integrated community services feedback from public … · 2016-05-05 · 1 integrated community...

1

INTEGRATED COMMUNITY SERVICES

Feedback from Public Engagement Event

Dorchester and surrounding area 23.03.16

INTRODUCTION

In response to the need to co-design integrated community services with local people a series of 9 public engagement locality based events (supported by a virtual/online engagement opportunity) were held in March and early April 2016. This is an important stage in on-going engagement or participation work in Dorset – with a vital local community focus. OVERVIEW OF THE EVENTS

The initial focus of each event was to listen and learn from local people, with lived-experience and knowledge of each area, exploring what they felt we need to consider when developing health and care services in their particular area of Dorset. A presentation was then given explaining:

Why health and care services need to change

What has been done so far and

Introducing some emerging ideas for improving health and care in the community.

Attendees were then invited to review information on the vision for community services and emerging ideas in greater detail. This was done through an interactive ‘walk-through’ of information posters displayed on a series of boards. Staff were on hand to answer questions and local people were invited to capture their views on colour coded post-it notes on the posters - reflecting on a) what they felt is good/positive about the ideas/proposals and c) what they feel should be given consideration/any concerns or questions they might have. This methodology was developed in response to feedback from local people about having shorter presentations, more time to review and consider information presented and the opportunity for all attendees to provide feedback. The day after each event all of the posters were displayed online with an electronic survey to enable other people to provide their views. FEEDBACK FROM EVENT ONE

On Wednesday 23 March 2016 the first ICS public engagement event was hosted at the Dorford

Centre in Dorchester.

47 members of the public attended this event.

This paper pulls together all of the feedback provided at this event. 280 pieces of feedback were

provided at this event.

2

A synopsis of the feedback is provided within the main body of this report and all feedback (as

captured by attendees) is listed in the appendices.

Feedback is provided in two sections:

Section One: What we need to consider when developing community health and care services in

Dorchester and the surrounding area.

Section Two: Feedback on ICS information displayed in the information ‘walk-through’.

SECTION ONE: WHAT WE NEED TO CONSIDER WHEN DEVELOPING COMMUNITY HEALTH AND

CARE SERVICES IN DORCHESTER AND THE SURROUNDING AREA

Attendees were asked to give consideration to the following question:

“Based on your local knowledge and experience please tell us what you feel we need to consider

when developing community health and care services in Dorchester and surrounding area?”

This was done individually in the first instance, with attendees capturing their thoughts on pre-

prepared feedback cards. Attendees then discussed their thoughts with others and feedback was

shared with everyone at the meeting, to provide a collective sharing of emerging priorities within

the local community.

All of the feedback collected has been collated and themed to ease interpretation. A number of the

themes are not mutually exclusive and there is a degree of overlap which should be considered

when interpreting and responding to the feedback. To provide consistency across the 9 event

reports themes are listed in a set order, rather than in order of strength.

As mentioned above, a synopsis of the feedback is provided below with all feedback (as captured by

attendees) listed in the appendices.

Synopsis

Prevention/Education

A strong theme to emerge was the importance of giving consideration to preventative care and

providing patient education to support this. There was an interesting suggestion that patients be

used to ‘educate’ fellow patients and the need to educate the general public on what services are

for – to set expectations, was also noted.

12 comments of this nature were received.

Integration of Health and Care services

There was strong recognition about the importance of joined up or integrated care. Many attendees

advocated the need for joined up services and plans across health, social care and the voluntary

sector, across organisations, across primary and secondary care and across physical and mental

health.

18 comments received

3

Community Hospitals

There was some support for community hospital provision in the area, particularly for the care of

patients discharged from an Acute Hospital. Some comments complained about the need to send

patients out of the area to recover in community hospitals elsewhere, e.g. Bridport, Wareham and

Swanage.

9 comments received

Community Services

There was strong support for the important role of community services and care at home to enable

discharge from acute hospitals, relieve pressure on acute hospitals and support re-ablement. The

provision of services in a community centre or hub was also mentioned. Some contributors asked for

a greater breadth of community services to be developed i.e. pain clinics.


Care closer to home

There was good support for delivering a wider range of services closer to patients’ homes. Some felt

that travelling to Poole/Bournemouth for minor outpatient operations and some services was too

far.


Service availability/7 Day services

Some feedback supported access to GP, community services, and MIUs across 7 days, particularly for

working people.

9 comments received

Access to services

Excessively long waiting times, overly complex referral procedures, and disability access (physical

and learning disability) drew comments in this area.

7 comments received.

Mental Health – Adult

Underinvestment in Mental Health services, lack of provision, and accessing those that were

available attracted comments. There was support for ensuring that physical and mental health

should be regarded as equally important and that services to treat both should be more joined up.


Children and Young People

Attendees stressed the importance of ensuring accessible children’s services, including physical and

mental health and also education regarding available services and life styles choices.

4

7 comments received

Voluntary Sector

The meeting reflected the important role that the voluntary sector has to play in the provision of

integrated community health and care services. A variety of roles were mentioned including helping

to provide support on discharge and at home and providing support and self-help services.

6 comments received

Transport & Parking

Many people were keen to emphasise the difficulty some patients had in reaching their

appointments because of transport problems. The availability of public transport, un-serviced

routes, the problems encountered by the elderly when using public transport, and particularly

rurality all drew comments.

25 comments received.

I.T/Technology

There was strong support for shared IT systems to improve access to records and care plans. One or

two people also referenced the ‘use of technology’ generally in community health and care

provision. One person was keen to mention that some elderly people do not have or are unable to

use technology support.


Staff and staff training

A number of pieces of feedback related to ‘workforce’ of staff issues. It was recognised that staff

availability, recruitment and training is important in providing community health and care services.

The difficulty of recruiting staff to care roles drew particular comment.

9 comments received

Geography, Demography & Diversity (Service planning/Demographics and Age related concerns)

Attendees advocated the importance of considering Dorset’s existing and emerging demographic

profile to include new housing growth and an older population, when planning for community

health and care services. The importance of giving consideration to Dorset’s geography (rural vs.

urban) and diversity, including hard to reach groups was also mentioned.


Other comments

Other comments relevant to community services were also received in the following areas

GPs/ Primary Care services – use as hubs, quicker appointments. 3 comments

Mental Health – Children and Young People – CAMHS. 1 comment.

5

Carers – listen to carers. 1 comment.

Communication - Engagement with the public and patient groups and making information

available to patients. 6 comments.

Funding Concerns - Financially incentivise GPs. Where is funding coming from for ICS? 7

comments

Disability/Respite – Difficulty in accessing. 1 comment.

Specialist care – Support for centres of excellence. 1 comment.

Acute Hospitals – Excessive waits for appointments. 1 comment.

Pharmacy services – Increase opening hours. 1 comment.

General Comments and Quality of Service – Political interference in NHS. 3 comments.

6

SECTION TWO: FEEDBACK ON ICS INFORMATION DISPLAYED IN THE INTERACTIVE INFORMATION

‘WALK-THROUGH’

After receiving a presentation on integrated community services attendees were invited to review an interactive ‘walk-through’ of information posters displayed on a series of boards. Staff were on hand to answer questions and local people were invited to capture their views on post-it notes reflecting on a) what they felt is good/positive about the ideas/proposals and c) what they feel should be given consideration/any concerns or questions they might have. The series of posters displayed information in the following areas:

Our Vision: Our vision for community health and care services – as informed by local people

– including what this would mean for local people, workforce and systems and the

importance of prevention, joint working, better access and IT.

Local Views: Local people’s views on community health and care services captured in 2013-

14 and in 2015.

Emerging models: The fact that different people have different needs requiring different

models of care and some emerging models that might meet these needs.

New ways of working: Examples of new ways of working that are already happening,

integrating community health and care services

Community vanguard proposals: Proposals and emerging ideas from community vanguards

– groups of GPs and other service providers looking at how the emerging vision might be

met locally.

Service specific information: Service specific information in a number of areas including

mental health, maternity, paediatrics and blood services.

Local voices matter: Comments from local PPEG members about why local voices are so

important.

The feedback captured on the posters largely reflected the themes identified in section one.

Positive comments were generally in support of the vision for integrated community services, the

emerging models of care and other information displayed (as described above).

Concerns tended to reflect those captured in section one.

The amount of feedback on each poster doesn’t lend itself to ‘theming’ – for comments on the

individual posters collected at this event please see Appendix 2.

Feedback on the posters has also been considered across all 9 locality based events and a more

detailed analysis is provided in the overall report – available to read on

www.dorsetccg.nhs.uk/events.

http://www.dorsetccg.nhs.uk/events

7

NEXT STEPS

The ICS Steering Group, together with NHS Dorset CCG’s Engagement and Communication Team, will

work with colleagues and partners to coordinate the following:

Individual reports for each event and a ‘master’ report to be shared with health, care and

voluntary sector partners, Clinical Working Groups, Clinical Delivery Groups and Community and

Acute Vanguard Programmes.

Local views provided within the reports to be used to inform emerging models of care.

Frequently asked questions will appear on NHS Dorset CCGs website.

Suggestions made within the reports to be shared with appropriate groups or organisations.

Feedback, on how people’s views are used and responded to, to be shared with attendees and

other local people through the CCG’s “Feedback” bulletin and website.

Local people to be informed of further opportunities for engagement prior to public

consultation.

For further information or if you have any questions please contact

[email protected]

mailto:[email protected]

8

APPENDIX ONE

SECTION ONE: WHAT WE NEED TO CONSIDER WHEN DEVELOPING COMMUNITY HEALTH AND

CARE SERVICES IN DORCHESTER AND THE SURROUNDING AREA

Prevention/Education

Need to build up services that keep people well.

Prevention. Education.

Good access to information about preventative measures.

Prevention – keeping people out of hospital and especially A&E.

Education to reduce the incidents of malnutrition and pressure sores.

We still have high incidents of malnutrition and pressure ulcers in the community – what is

being done to improve the situation?

Self-help for those who can (to help reduce pressure on direct services).

More community education for patients.

If patients had knowledge that was up to date they could better manager their conditions.

Patient education of long term conditions to be paramount as the more patients know of

their condition will impact on cost of complications resulting from a patient having a poor

understanding of their condition.

Need to use patient’s themselves to ‘educate’ fellow patients.

Public education – what services are for, need to set expectations.

Integration of Health and Care services

We need to support GPs better to look after people in their own homes by integrating

health, social care and voluntary sector support.

Cross sector partnership using agreed systems and processes.

Integration of social/community service with health care including Mental Health

Link health with social care.

Integrate all service providers and do away with splits of no DHC, CCG, NHS, Public Health

etc. – just one organisation.

More integrated care.

Integration with non-clinical support services to help people in the community.

Struggling social care, shortage of social workers and caregivers – need to integrated with

health.

Need to ‘joined up’ and co-ordinated services.

Linking up services so they are coordinated and appropriately signposted.

GPs working collaboratively with all health and care professionals.

Make it easier to have specialist care/support/advice in a joined up way.

I would like multidisciplinary teams to treat patients with multiple conditions e.g. stroke,

heart disease, diabetes, podiatry and kidney disease.

Standardised care pathways so not so much variation between people’s experiences when

accessing services.

Joined up planning with acute – to make positive impact on delayed transfer of care stats.

9

Social care assessments to be done in conjunction with other professionals so join up – esp.

for people with long term conditions.

Developing relevant and accurate care plans for my coordination.

Continuity of care.

GPs/ Primary Care services

GP surgeries – use as hubs, pharmacies in rural areas, no or less travel for patients.

Quicker access with my GP as she’s part time and on average takes 3 weeks to get an appointment. Could we have e-mail consultations similarly used in the North of England?

Quicker access to GP reminders for diabetic checks, more diabetic education.

Community Hospitals

As Dorchester has no community hospital should we not have a robust 24 hour care service

instead of sending people to Wareham/Swanage?

There is no “community” hospital in Dorchester so these services could be provided some

distance from home.

Don’t cut community hospitals and/or don’t send patients from DCH to Bridport Community

Hospital to recover from Major Op at DCH – it happens at present and shouldn’t –

Dorchester/area needs a community hospital as well as its acute DCH.

Maintain local community hospitals to help with access e.g. Bridport etc. to ensure no one

has to travel to Bournemouth.

The assets we currently enjoy – community and district hospitals. Local expertise.

Community Hospital for Dorchester?

Local community hospital services for rehab/hospital avoidance – freeing up acute hospital

beds.

Use community hospitals for convalescence, moving out of hospitals – short term care.

Keep local hospital provision local not 30 miles away.

Community Services

Bring back true convalescent homes – I feel it would reduce bed blocking – a half way home before going home.

Community resources/services

Reablement services are very effective and should be maintained.

Community support to enable elderly people to maintain their independence or return

home from secondary care more quickly.

Need for community physiotherapists to relieve pressure on hospital services.

All services to be available at community hubs.

Availability of drop in centre for non-urgent medical problems like Weymouth Hospital –

need to have something similar in Dorchester – rather than go to A&E.

People helped to stay in own homes for treatment.

Need to promote more for individuals to remain in their own home rather than hospital

admission.

Longer visits for elderly visits in domiciliary care.

Care taken to home.

10

Ensuring that when people return home from a hospital stay they have someone in place to

welcome them and settle them back into their homes.

Finding and establishing a service that can support people when they are discharged from

hospital before reablement starts.

How to help people get home after being in hospital with the care they need.

Interim care to enable early discharge from hospital.

Follow up transition back home following hospital stay.

Social care workers need to be able to spend more time with their clients.

Funding for osteopathic services has been cut from the local GP so is no longer available on

the NHS – surely this would be cost effective and save money on other things.

Ability to refer on when appropriate – BUT only after as much care as possible is done

locally.

Are you aware of the Magnas Housing support officers have been decreased from a Support

Office to two Courts – now reduced to 8 for the whole of Dorset and North Devon – so may

impact on NHS Care Services. Residents very unsettled by these discussions. So therefore

may impact on your funding! No access except for 2 residents to computers – the older

people cannot understand IT and have no interest in being taught.

Pain clinic services nearest o home i.e. pain injections and consultations.

Care closer to home

Distance to nearest services reflecting the rural nature of the area. Rationalisation to focus

on services to meet community needs.

Too many services are NOT available locally: Poole/Bournemouth are too far away for many

services e.g. short-stay/outpatient operations.

Having sufficient health and care services in appropriate places that people can access easily.

Care closer to home – outpatients in Community MIU.

Care closer to home.

Geographical – service to be distributed where possible so as close to home as possible.

Ability to refer on when appropriate – BUT only after as much care as possible is done

locally.

Pain clinic services nearer to home i.e. pain injections and consultations.

Continuation of Warfarin clinics nearby.

Treatment for pain available locally not at Blandford.

Radiotherapy should be available locally not entail constant difficult trips to Poole.

Keep local hospital provision local not 30 miles away.

Service availability/7 Day services

7 day a week access to GP services. Patients with long term conditions are often using their own personal leave.

GP hours and pharmacies – increase – especially over holiday periods.

GPs need to be open longer so working people can visit and not take time off work.

Quicker access with my GP as she’s part time and on average takes 3 weeks to get an appointment. Could we have e-mail consultations similarly used in the North of England?

Better access to GP services at weekends and evenings.

11

Times when community services are available.

Accessibility to minor injuries units over weekends.

Extra hours during evenings and weekends to prevent people having to go to A&E.

Excessive waiting times at hospital for elective treatments – meaning that normal life is put ‘on hold’ for a year or more from GP referral to final outcome.

Extension of pharmacy and GP (primary care) services.

Access to services

Making it easy to access the service you need – simple. Too complicated at the moment.

Lack of inclusive accessibility e.g. for a great number of people in addition to the 20% of approx. officially ‘disabled’.

Ensure that all services are accessible – not only physically but also from a communication point of view – e.g. easy read, dementia friendly.

Deal with waits for physiotherapy.

Podiatry treatment referrals are difficult to obtain as the referral form is overly complicated.

Quicker appointments for skin cancer.

Mental Health – Adult

Access to acute services for mental health.

Underinvestment in mental health services.

Better access for people with mental disabilities.

More mental health services/support – better assessment for those at suicide risk.

Mental health services are very different to the promises made when beds were closed.

The crisis team and the home treatment team have 4 people covering an area from Lyme

Regis to East Dorset.

Mental health is as important as physical health.

People who have severe mental and physical health problems receive support for one or the

other but not for both, they need proper assessments of need.

Physical and mental health to be looked at as a whole.

Having closed mental health units – care in the community has to improve.

Holistic approach – joined up physical and mental health services.

More support for mental health.

Better provision for mental health care.

All professionals having some awareness and understanding of dementia.

Specialist day hospital service and local respite for people with dementia or other high risk

care needs.

Standardise access to learning disability resources like Yellow Health Books and East Read.

Reasonable adjustments for people with Learning Disabilities e.g. short waiting times quiet

clinics.

Mental Health – Children and Young People

Follow up services – especially CAMHS.

Children and Young people

12

We must work with the children and young people to ensure they have access, in a format

they need, to physical health/emotional health services to prevent them becoming unwell

and living healthy lives.

Services provided locally – children’s services especially.

Good choice of services for children at their school so they don’t miss lessons.

Communication with young people on existing services available to them.

Work with schools and colleges to develop ideas.

Educate children at young age to lead healthier life styles and prevent problems in later life

(Diabetes and blood pressure).

All Primary aged children should have annual access to a visit from Life Education – helping

children make health choices. www.lifeducationwessex/org/uk Mobile classroom visits

schools.

Voluntary Services

Appropriate referrals to outside agencies like Wayfinders to get help arranged for patients

being admitted to hospital so that things are in place ready for when they are discharges.

Holistic provision such as health coaching via 3rd sector – can help people access services

more readily.

Voluntary sector/3rd sector.

To consider the services available from the voluntary sector currently being delivered in

other areas and not Dorchester. E.g. assisted discharge Poole Hospital. Support at Home –

Poole area – delivered by the Red Cross.

More joined up thinking with the voluntary sector e.g. linking with Walking for Health

Groups – which are free. Why don’t GPs prescribe this sort of thing – i.e. Walking for Health

or Phyios the same. The Health Services don’t exploit what’s out there.

Re-establish Friends of the Hospital who can bring people to hospital and maybe use them

to support people on discharge

Carers

The professionals should ‘listen’ to the caring family members of elderly people.

Transport & Parking

The surrounding area is very rural – with poor transport. We must take as many services as possible to patients in their own home, local GP practice or community facilities.

Ensuring transport is available to enable patients to access services.

Transport/accessibility.

Transport to services.

Transport.

GP is good although public transport access is limited.

Dentistry – very good, though difficult to access by public transport.

My neighbour can’t walk to pharmacist or GP and has no car.

Accessibility it you don’t have transport or the condition doesn’t allow you to drive especially if specialist hospital is in the east e.g. concern treatment in Poole.

Accessibility – transport/time vs availability of services.

http://www.lifeducationwessex/org/uk

13

Transport – particularly to and from villages.

Transport.

Access to transport – in Mid Dorset rural patch.

Transport for the elderly/disabled.

Transport – public, community based/volunteer.

Service to be on transport routes.

Services to be on good public transport routes.

Access to transport.

Availability of good local transport. Bus services are being reduced or stopped on a regular basis.

Availability of transport - in particular local bus services.

Transport in isolated communities – reduced bus services for example will cause problems.

Safe roads (supporting motorcyclist) in conjunction with local authorities.

Remember bus passes cannot be used before 9.30am.

Centres of excellence preferable even if it means travelling.

Parking problems at hospital when you need to get seen. Is there something that can be

done to ease the cost. Extending parking facilities into Damers Road should move to

Poundbury.

I.T/Technology

Information sharing across agencies.

Records on computer so can be accessed from anywhere if admitted as emergency wherever you are in the country.

Electronic documentation/medical history to aid continuity.

Electronic medical notes and history so it’s more accessible (for walk in appointments and locums).

Have shared IT systems/person held records.

Communication – all IT systems need to be able to communicate. Patients need care plans that are detailed and form a contract between HCPs, patients and carers.

Having consistent history of my health available wherever I attend in the county.

Avoid over reliance on electronic communications.

Use of Technology.

Better use of mobile technology.

Are you aware of the Magnas Housing support officers have been decreased from a Support Office to two Courts – now reduced to 8 for the whole of Dorset and North Devon – so may impact on NHS Care Services. Residents very unsettled by these discussions. So therefore may impact on your funding! No access except for 2 residents to computers – the older people cannot understand IT and have no interest in being taught.

Communication

Lack of information need to explain – what is Dorset Healthcare?

More support and advice for epilepsy for newly diagnosed patients.

A proactive Patient Participation Group (PPG) as the one I joined in November (inaugural

meeting) has not met since due to the practice having another GP practice passed to them

(Crossways has now taken on Broadmayne patients).

Are you aware of the Magnas Housing support officers have been decreased from a Support

Office to two Courts – now reduced to 8 for the whole of Dorset and North Devon – so may

14

impact on NHS Care Services. Residents very unsettled by these discussions. So therefore

may impact on your funding! No access except for 2 residents to computers – the older

people cannot understand IT and have no interest in being taught.

Quicker access to GP reminders for diabetic checks, more diabetic education.

To be consulted when proposed changes are being considered by the CCG re prescriptions

for people with coeliac disease.

Staff and staff training

Staffing – training and availability.

Available staffing.

Keep health providers on board – the Government has already alienated junior doctors so

that the service they provide will be reduced. Don’t let this happen with pharmacists and

other services.

Staff education that need to be updated at 2-3 yearly intervals. Medicine moves forward at

an alarming rate, treatment changes.

Availability of affordable housing thus enabling recruitment of good quality staff.

Employ enough staff of all disciplines to give adequate care.

Non-qualified (care staff) from both health and social care should both receive same training

– become more generic.

Ensure that all services are accessible – not only physically but also from a communication point of view – e.g. easy read, dementia friendly.

Better understanding of coeliac from GPs.

Finding and training more carers in communities that might not be accessed by the agencies.

This is particularly needed in rural areas.

Geography, Demography & Diversity

The longer term future growth that will take place in the area, esp. population growth of

Dorchester and Weymouth (housing growth). I work for the Dorset Councils Partnership

planning for the long-term growth of the area. Building in consideration of growth into

future health service provision is important. We should be engaged in you planning process

(growth = population/housing) and you in ours! Please e-mail me at………….

Planning for ageing population.

Increasing elderly population.

Demographics.

Population profile – age and health (set basic need).

Population distribution relative to core services – enable flexibility to balance services

relative to point of need (does not always equal demand!).

Pockets of deprivation.

The age structure of the population and actual trends of the population.

Hard to reach groups.

Consideration of those living further afield (Lyme Regis) – availability of Devon/Exeter provision. Rural Vs Urban

The difference between urban and rural e.g. rural isolation, transport links.

15

Funding Concerns

Focus and encourage the local authorities to fund more care from the council for vulnerable

people who need help. Council tax precept for social care is far too small.

Charge people who don’t turn up for appointments.

Funding.

Available funding.

How are these improved services to be adequately resourced and funded?

GPs are given incentives to target certain groups at various times – is this economically

viable or effective?

Remove ‘internal market’ and make NHS a proper ‘public service’.

Disability/Respite

Respite care for older relatives e.g. dementia is difficult to organise and of very variable

quality.

Specialist care

Centres of excellence preferable even if it means travelling.

A & E

Acute Hospitals

Excessive waiting times at hospital for elective treatments – meaning that normal life is put ‘on hold’ for a year or more from GP referral to final outcome.

Pharmacy services

GP hours and pharmacies – increase – especially over holiday periods.

General Comments and Quality of Service

Make care plans routine – hardly anyone has them despite NICE/NHS England guidance.

Political interference in service provision.

Interference from the EU and transatlantic trade provision.

16

APPENDIX TWO

SECTION TWO: FEEDBACK ON ICS INFORMATION DISPLAYED IN THE INTERACTIVE INFORMATION

‘WALK-THROUGH’

The feedback provided for each poster that was commented on is listed below. To view all of the

posters displayed at this event visit www.dorsetccg.nhs.uk/events

Our vision for community health and care services in Dorset – as informed by local people

Positive comments:

Agree – good idea!

Concerns, questions and suggestions:

Blue sky thinking is great – but who is assessing how money can be saved?

Balance clinical care with quality of life.

Set expectation level early on – please don’t let people believe that there is an ‘entitlement’

to any level of service they want!

There isn’t an unlimited pot of money.

For people that don’t have family to support them and who cannot speak up for themselves.

A strong advocacy service that will speak up for them. Often families feel that they are left

out of the picture in the care planning.

http://www.dorsetccg.nhs.uk/events

17

Our vision for community health and care services in Dorset – health and care systems


Does health and wellbeing services = health and social services?

When people are looking for the information they need they should consider using

Wayfinders who are a one stop shop for all things and will respond very quickly to a referral.

18

Our vision for community health and care services - workforce

Positive comments:


Community work can be professionally isolating. Need to link to senior and specialist

colleagues + time for training/updates to get research to frontline.

Why not joint funded training for care workers so that you don’t have NHS staff having to

visit to open medicine bottles.

19

Our vision - Working better together

Positive comments:

Very important.

Essential.

Concerns, questions or suggestions:

Need to link health and social care.

It should become an action to have a physical health community team that has a social

worker.

Enable self-care where possible – ‘support’ should enable as high a level of independence as

possible.

The split between physical and mental health treatments is becoming out-moded. Will need

to have access to clinical psychology.

Little evidence of wanting to work with voluntary sector. Reluctance to provide funding for

voluntary sector.

20

Our vision – better access to services

Positive comments:


I can’t believe that the move towards 24/7 services is cost effective.

Take public transport into consideration.

Vision? But what about those with sight issues – most of which can easily rate as needing

urgent treatment but which in Dorset West can mean a requirement to get to conurbation

appointment first thing and when patients can’t drive due to sight!

Care closer to home must include acute care – as with all the joined up thinking – eventually

people do get really ill and need acute care.

This is good but consider using community events to administer appropriate outpatient

services like flu jabs or INR clubs. The Giant Social at Cerne Abbas has a flu clinic once a

year. Having services in communities means not having to go to hospital or surgeries and

can encourage social interaction which is good for wellbeing.

21

Our vision - prevention


Prevention needs to start as young as possible. All Dorset children should have an annual

visit from Life Education mobile classroom visits school programme for aged 3-11. ‘Harold

the Giraffe’ www.lifeeducationwessex.org.uk .

Make sure patients are properly educated about any long term condition they have.

Dorset POPP will support initiatives to keep people health and fit.

Perhaps nurses should lead by example.

Suggestion to reduce isolation – INR clubs/luncheon clubs.

http://www.lifeeducationwessex.org.uk/

22

Our vision - IT

Positive comments:


There’s a track record of wasted public money with IT. I do not have a problem in clinic at

Poole Hospital. I have a well summarised GP letter, notes and results from Poole and

Bournemouth hospitals and x-rays from DCH as well.

Clinicians ask patients to tell their story even if they have access to information because they

need to know how they view their illness and therefore how they can be best helped.

£ billions have been spent on IT systems for NHS over the past 10-15 years with many

failures!

As a software engineer of many years I see no problems with the provision of patient history

data to a central system but you need to ensure that all data providers sign up without

exception.

No mention of IT can be accessible to those un-sighted or who can’t afford it or who have

some other dorm of inability,

Why is this so complicated in the 21st Century?

More focus on digital solutions.

23

Our vision for health and care services – views collected meetings and surveys


It is not possible in the foreseeable future for GP services to be provided outside the Mon –

Fri norm – for financial and recruitment reasons.

24

Our vision for health and care services – views collected events and meetings

Positive comments:

Good idea – saves duplication.


‘xx’ commented that much of what the speaker said in her presentation was said by the

‘audience’ – so perhaps you’ve heard enough and now is the time to save the money that

these presentations cost and get on with the job. Well done!

We were told that views of 29,000 have been sought – not this (well organised/presented)

exercise – we think time to stop consulting and (spend the money less towards) start the

solutions! It was great the same views are being received. Note: the 29,000 refers to the

number of qualitative comments themed following The Big Ask and 4 Citizens Panels in 2014.

25

Different patients have different levels of need


Need to provide % of population age structure.

20% in orange and 80% in green – but the information needs showing accurately.

26

Different community care models


? costings as finance an issue.

Could be viewed as a pyramid of complexity leading access to more specialist care as well a

pyramid of intensity.

27

Rapid access to health and care teams

Positive comments:

Seems a good idea.


Need to ensure rapid response to reduce acute admissions.

Some people with some health needs may prefer not to be seen at home with all the

distractions that may involve.

28

Proactive ongoing care for people with medium intensity needs

Positive comments:

Good

Good idea!

Agreed.


Will this be managed locally or will it be a central control for Dorset?

29

Creating community hubs

Positive comments:

Local access to diagnostic support could be very helpful and speed up results of tests –

better treatment.


Concern about access to specialist advice e.g. neurology consultant advice. Some conditions

are rare and the Hub will need to be big enough to develop expertise.

Need for some patients to get a physical/fit e.g. to use physio equipment and other

technologies.

30

Weymouth and Portland Integrated Care Hub


Too many unexplained acronyms

Sorry can’t understand last 3 points – unfamiliar language.

31

Weymouth and Portland Integrated Care Hub - results


Research evidence from us on virtual wards somewhat ambivalent.

32

Weymouth and Portland Integrated Care Hub – moving forward


Some patients with long term conditions need continued monitoring and sign posting and

can’t be adequately managed with this approach.

What is SPOA?

33

Virtual Wards – Joint working


Hands on care essential.

34

Virtual Ward - example

Positive comments:

Lots of good features – integrated with mental health, access to consultant opinion.


GPs need to be constantly updated on back up services available.

We need a system that will also work for a younger person.

35

Voluntary Sector in Purbeck - example


How are volunteers recruited?

36

Co-producing Mental Health Services


Ensure specialism is not diluted or tendered out like “CADAS”.

Please consider crisis care for over 65.

37

Maternity Services Vision

Comments, questions or suggestions:

There has been a national shortage of midwives for at least 10 years. How are these ideas to

be implemented with known staff shortages?

38

Labour Line

Positive comments:

Sounds ideal – can it be the model for other conditions/needs?

39

Proposed Integrated Health and Care Hubs


Will integration move in time to a shared budgetary and managerial responsibility between

Health and Social Services?

Hubs? The speaker suggested it may be a place or may be virtual. I wish you would give a

real example.

Huge emphasis placed on integrated social care which is great but needs to be better

information about how primary care works for the ‘occasional’ patient too.

40

West Dorset Cluster – Proposed Clinical Pathway – Diabetes & Proposed System-wide Efficiencies

Positive comments:

Great idea – now I’ve been told what is involved.


Why diabetes especially. Maybe use a traffic light system and prioritise care for patients at

highest mental and physical risk and assess effectiveness by bringing them to a lower level.

Have you finished the vanguard with people’s views, the work that has already been

undertaken, CCG information or the specific outcomes for all the workshops for diabetes,

care planning, education, the main case survey across Dorset for diabetes???

There are too many different healthcare providers and different payments, employment

contracts with clinicians to make integrated care cohesive.

The diabetes vanguard has been exceedingly rushed, has sufficient time been allocated to

actually find out who is doing what across Dorset?

Care plans for diabetes should contain all the necessary information – including results of all

screening procedures – cholesterol, lipids, kidney function, ACR, BMI, retinal screening,

annual foot check – all of which are part of annual review – must have a copy of their care

plan.

What is the vanguard project? Please explain in plain English not business speak. From the

poster I have no idea that you are considering the problems that exist in Diabetes care. Is

the purpose of ‘this world?’

Use walking for health groups for rehabilitation – see www.walkingforhealth.org.uk

Unless do have education with regular updates you are not going to enable patients to

manager their own diabetes.

http://www.walkingforhealth.org.uk/

41

Other comments recorded

Positive comments:


Fundamental conflict: a) increasing health/care demands for an increasing and aging

populations. Some services might be streamlined and integrated and so be more effective

BUT b) overall there must be a greater cost but we are faced with a reduction in resources.

Any honest review must make this clear.

USA – 17% GDP on health, EU 9-13% GDP on health, EU average 10/11% on health, UK 9%

probably falling to nearer 7%. EU average would address concerns.

Don’t use ‘bed blockers’ – implies patient’s fault. Use ‘delayed discharge’.

Please explain simply what all the routine terminology is, the general population has little or

no idea what you are on about.

Lots of ‘thinking’, ideas, plans etc. but how will any of it get implemented without adequate

resources?

Mobile GP surgery – with ultrasound, ECG, blood testing facilities.

integrated community services feedback from public … · 2016-05-05 · 1 integrated community...

Documents