and Dagenham were one of the stakeholders who were sent a draft of the BHR CCGs consultation document about proposed changes to stroke rehabilitation services. The idea was to receive contributions and suggestions in the development of the document to ensure the general public can have a clear understanding of the recommendations and the reasons behind this. Healthwatch Barking and Dagenham contributed to the changes that were made to the initial draft.

BHR CCGs’ engagement strategy

Healthwatch Barking and Dagenham’s Board were asked to give their views on what should be included BHR CCGs engagement strategy. Healthwatch representatives also attended the stakeholder event where the main themes of the findings were presented and discussed.

6.2 Healthwatch Havering Statement

A key part of our role at Healthwatch Havering is engagement. We are passionate about this responsibility, listening carefully to people, recognising that by empowering and informing people and working in partnership with other members of the health and social care community the opportunities that are created for residents are vastly improved.

During 2015/2016 we have worked with the BHR CCGs on a number of projects aimed at engaging and informing our residents. We have a collaborative relationship with the CCG which keeps the debate positive and together we work hard to get things done.

We have been involved in a number of engagement opportunities during this year, some massive ones such as “How do we transform urgent and emergency care to meet the needs of our residents?” and some more simple ones such as the Stroke Rehabilitation consultation.

Urgent and Emergency Care: As we began this engagement we promised the residents that this would be an on-going debate for which they would always be a part of and with the opportunity to influence the services.

We have worked with the CCG in supporting a range of events that has allowed local residents and the voluntary sector to become involved in understanding the challenges facing urgent and emergency care services in our borough.

The events placed the greatest emphasis on listening – this included highlights of what worked well and importantly, not being afraid to hear when it was pointed out by residents – where things had gone wrong or did not meet the needs of patients and carers. The events had good simple graphics and there was always feedback information for people who attended.

This engagement has brought together a network of organisations and individuals and built a firm platform for the continued involvement of local residents on such an important service.

Stroke Rehabilitation Service: Another example of our engagement with the CCG has been with the Stroke Rehabilitation Service. From the outset we were part of designing the process, this included being able to influence the questionnaires, seeking reassurance that all staff across the pathway would be able to share their thoughts and ideas on how to improve the service and that the service model would ensure best practice and be subject to monitoring during and after implementation.

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Engagement Strategies: Early in 2016 we were invited to be part of a workshop

‘Developing Strategies for Patient and Public Engagement’. This workshop brought

together over 50 people from very diverse backgrounds, it provided a real opportunity to

think ‘outside of the box’ on how we develop engagement strategies.

The workshop sought to understand how we engage innovatively and creatively in order to

be able to really enable residents, particularly those most vulnerable in our community to

have a voice.

6.3 Healthwatch Redbridge Statement

We continue to work closely with our colleagues in Redbridge CCG this year. Amongst other

engagement work, we would highlight the areas below as being of particular importance:

Stroke Rehabilitation Consultation: We were invited to be actively involved in the pre-

consultation review of stroke services in Redbridge. We found this to be an effective

consultation with input from many voluntary and community groups working with stroke

survivors. We held our own independent meeting to enable us to respond to the consultation.

Our response echoed the publics’ view that the consultation had a positive impact on local

people.

Urgent and Emergency Care: Working with our Healthwatch colleagues in Barking and

Dagenham and Havering we were commissioned by BHR CCG’s to identify and engage with

users of local urgent and emergency services to identify their reasons for using each service.

Within a very short timescale (less than four weeks); we jointly interviewed almost 1,000

individual patients and carers, held 10 focus groups and visited a number of GP hubs across

the three boroughs.

Accessible Information Standard: We have been actively promoting the new standards for

accessible information and have been pleased to involve BHR CCGs in our work this year.

They have supported us to engage with all GP Practices and have actively promoted our

work. We continue to work closely with the CCG in ensuring the positive promotion of the

standard. BHR CCGs supported us to run a work shop for Practices across the three

boroughs attended by 70 practice staff in July.

Over the year the CCG has been developing its engagement strategy. We have been

engaged as part of the Patient Engagement Forum although we would hope to have seen

more community engagement taking place around this strategy. We sometimes feel there is

an over-reliance on the PEF as a single source of engagement.

Although we have been promoting the IAPT campaign; our work programme has not

allowed us to take a more active role however we have continued to report any

developments

We play an active role as a non-voting member of the Redbridge CCG Governing Body and as members of the Primary Care Transformation Board and Primary Care Co-Commissioning Committee. We have continued to act independently, to both support and challenge the CCG in its work to ensure local people’s views are taken into consideration when commissioning local health services.

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