statement of involvement 2012 13 final

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Patient and Public Engagement

Annual Statement of Involvement

April 2012 – March 2013

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Contents

Page

Acknowledgements 3

Introduction 4

About Us 4

Our Approach 5

Changes to NHS Commissioning 8

Duty to Report Requirements 8

The Patient and Public Engagement Annual Report 9

Consultations Undertaken April 2012 to March 2013 10

On Your Doorstep 10

Relationship Matrix 11

Equality Delivery System 12

Calderdale and Huddersfield Strategic Review - Children 14

Calderdale and Huddersfield Strategic Review – Planned Care 16

Calderdale and Huddersfield Strategic Review – Unplanned Care 18

Calderdale and Huddersfield Strategic Review – Long Term Care 21

Patient Participation Directed Enhanced Service (DES) 23

Safeguarding 25

Urgent Dental Care 26

Care Programme Approach 28

Creative Minds 29

Employment Matters 30

Folly Hall Environmental Project

32

Rapid Access Intervention and Discharge 33

Travel and Transport 34

Welfare Room 35

Projects planned for 2013-14 36

Calderdale CCG Contact Details 38

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Acknowledgements

We would like to thank all of the individuals and organisations who have taken part in our

consultation and engagement activities over the past year, and shared their experiences of

using local services. Your contributions have helped to inform our commissioning decisions,

ensuring your local NHS continues to provide quality and responsive services.

This report gives us the opportunity to tell you what consultations have happened over the last

year, what you told us in those consultations and what we have done with the comments you

made.

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Introduction

The NHS has just gone through a major reconfiguration. Calderdale Clinical Commissioning Group

(CCG) was established in shadow form in 2011 and started to take over the responsibility for

commissioning and planning some local health services together from NHS Calderdale, Kirklees

and Wakefield District Cluster Primary Care Trust. The CCG was formally established in April 2013

and is now responsible for ensuring that people living in Calderdale have access to high quality

health services.

Under section 24A (1) of the NHS Act 2006, Primary Care Trusts had a statutory duty to report

annually on engagement activities relating to commissioning decisions. This duty has transferred

to CCGs. It covers the period from 1 April 2012 to 31 March 2013, but includes details of planned

engagement activity for 2013-2014.

About us

Calderdale Clinical Commissioning Group (CCCG) became a statutory body on 1st April 2013. We

cover 26 GP practices and commission healthcare for a population of 213,000. We have a budget

of £265 million and our Vision is:

'To achieve the best health and well-being for the people of Calderdale within our available

resources'.

Our Values are:

Preserve and uphold the values set out in the NHS Constitution.

Treat each other with dignity and respect.

Encourage innovation to inspire people to do great things.

Be ambassadors for the people of Calderdale.

Work with our partners for the benefit of local people.

Value individuality and diversity and promote equity of access based on need.

Commission high quality services that are evidence-based and make the most

of available resources.

Encourage and enable the development of care closer to home.

In 2013, the CCG approved its Patient and Public Engagement and Experience Strategy which sets

out our plans for the next three years. It is also in place to ensure that we adopt a whole system

approach to supporting this work. The strategy will provide clear direction to our work in relation

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to Patient Experience and Engagement. It is accompanied by an implementation plan containing

outcomes, targets and timeframes. Our strategy will enable us to meet our responsibilities under

the Health and Social Care Act 2012:

putting patients at the heart of everything we do

focusing on improving those things that really matter to our patients

empowering and liberating clinicians to innovate, with the freedom to focus on improving

healthcare services and,

The recommendations of the Francis Report.

The strategy shows that we are committed to ensuring that we actively engage with patients, the

public and other key stakeholders to ensure that the commissioning, design, development,

delivery and monitoring of healthcare in Calderdale meets the needs of our population. By

listening to patients, and learning from their experience of health care we can understand what

really matters to people.

Our Approach

0ur approach to public engagement and consultation is to ensure that we use a variety of

different mechanisms, methods and approaches to engage with people. We need to understand

how we can best involve people, when they need to be engaged or indeed want to be engaged.

We want to make sure we hear from all the people and communities in Calderdale - everyone’s

opinions matter. We understand that the way we ask for people to share their views can make a

big difference to who responds so we will ensure we design our patient experience and

engagement processes with this in mind. We will also use equality monitoring to assess the

representativeness of the views we have gathered and where there are gaps or we identify trends

in opinion these will be looked into and plans made to address them.

The Annual Report for Involvement is our opportunity to present the work undertaken, catalogue

our activities and present any changes as a result of this work. This report will be published on

our website and circulated to our member practices and key stakeholders. We also have a number

of other mechanisms in place to manage our engagement activities and gather your views, these

are highlighted below.

Patient and Public Engagement and Experience (PPE&E) Steering Group

The purpose of the Patient Experience and Patient and Public Engagement Steering Group is to

shape, steer and advise on any engagement and consultation activity.

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Calderdale Health Forum

The ‘Calderdale Health Forum’ has been set up by Calderdale CCG as a forum to gather together

representatives from each of the member practices patient reference groups (PRGs). PRGs are

made up of patients from the practices, and they meet regularly with the practice manager. The

Health Forum meets quarterly to ensure that we can gather all practice representatives together

to inform them of our plans, consider and proposals and engage with them on any decision

making.

Health Connections

Health Connections has been set up to help the CCG engage with health-focussed third sector

organisations. The aim of the project is to support the third sector voice in commissioning and to

use their communities to ensure we reach local people at a grass roots level.

Relationship Matrix

Our relationship matrix has developed to make sure we have up to date contact details of

community and voluntary groups from a variety of locations across the district. This matrix

ensures that we engage with groups representing the nine protected equality characteristics.

Calderdale CCG website

Calderdale CCG has a website which provides information to the public including a section called

‘Get Involved’. As a CCG we will fully use our website to inform of our plans to engage, raise

awareness of any consultation activity and also provide opportunities to become involved. This

website is updated on a regular basis so we can regularly report on the outcomes of all

consultations and what we have done as a result of our engagement activity.

Patient Advice and Liaison Service (PALS)

PALS help the NHS to improve services by listening to what matters to patients and their families,

and making changes when appropriate. PALS provide the following functions to the population of

Calderdale:

Providing the public with information about the NHS and help you with any other health-related

enquiry

Helping resolve concerns or problems for those using the NHS

Providing information about the NHS complaints procedure and how to obtain independent help if

the person decides they want to make a complaint

Providing information and help for example: support groups outside the NHS

Improving the NHS by listening to concerns, suggestions and experiences ensuring that people who

design and manage services are aware of the issues raised

Providing an early warning system for NHS Trusts and monitoring bodies by identifying problems or

gaps in services and reporting them.

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Health Watch

Healthwatch is the new consumer champion for both health and social care. It exists in two

distinct forms – local Healthwatch and Healthwatch England. Local Healthwatch is an

independent organisation and Calderdale CCG is working alongside the service to ensure that it

forms part of our engagement of the local population. The aim of local Healthwatch is to give

citizens and communities a stronger voice to influence and challenge how health and social care

services are provided within their locality.

Patient Opinion and NHS Choices

Patient Opinion is a feedback platform for the public so they can share their story or experience of

healthcare services. Anyone can post an opinion on the website. NHS Choices also provides a

similar facility. Calderdale CCG will search these facilities by provider to listen to what patients are

saying about NHS services.

National and Local surveys

National and Local surveys take place throughout the year from various providers and local GP

practices. Patients are encouraged to contribute to these surveys. The public can use surveys to

have their say on current services and Calderdale CCG is able to use such surveys to understand

the patient’s view of the service. In addition surveys can be used collectively to inform

commissioning decisions.

Real time feedback and ‘I’d just like to say’

We work closely with our provider organisations to set up systems to monitor patient views of

services as close to them receiving it as we can. These surveys help us to understand in real time

what is happening in the service and how patients are finding the care and treatment they

receive. In addition the CCG website features a feedback form ‘I’d just like to say’, which patients

are encouraged to complete. This form is also circulated by staff at public events. Information

gathered by both of these mechanisms are stored on databases and used to inform

commissioning decisions.

Service redesign activities

Throughout the year we actively promote any activities for people to become involved. In

addition we ask if people would like to have their name stored on a people bank so we can

contact individuals directly about healthcare services.

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Changes to NHS Commissioning

The Health and Social Care Act 2012 sets out the government’s proposals to modernise the NHS.

There are two simple principles at the heart of the Act – that patients should share in every

decision about their care and those responsible for patient care should have the ‘freedom and

power to lead an NHS that delivers continuingly improving care’.

As part of the changes, GPs have taken over commissioning responsibilities from primary care

trusts. Calderdale CCG is chaired by Dr Alan Brook and the Chief Officer is Dr Matt Walsh.

CCGs are responsible for planning and buying most NHS services for patients including community

services, mental health and hospital care. They will be overseen by NHS England who will hold the

CCGs to account for the quality of outcomes they achieve and directly commission services such as

primary care. The CCGs need to demonstrate that they are working closely with patients. This

report is part of that process.

Duty to report requirements

The information required is set out in ‘Real Accountability’, the guidance published by the

Department of Health in 2009. This not only applies to formal consultations on service changes,

but to any activity where patients or the public are asked for their views on particular proposals or

issues before a decision is made.

The duty to report requires CCGs to report on consultations undertaken:

by the CCG, NHS trusts or NHS foundations trusts, that are independent of the CCG, but

where the outcome will influence the commissioning decisions of the CCG

by the specialist commissioning group for the strategic health authority area, which will

have an impact on the commissioning decisions for the CCG

by shadow Clinical Commissioning Groups which have an influence on the commissioning

decisions of the PCT

Jointly with another organisation through an integrated management arrangement, such

as with a local authority, on commissioning decisions by the CCG.

The guidance stipulates that the following information needs to be included for each consultation:

Who did we consult?

The issues or proposals which people have been asked to give their views about

Information made available to people during a consultation

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A summary of the feedback obtained or received and the range of views expressed by

different people

Commissioning decisions and relevant decisions taken by the CCG following the

consultation

An explanation as to how views were taken into account when decisions were made and

how feedback influenced the decisions taken. This should include whether anything was

commissioned differently as a result of the feedback received and main issues considered

on which it was not possible to act, and the reasons why.

The Patient and Public Engagement Annual Report

When there are decisions to be made which affect how local NHS services are commissioned, we

make sure we talk to those patients who will be most affected and for those larger pieces of work

we make sure the general public are made aware of any proposals so they too have the chance to

have their say. We carry out one-off pieces of work as well as involving patients and the public on

an on-going basis through the partnership arrangements we have in place with local patients and

communities.

The report includes all consultations that have been undertaken and completed during 2012/13,

including any that started before 1 April 2012 or that started during the period of this report, but

are not yet completed. It also includes details of the consultations planned for 2013/14.

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Consultations Undertaken April 2012 to March 2013

‘On your doorstep’ event with the Voluntary and

Community Sector

June 2012 Even as a shadow organisation, we were keen to look at new ways of engaging. We started our

engagement events with the Voluntary and Community Sector and held our first ‘On your

Doorstep’ event in June 2012 as part of our training programme for practice staff.

Who did we consult?

We used the Engagement Team’s contacts, including the Relationship Matrix and Voluntary Action

Calderdale to invite as many organisations as possible to attend the event.

What did we ask?

The events were arranged to give the VCS organisations the opportunity to hear about the CCG

and its priorities, challenges and plans for the future. The CCG was also keen to hear about the

work that the voluntary and community sector do.

Every group that attended the event was given the option to be allocated a table to display

information about their work and achievements and have the opportunity to talk to CCG members

and our staff about potential offers for the future in a short 10 minute pitch. This was done in a

‘speed dating’ style, to ensure that each VCS had the opportunity to speak to a number of CCG

representatives.

What did they tell us?

The main issues raised by the VCS organisations and CCG members and staff were:

Need for funding

The need to raise awareness of their services within primary care

Desire to work with the CCG

Opportunities to provide services for the CCG

The usefulness of having a VCS organisation directory with brief details of each charity/

voluntary organisations services offered to be available for primary and secondary care

providers

The potential for the CCG to support VCS projects going forward.

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What did we do?

The CCG used £750,000 worth of non-recurrent funding as a grant to the third sector to set up a

’Health Connections’ umbrella project to support the voluntary and community sector sustain and

capacity build itself over the next three years. Money within the grant was also used to fund one-

off schemes through non recurrent business planning and small grant schemes all of which are

designed to develop a sector which is business ready.

Where can you find more information on this work?

This can be found by visiting the website of ‘Health Connections’ in Calderdale.

Relationship Matrix

The relationship matrix provides a detailed breakdown of the relationships the engagement team

has developed in the local area. This relationship matrix is not a mailing list but the detailing and

tracking of those key relationships which support the day to day business of the engagement

team. A relationship is defined as a two way conduit, built on mutual understanding and trust

which has evolved over time.

How has the Relationship Matrix been created?

The relationship matrix has been created as a result of extensive mapping and networking. Using

the nine protected characteristics outlined in the Equality Act 2010 as a baseline, we note the

primary characteristic for all organisations we have contact with. The nine protected

characteristics are:

Age

Disability

Sexual Orientation

Religion and Belief

Race

Pregnancy and Maternity

Marriage and Civil Partnership

Sex (gender)

Transgender.

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Who can use the Relationship Matrix?

The relationship matrix is used as a tool by the Communications and Engagement team to assist

customers and colleagues in reaching the organisations which engage with patients, carers and

the public on an on-going basis.

This is done by working directly with an ‘enabler’ who has links into or who works for, the group

or organisation. This is the primary relationship. The ‘enabler’ ensures that any correspondence

is shared with their members, volunteers and client group.

On completion, the matrix was reviewed to ensure that our engagement processes included

relationships with groups representing the nine protected characteristics.

Equality Delivery Service

The Equality Delivery System (EDS) has been designed by the Department of Health to help NHS

organisations measure their equality performance, and understand how driving equality

improvements can strengthen the accountability of services to patients and the public.

It supports NHS Calderdale CCG to identify local needs and priorities, particularly any unmet needs

of populations, and allow particular groups of patients to assist in the commissioning of services to

deliver better health outcomes.

It will also help NHS organisations to demonstrate compliance with the Equality Act 2010.

At the heart of the EDS is a set of 18 outcomes grouped into four goals;

1. Better health outcomes for all

2. Improved patient access and experience

3. Empowered, engaged and well-supported staff

4. Inclusive leadership at all levels.

One of the features of the EDS is that it relies on organisations working with local interests to

assess organisational performance. This engagement will strengthen existing relationships and

build new ones, ensuring that patients and the public have a voice in the grading and setting of

objectives for the organisation.

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Who did we consult?

A consistent approach to engagement was carried out across NHS Calderdale, Kirklees &

Wakefield District. A short questionnaire was developed to use generically across the cluster and

six events were organised, two within each cluster area. In total 22 people attended all six events,

with 8 people attending in Calderdale, 11 people attending in Kirklees and 4 in Wakefield.

To ensure effective engagement with local interests the Equality team worked closely with the

Engagement team to;

recruit representative communities and local people to attend the local events

visit community groups and give out flyers and questionnaires

attend events to raise awareness of the EDS and the upcoming events.

Those who returned the interest forms were sent an invitation to attend the 2 events for their

chosen cluster area and to be part of an Equality Panel to help grade and set objectives for the

organisation. They were also asked what their area of interest was aligned to the nine protected

characteristics.

Staff Engagement

Engagement with staff was also undertaken to ensure their views and experiences also

contributed to the final two goals of the EDS:

1. Empowered, engaged and well-supported staff

2. Inclusive leadership at all levels.

What did we ask?

The engagement focused on the following goals with local interests: 1. Better health outcomes for all

2. Improved patient access and experience.

Event 1

Participants were presented with the organisation’s self-assessment of each of the 18 outcomes

and overall assessment for Goals 1 and 2. They were then asked to consider the evidence

presented and grade the organisation using colour coding voting cards whilst giving feedback on

their own or their service users’ experiences of NHS services from their interest areas among the

nine protected characteristics. (Appendix 3, Grading Template)

Event 2

Participants were presented with the collated grades and feedback from the previous meeting and

were asked to seek agreement. As there were some different people at each event, this allowed

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for people to catch up on what had happened and also feed in their views should they disagree

with the grade given. Some grades were adjusted.

Those present then looked at the areas of weakness for the PCT concerned. They gave feedback

about what would make a difference to those areas and we agreed priority areas for action.

To assess our progress against the above two goals a staff survey was developed and shared with

all staff via the electronic newsletter as an article and a link to the survey. This was circulated twice with limited success. There were nine respondents from Calderdale and

two from Kirklees and Wakefield. To address this, feedback was also extracted from the national

NHS staff survey, which is undertaken every autumn.

What did we do?

The EDS is a new process and this was the first time it was used. To have undertaken the grading

in the manner described in the handbook would have been unworkable within the timescales we

were working to. It is recognised that narrow timescales had a negative impact on the process;

however this practical and accessible approach was developed to create a baseline of information

to be used within the first year and in future years. The process will be evaluated and lessons

learned to influence future implementation.


We pulled together a report and this can be found at http://www.calderdaleccg.nhs.uk/get-

involved/

Calderdale and Huddersfield Strategic Review – Children

September to January 2013

As part of the Calderdale and Huddersfield Strategic Review we consulted with a wide range of

young people on unplanned care services in Calderdale and Greater Huddersfield. The Strategic

Review is a review of current services across 7 partner organisations. These organisations

comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation

Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation

Trust.

Who did we consult?

Engagement evidence was gathered from three main sources:

http://www.calderdaleccg.nhs.uk/get-involved/

http://www.calderdaleccg.nhs.uk/get-involved/

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An ‘Unplanned Care’ survey which was circulated throughout children and young people’s

networks and completed through one to one interviews.

Evidence from other engagement activities undertaken in the last three years.

Patient feedback and enquiries over the last three years, gathered from Complaints and

Patient and Advice Liaison Service information.

This broad, inclusive approach was designed to maximise the use of all feedback and views

provided by children and young people, and ensure good representation from all sections of the

community, including a wide range of views from the protected groups as set out in the Equality

Act 2010.

We worked closely with council colleagues to support the distribution of an unplanned care survey

throughout local networks. The survey was also taken out to a variety of young people settings

throughout Calderdale and Greater Huddersfield where children and young people were

interviewed using the survey on a one to one basis. We received 254 children and young peoples’

views including 12 parents.

What did we ask?

We asked for children and young people’s views on unplanned care services using a survey and

gathered general views on health and social care services.


Young people told us:

Involve us in planning and delivering services/activities, for example as peer mentors and

educators and in decisions about our care.

Have the right adults working with us (people we can trust, who we can talk to in

confidence, who are not judgemental, who like young people). Use the people who we

have contact with the most to provide health messages.

Support our parents, carers, siblings and friends so they can support us.

Provide young people friendly venues in our local area, on line or through youth

centres/workers and the places we go to.

Because of transport issues, we need local venues, close to home and available at the

times we would like such as straight after school in our lunch break or Saturday mornings.

For specialist services we are happy to travel up to 30 minutes.

We want to know what we can expect from a service (clear information, use a variety of

ways to get the information through, use young people). We want information on the

things we want to know about such as sexual health, drugs and alcohol, diet, lifestyle and

emotional issues.

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What did we do?

The findings of the consultation exercise were considered by the Children’s working group. The

findings have been used to help shape business cases for the work stream and ensured that young

people have a voice in the future of service reconfigurations that will continue throughout the

coming year.


We pulled together all that was said on the day and prepared a report. This can be found at

http://www.rightcarerighttimerightplace.nhs.uk

Calderdale and Huddersfield Strategic Review – Planned

Care



stakeholders on planned care services in Calderdale and Greater Huddersfield. The Strategic

Review is a review of current services across 7 partner organisations. These organisations

comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation

Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation

Trust.

Who did we consult?


Planned Care engagement event held in January 2013.


Patient and Advice Liaison Service information, together with a review of local patients’

posts on the Patient Opinion website.



provided by Public, Patients, Carers and Local Voluntary and Community Groups, and ensure good

representation from all sections of the community, including a wide range of minority groups.

The Planned Care engagement event was attended by a mix of individual service users and those

representing patient groups and organisations involved in supporting or delivering services,

including the third sector. The circulation of the invitation included the engagement team’s

relationship matrix, local third sector networks and CCG mechanisms such as the Patient

Reference Group Network / Health Forum and local PRGs.

http://www.rightcarerighttimerightplace.nhs.uk/

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What did we ask?

Following the introductory presentations, participants were split into five break-out groups to

promote discussions on what they felt makes a good service. People were encouraged to think

broadly, with basic structure provided to the discussion through the focus on the questions:

1. What Matters to you?

2. What do you want to keep?

3. What could be done differently?

Other discussed themes included:

• Prevention.

• Holistic care planning focused on personal needs and goals, with regular reviews.

• Personalised care.

• Staff attitude/culture.

• Timely and effective diagnosis/referral for early intervention.

• Effective communication between staff and patients and between staff/organisations.

• Care co-ordinator role – single point of contact.

• Support for carers.

• Third Sector (voluntary and community groups) involvement in support and service

provision.

• Patients and public involved in commissioning decisions.

• Social care funding adequately supported and managed.

• Travel and parking considerations.

• Inconsistent access and lack of integration of IT systems across healthcare system.


There are a number underpinning themes which were evident across the whole range of

engagement evidence gathered. These are described below:

Focus on moving more services to be community based – more care in or close to the

home, with consideration for ease of location and adequate parking/public transport

access

Timely and consistent access/ referrals to services available round the clock – choice of

appointments, with minimum changes/cancellations, and on time

Early and effective diagnosis and intervention

Collaborative care planning (treat the person as a whole), supported by regular reviews and

patients engaged in decisions about their care

Co-ordinated/integrated care, underpinned by effective communication between services and

staff-patient.

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Single point of contact/ co-ordinator role.

Consistently high quality of care provided by friendly, helpful and pro-active staff.

Provision of Information on patients’ condition and treatment, the care pathway process,

and available local support services (directory of services).

Supported self-management, including Assistive Technology.

Emotional, psychological and practical support, including support for carers and adequate

social care funding.

Commissioning needs to involve local patient and wider public representatives, and focus

funding on all aspects of patient support, including voluntary sector services and self-

management support.

What did we do?

The findings of the consultation exercise were considered by the ‘Planned Care’ working group.

The findings have been used to help shape business cases for the work stream and ensured that

the public have a voice in the future of service reconfigurations that will continue throughout the

coming year.




Calderdale and Huddersfield Strategic Review –

Unplanned Care



people on unplanned care services in Calderdale and Greater Huddersfield. The Strategic Review is

a review of current services across 7 partner organisations. These organisations comprise of

Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation Trust,

Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation Trust.

Who did we consult?


Unplanned Care survey conducted over the period November 2012 to January 2013.





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provided by public, patients, carers and local voluntary and community groups, and ensure good


The survey was conducted over a two month period from mid-November 2012, with the final

surveys completed on 16 January 2013. The general survey was distributed in paper form to

individuals via a wide range of participating organisation across Calderdale and Greater

Huddersfield. These included local community groups, organisations and their distribution

networks, local venues (e.g. a primary school, toddler group, and women’s activity centre).

In addition, the survey was also made available to the public in web form, accessible through the

external websites of the partnership programme organisations. 93 forms were returned via this

channel. In total, 1,339 general surveys were gained during the engagement process.

What did we ask?

We asked people to complete a survey on their choice of unplanned care, their experience of

unplanned care and their preferences for future unplanned care services.



engagement evidence gathered. These are described below, and are evidenced in detail in the

sub-sections of the report, as appropriate:

Patients did not always feel that they knew where best to go to access the care they

needed.

GPs and community-based health care elements were often closed when the patients

needed to access them, forcing them to go elsewhere, despite their preferences to use

these services. Other access issues, most commonly related to availability/choice of

appointments, were also commonly raised by patients.

Patients found the system fragmented with poor continuity of care – passed round from

pillar to post, sometimes returning to A&E and other services on multiple occasions**.

There was a need identified to build a more patient-centred approach and particularly to

improve discharge and “hand-on” processes.

Delayed diagnosis and/or mis-diagnosis.

Some concerns that staff not sufficiently caring and did not take patients’ concerns about

their health seriously enough, or consider their individual circumstances and needs.

Inconsistencies in standards/quality of care received - patients consistently cited high

standard/quality of care as important, but quite often report big inconsistencies in services

or along different stages of their pathway.

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A number of examples of poor communication/ information provided to patient on their

condition and subsequent management, and sometimes between different areas within

the wider healthcare system at various stages of the patient pathway.

Several cases where patients felt they were inappropriately discharged from A&E and were

subsequently readmitted to hospital shortly afterwards.

Patients placed high value on rehabilitation services/ being supported to self-manage/

manage their condition at home.

Several groups of patients, most notably those with long term conditions, regularly used

and reported poor experiences of a number of aspects of emergency and urgent care

services. This further highlighted the importance of effective management of long-term

conditions within the urgent care and wider local healthcare system. This review also

highlighted the need to put in place better plans to cater for disadvantaged groups such as

elderly people and/or those with cognitive impairment, and families with young children,

who all featured heavily as users of urgent care systems, across the evidence base.

Issues were raised about making better use of supporting technology, for instance telecare

facilities and problems related to health professionals having limited (and variable) access

to patient information available at point of contact.

Other problems, mentioned predominantly in relation to A&E attendance, were patients’

concerns about long waits and not being told how long they would have to wait/ reasons

why, and some patients were concerned that they received no, or inadequate pain relief.

What did we do?

The findings of the consultation exercise were considered by the ‘Unplanned Care’ working group.


the public have a voice in the future of service reconfigurations that will continue throughout the

coming year. An example of how this work has shaped future service provision is evident through

the unplanned care work which has taken place earlier this year.





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Calderdale and Huddersfield Strategic Review – Long

Term Care



Stakeholders on ‘Long Term Care’ care services in Calderdale and Greater Huddersfield. The

Strategic Review is a review of current services across 7 partner organisations. These

organisations comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield

Foundation Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS

Foundation Trust.

Who did we consult?


Long Term Care engagement event held in December 2012.






provided by Public, Patients, Carers and Local Voluntary and Community Groups, and ensure good


The purpose of the ‘Long Term Care’ event was to ensure that the care stream had an opportunity

to engage with the public as part of the pre consultation process. The event provided an

opportunity for care stream members to share the areas they wanted to look at as part of the

review and present the messages already given by the public to check they were still relevant.

The event invitation went out through the relationship matrix and to a cross section of

organisations that are well placed to provide a view on Long Term Care services.

What did we ask?

The event included presentations from the care stream members, with the afternoon organised as

themed workshop discussions using case studies on:

Assistive technology

Self-care, and;

Integrated Care

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In addition there was a ‘general theme’ table which was used to discuss any other issues the

attendees wanted considered as part of the review. Following the discussions a number of

themes emerged.



engagement evidence gathered. These are described below:

Have to assess people’s needs and personal objectives holistically up-front – no one size

fits all.

Effective care planning and on-going collaborative decision making (i.e. keep involving the

patient) – this will aid common vision of service user, carer, family healthcare professionals

etc, and make integration more achievable.

Training and on-going education provided to patients, and their carers and families, to

better understand their condition and support elements such as self-care, assistive

technology etc.

Need to improve access to services and appointment systems, with greater availability

outside normal working hours.

Information on services provided needs to be made more accessible (touched on above,

e.g. independent brokerage for DP etc).

Single point of contact for patient is widely covered and, where, available, model is

generally highly praised (e.g. Cancer, Respiratory) – again this works on several level (single

point of contact for assessing needs, planning, and co-ordinating day-to-day care, single

point of access to information on available services, activities, choice etc).

Integration of care is so important to ensure high standards of care, efficiency and good

patient experience (e.g. lots of good ones – hospital discharge, integration of self-care

elements with other elements, intermediate care facilities etc).

Continuity of care/service is a recurring theme, on several levels (on personal level, helps

user to have contact with the same staff each time, build relationship and understanding,

on wider level, continuity of service – avoid lots of short-term contracts, delays, gaps in

service provision etc).

Put greater emphasis on quality of services and the care they provide. Balance out quality

vs. cost – get value for money, but don’t just go for cheapest option.

People consistently advocate the need to have services close to home and embedded

within their community.

People generally happy to embrace elements of self-care/management supported with by

appropriate assistive technology, provided this is tailored to their needs and adequately

supported within the wider health care system on an on-going basis, i.e. not just as a direct

placement for some other care element, and left to get on with it.

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It is also important to support carers, providing them with respite and practical advice and

support.

Provide and encourage support groups and link patients with like-minded individuals with

knowledge and experience of their condition – important for emotional, psychological and

practical support. Also include transport considerations within range of practical support.

Commissioning needs to involve local patient and wider public representatives, and focus

funding on all aspects of patient support, including voluntary sector services and self-

management support.

What did we do?

The findings of the consultation exercise were considered by the ‘Long Term Care’ working group.


the public has a voice in the future of service reconfigurations that will continue throughout the

coming year.




Patient Participation Directed Enhanced Service (DES)

April 2012 The Patient Participation DES spanned two years from 1 April 2011 until 31 March 2013 and was

aimed at making sure that patients were involved in decisions about the range and quality of

services provided and, over time, commissioned by their practice. It aimed to encourage and

reward practices for routinely asking for, and acting on, the views of their patients. This included

patients being involved in decisions that led to changes to the services provided or commissioned

by their practice, either directly or in its capacity as gatekeeper to other services. The DES aimed

to promote the proactive engagement of patients through the use of effective Patient Reference

Groups (PRGs) and to seek views from practice patients through the use of a local practice survey.

The outcomes of the engagement and the views of patients were published on each participating

practice’s website.

The information presented here was from the activities that the GP practices undertook during

April 2011-March 2012. This information was then made available for the shadow CCG to view in

April 2012.

http://www./

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Who did we consult?

Out of the 26 practices in Calderdale, 17 practices signed up, of these all submitted an outcomes

report and published it on their practice website. From the information provided we are aware

that at least 278 patients in Calderdale are involved in a PRG. Of the 17 PRGs, 10 (63%) are face to

face, 2 (12%) are virtual and 5 (25%) are a combination of face to face and virtual.

What did we ask?

The patient survey was developed with the PRG to ensure that the questions being asked

represented patients’ priorities. The main priorities for the PRGs in Calderdale were:

Being able to reach the surgery to make an appointment – in particular the telephone system

Ability to make an appointment and an appointment with their preferred GP.

Attitude of reception staff

Opening times of the practice

Waiting room


All of the 17 practices that participated in the DES undertook a patient survey. The results from

the surveys showed the following to be of particular concern to patients:

being able to make appointments with their preferred GP within 48 hours

longer opening hours

waiting rooms to be pleasant environments which provide up to date information on services

available at the practice

the lack of privacy and confidentiality when talking to the receptionist

Lack of car parking

The surveys also highlighted a lack of patient awareness of the different ways of making an

appointment; services provided by practices and the opening hours of practices, in particular

extended opening hours

What did we do?

Each practice that participated in the DES was responsible for developing an action plan for their

Patient Participation Group. The CCG has used the information from the practices to inform

development in Primary Care.


The reports were published on each participating practice’s website.

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Safeguarding consultation

April – September 2012 Voluntary Action Calderdale delivered a survey on safeguarding to voluntary and community

sector organisations and public providers. The survey was delivered in order to obtain views

which would support future safeguarding practices.

Who did we consult?

Voluntary Action Calderdale consulted a number of organisations working with vulnerable adults.

This included both staff and service users; the types of service consulted met the following

criteria:

Services working with older people

Services working with mental health service users

Services working with substance misuse

Services working with young adults

Services working with adults with a learning disability.

What did we ask?

We asked staff and service users what needed to happen to make services safe. This included

how to report abuse, what would happen if it was reported and the best way to ensure people felt

safe in doing so. In addition we also asked about safeguarding training, if people knew what it was

and had received it, and the best way to sign post people to report abuse.


Staff told us that they had either had some or very little safeguarding training, in most cases staff

did not know training could be offered. Service users wanted to understand how safeguarding

concerns were dealt with and clear information on what would happen if an incident was

reported.

What did we do?

We listened to what people told us and offered training to all staff in the first instance, in addition

the feedback went to the joint board for safeguarding and an action plan to ensure publicity

advice and information is appropriately delivered will start this year. Members of the public who

represented their views in the consultation have also been asked to join a safeguarding network

which will continue to shape future commissioning arrangements and identify the best approach

to preventing safeguarding issues. This will continue throughout 2013/2014.


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You can find out more information about this work by visiting the Calderdale CCG website on

www.calderdaleccg.nhs.uk

Urgent dental care

1 February 2013 - 26 April 2013

Unplanned or urgent care services are provided in West Yorkshire for people who are resident in

or visiting the area and do not have a regular dentist but need to access treatment quickly. The

service is also used by people who need dental treatment but cannot access their regular dentist,

for example during the weekend or over a bank holiday. There are currently five different services

across West Yorkshire and the contracts for these come to an end on 31 March 2014. A new

service needs to be put in place across the whole of West Yorkshire. The views of Calderdale

residents were sought as part of this process.

Who did we consult?

A total of 547 responses were received from West Yorkshire. Those respondents with a

Calderdale postcode, numbered 224 (40% of the total population consulted). Those people who

were consulted included representation from the following:

Patients and the public

GPs

Dentists

Children’s centres

Voluntary sector

Equality monitoring suggested representation from a wide range of service users across a large

area of West Yorkshire, including Calderdale.

What information did we give?

Members of the public were asked about the urgent dental care service in the Calderdale area.

They were invited to give their views on whether they knew about the service and if they had

visited a dentist urgently, what their experience had been and how easy it had been to get their

appointment. Questions were also asked about which times of day would be preferable to attend

an emergency appointment and what the travel arrangements would be.


A significant number of individuals were not aware of the urgent, unplanned dental service and

almost 75% had not used the service. It is not clear how many people were registered with a

http://www.calderdaleccg.nhs.uk/

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dentist and whether those that had not used the service had received treatment from their own

dentist during a normal working week. Of those people that had used the service, most said it had

been easy to contact and find, with the majority responding that they had been able to get an

appointment. Most people had been seen during the day between Monday to Friday and had

been satisfied with the service. Preferences for times of appointments were fairly evenly split, but

the majority of people would prefer a morning appointment given the choice.

In respect of travelling to the service, there was a fairly even split between those who would use a

car and those using public transport and the majority of respondents would prefer any future

service to be within 15 – 30 minutes travelling distance. It was not clear whether this would be

from home or from a place of work. The majority of respondents also felt it would be useful to

have a choice of venue, although 27% would not have found it helpful to have a choice of venue.

In respect of the qualitative data that was received regarding any other comments about the

service, the most important issue appeared to be access to the service, either for disabled users,

or in terms of ease of location, car parking, or in respect of proximity i.e. how near it was to the

respondent. Issues relating to the quality of treatment and the appropriateness or otherwise of

treatment were also mentioned.

What did we do?

This work has helped inform the West Yorkshire Unscheduled Dental Care service specification.

This specification will be used during the tendering process.

Where can you get more information about this work?

The final report detailing all survey responses and recommendations can be downloaded.

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Care Programme Approach (CPA)

Improving the quality of care South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Service users, carers, staff in a series of workshops together with the annual CPA audit.


We asked service users, carers and staff:

Are you involved in your own care plan?

What are your experiences of care plans?

Do you know what a CPA review is?

What are your experiences of CPA reviews?

This was done in order to listen to experiences of individual service users and carers and to

develop a shared understanding of:

• Good practice

• Ways of working together in producing care plans

• Reviews of care

Service user, carers and staff also took part in visits to services at ‘Manchester Health and Social

Care Trust’ and Lincolnshire’s ‘NAVIGO’ Health and Social Care which are deemed to be flagship

providers in terms of care planning


Very detailed work from which 4 key themes emerged:

• Person centred care – co-production/Engagement/Involvement

• Effectiveness

• Language

• Clinical

What did we do?

A report of findings was submitted to the ‘Executive Management Group’ and changes will be put

in place in the forthcoming year.


Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.

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Creative Minds

Developing creative approaches in health services was

created in 2011 South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Service users, carers, staff in a series of consultation events.


Service users and all others involved were asked what they thought about the creative minds

strategy and its process for example becoming a partner of creative minds and what should be

supported and how?


Feedback was very good and has created great interest. Events are well attended like ‘creative

minds live’ at the Packhorse Gallery in Huddersfield which saw 150 people take part in a whole

range of creative activities. People also said that they would like events to mark the Olympics.

What did we do?

A wide variety of projects have been supported within services and with local partners like HOOT,

AIM and S2R. Events were organised to help celebrate the Olympics, a magazine was published

which highlights the work of the projects and the impact made.



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Employment Matters Project In 2012 the Trust employed a service user to take on this project. The idea is to help the Trust to

become a more exemplary employer for people with mental health issues, learning disabilities and

hidden impairments and to support workers in helping people to gain employment elsewhere.

South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Service users, carers, staff, partner organisations. We conducted a series of workshops. There was

also a workshop on this subject at our Hidden Impairments conference in November 2012.


Stakeholders were asked the following questions:

What do you think are the health benefits of working?

Do you think volunteering is a good route back to employment?

How could the Trust become an employer of choice for people with mental health

conditions, hidden impairments and learning disabilities?

What could the Trust do better to help people using its services to progress towards

employment?


The responses were very positive from nearly all participants, including service users.

Nearly everyone said that working led to increased confidence and self-esteem, which is crucial

for good mental health.

Participants were mostly in favour of using volunteering as a way of getting into employment. In

particular, the opportunity to learn new skills and gain experience for future employment was

emphasised.

There was general agreement that the most important thing the Trust should do is to treat

potential, new and existing staff as individuals, understand them and try to meet their needs.

Reasonable adjustments were seen as key, and many different kinds of adjustment were

suggested, including:

- Flexible working hours

- Awareness raising in the workplace to increase understanding and reduce stigma

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- Specialist technology for people with hidden impairments

- Phased returns

- Increased informal supervision

The importance of skilled managers was emphasised. Managers should have appropriate

awareness and lead by example; and ensure the wellbeing of their staff is considered by

encouraging a healthy work/life balance, taking regular breaks and so on.

Several barriers were identified:

- Job adverts and applications being available only on NHS Jobs was seen as a barrier. Many

people don’t have access to the internet or are not computer literate, and this shouldn’t

prevent people from applying.

- The need to provide several years’ worth of continuous employment history is difficult for

many people with disabilities and health conditions

- Traditional job interviews are often very difficult for people with mental health conditions,

learning disabilities and hidden impairments. Alternatives, such as working interviews and

job trials should be considered.

Many other ideas to increase employment opportunities within the Trust for people with mental

health conditions, learning disabilities and hidden impairments were suggested, including:

- Increased use of job sharing

- Easy read job descriptions and contracts

- Part time jobs with only a few hours.

Another suggestion was that the Trust should ask all the organisations it contracts to do work for

them to sign up to Two Ticks (Positive about Disability) and Mindful Employer.

What did we do?

In 2013 we launched the Employment Matters magazine, a website and toolkit. These

incorporated the learning from the workshops, work with our Human Resources team and

vocational workers. As a result a request from members of the Trusts Hidden Impairments Project

(which includes service users and carers) conditions like ADHD, ASC and ADHD were included in

Employment Matters.



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Folly Hall Environmental/Service Improvements

South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Services and carers at dialogue groups in Folly Hall during 2012.


Following the Folly Hall visitor survey conducted in late 2011/early 2012 an action plan was put

together on improvements which could be made. These were shared with the dialogue groups for

discussion.


Feedback was positive with people already recognising the improvements like the screening of the

café area and the adjustments to the reception desk. Services users and carers were willing to

come forward to be part of any inspection/project teams

What did we do?

Most of the improvements are complete. In terms of inspection the Trust is moving towards

incorporating the use of the ‘15 steps’ test which would place public involvement at the centre of

inspection processes.



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RAID Project (Rapid Access Intervention and Discharge) South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Dialogue groups and a focus group with staff, service users and carers


Service users were given on outline of the idea and were asked to comment. At the focus group

more detailed plans were unveiled and shared for comment. Information was shared on the

findings of research undertaken on different RAID models and approaches. We discussed the

business case and processes.


People agreed that it was a good idea and were pleased it was being put forward. People

volunteered to be part of the focus group. People wanted to be involved in the project in

particular areas, for example staff recruitment. People hoped it would be a success.

We had discussions on response times, locations and makeup of staff. We discussed proposals for

peer support. It was agreed that the target age group would be restricted to adults (for now).

What did we do?

Steering group built up the business case with this information which has been accepted in

principle and work streams are now underway.



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Travel and transport issues for service users and carers South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

Discussions took place in dialogue groups with service users and carers. Focus groups held with

service users, carers and staff in August 2012.


We asked people to talk to us about public transport and tell us:

1. What are the issues?

2. What are the solutions?


It is a complex picture. These issues isolate people in the community. They prevent people from

getting visitors when in hospital. They prevent people from doing what would benefit them in the

community. There is not a great understanding of solutions.

What did we do?

Website information was provided on a range of transport and travel solutions. This work has

raised the profile of these issues across the Trust. We have made better connections with

transport providers. Our public information project team is currently working with service users

and carers on accessibility information for our venues.



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Welfare Reform South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?

In dialogue groups and other forums many service users and carers and staff have expressed grave

concerns about the adverse effects of welfare reform. So a focus group was set up in July 2012 at

Folly hall for service users, carers and staff. Subsequently issues have been revisited in dialogue

groups and in meetings with staff and joint events with the public.


We asked people to tell us:

1. What are the concerns?

2. What would people like as a solution?

3. What is the picture, locally, across the trust and what is our response so far?

4. What does the future look like?


People are very concerned. It is putting a strain on services and the public we serve. The public

want us to be proactive. They want us to think ahead. They want us to support them through the

processes. Staff wanted mechanisms in place which will enable them to support people.

What did we do?

An array of information and advice was made available on the Trust website and in on the intranet

for staff. This was based on the feedback from the focus group and dialogue groups. At a local

level we have been working with services and partner organisations like the DWP and

commissioner Ian Smith on how best to manage the support people need. In response to requests

we have had discussions at dialogue groups about volunteering, permitted work, employment

issues, welfare reform and benefits.

On a trust wide level we have produced a report for EMT based on solutions from services and the

public across the Trust. This was taken to EMT in August 2013. A meeting has been scheduled for

late September to look at an action plan. Regular updates have been given in dialogue groups.



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Projects planned for 2013 – 2014

Public and patient engagement and experience strategy and implementation plan

In Calderdale we have recently consulted with key stakeholders on our ‘Patient and Public

Engagement and Experience Strategy’. The strategy was sent to all PRG group members, through

our relationship network and shared directly with Calderdale Health Forum and the Governing

Body. We will continue to share our plans in this way and revise content based on the feedback

we receive.

Strategic plans

We are required to publish these documents and to make sure that we have your feedback; we

will engage on these later on this year, starting with the Calderdale Health Forum members

initially and sharing with our key stakeholders we will reflect on the comments made.

Equality Delivery System (EDS)

The Equality Delivery System (EDS) has been designed to help NHS organisations measure their

equality performance, and understand how driving equality improvements can strengthen the

accountability of services to patients and the public.

It will support us to identify local needs and priorities, particularly any unmet needs of

populations, and allow us to assist in the commissioning of services to deliver better health

outcomes. As part of this work, we will be engaging with local people and groups in September

2013.

Francis Report

The publication of the Francis report has been an important milestone and we will work to ensure

that the recommendations made are reflected in our work. To co-ordinate this, we will develop

an implementation plan and share this with our Health Forum members and public and patient

safeguarding group due to be established in November 2013.

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Calderdale and Huddersfield Strategic Review

The Calderdale and Huddersfield Strategic Review will continue to dominate the main focus of our

engagement and consultation activity. Four work streams will shape business cases using public

reference groups, engagement and co-production will feature strongly and we will consult

formally on any changes to the way services are provided and delivered.

Call to Action

The National ‘Call to Action’ local conversations will take place locally throughout September to

November. A report of findings will be sent to NHS England and information will be used locally to

support our local transformation work as part of the Strategic Review.

Service Transformation

Service transformation areas requiring engagement and consultation so far come under the

Locally Enhanced Service and Direct Enhanced Service. We will be engaging with service users on

Vasectomy services and talking to women on women’s services.

Unplanned Care in Calderdale will continue to be part of a formal consultation process. We have

already engaged with 2,500 people on unplanned care and intend to reach out to the wider public

to consult on the future options for the service.

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Contact details

If you are interested in getting involved in the work of Calderdale Clinical Commissioning Group or

would like to share your views on local health services, please contact us on the following details:

Address:

NHS Calderdale CCG

5th Floor F Mill Dean Clough Mills

Halifax

HX3 5AX

Telephone: 01422 281300

Facebook:

calderdaleccg

Twitter:

@NHSCCCG

You can find out more about us and have your say about local health services on our website,

www.calderdaleccg.nhs.uk

If you would like a copy of this report in another format

such as large print, audio tape or another language,

please contact the Communications Team on 01422

281300.

http://www.calderdaleccg.nhs.uk/

statement of involvement 2012 13 final

Documents