Integrated Lay Partners Group

Integrated Lay Partners’ Group Minutes 6 to 8pm, 14 November 2017 Room 5.4 Marylebone Road

Attendees Apologies

1. Stephen Otter (SO) (Chair) Tania Kernal

2. Trish Longdon (TL) Angelica Silversides

3. Sonia Richardson Munira Thoban

4. Carmel Cahill (CCa) Tim Spilsbury

5. Sola Afuape (SA) Sanjay Dighe

6. Jane Wilmot (JW) Julian Maw

7. Christine Vigars (CV) Michael Morton

8. Varsha Dodhia (VD) John Norton

9. Gabriela Francis (GF) Jaime Walsh

10. Sarah Bellman (SB)

11. JJ (JJ)

12. Ben Westmancott (BW) 13. Ray Johannsen-Chapman (RJC)

ILPG meeting Tuesday 14th November 2017

No finance report Unsure if ben is attending Apologises: SO, Carmel, TL, JJ, SR,CV, GF, SB, RJC

JJ; Introduced herself - interesting and informative read

Minutes Minutes alterations Actions completed BW could leave

1) STP updates abacus 2) Highlight report 3) Report

1) all of the different schemes in the STP -workforce etc input how to make it better all the different deliverables Still DA1, DA2, DA3 Shows monthly updates - red, amber and green RAG - blue o-handed over business operation

Reducing harmful drinking - what is going on? Look into the red blob. Amber to red DA4 newmental health conditions - moved from red to amber - grey blobs - this takes a series of time

March 2018 where we would expect to be -the whole lifecycle

Single sheet which stands by itself

Lots of projects in Ealing and not elsewhere is this NWL wide why not system wide

TL Why do S&T put all the resources in one area?

Can you click on link to go to the wider document? Unfortunately not.

S&T work with all the CCGs it is down to investment from the particular CCG

This couldshow where the CCG is investing

SB: good at all the projects - what is every where and what isnt

JJ: quarterly report - Comms can make more readable as a map

TL: GB patient activation work isnt moving quickly - why dont we know that

SB: idea online map of NWL boroughs go RAG depending on where we are - we may do it paper firstly

Car: Patient activation depends who takes it up and champion it (GP) Boroughs who have done well.

JW: if we are going to make decisions as an 8 it has to happen as one and really important we get this right

SO: 2nd document Main report monthy report page 3, 4 and 5 Ex summary or the other 40 pages JJ asks what has really gone well and what is needed - Sometimes we report up and out Joint Group

key issues joint care transformation what is the particular issue for this month - relates to the abacus - enables staff to drill down - what is the risk and the mitigation the Derivation document

TL: What is doesnt reflect is what is the prevention? If you are trying to work out what needs to happen

JW: what decision do the Joint Committee make?

JJ: Segway in the next document - the big things i want the lead =s to focus on

If it has an issue - it is wat we are dealing with now - maybe Workforce maybe funding

Into Thematical analysis - Workforce is huge issue - there was not focus - no by using the analysis deep dive into the analysis- discussion with the Joint Committee.

JW: how do we get that workback into the CCGs?

JJ: should be seen in the quarterly report - are the red blobs being mitigated?

CV: Much depends on the funding? At work stage do we move forward?

JJ: The diluaton - we need to have the appropriate LRep on all the forums - so more people look at them there is more of a collective response. I want people to be better informed - to challenge us and keep us on our toes

JW: It is not enough to 1 or 2 LPartners

SB: I dont want my team doing engagement without it going anywhere - new engagement assistant - we need to formalise the learning - in a format the response you said, we did - these issues could come to this group - your not able to see where u can push us better. We did it for Maternity we need to do more often

JJ: HW forum - take all of the energy be contructive

JW: It has to be demonstrated

VD: Is primary care on the agenda

JJ: Excellent from JJ

BW: Working collaborative Attending the the previous work together more closely - STP across NWL - reducing unwarranted variations - postcode lottery 8 CCGs for some time

GB meant at end of Sept - one Accountable Office - onefinacance officer

How do make decisions together - make the decision once

The bit where we come here : CCG are accountable to the local public and Govt how do maintain accountability- in public

Joint Committes meetings in public how would u like those to functions - how do we make sure they d not getdiuted - how do we weave them into the new arrangements

Two groups governance and organtionation group to report back on progress

Not ready by mid-Dec

What's it about the local accountability that u dont waht to loose?

Timetabling problems - agreement local views what that might look like has not be determined - members of the joint committee not to compromise - needs some flexibly - some decisions would have extreme decisions for some CCGs and not for others is their a veto - would the joint overrule?

TL:1) stream thejoint committee watch it whereever they go not expect to go to MBR - ask questions on Twitter - face to face of someone from localGB - helpful to have your views?

TL: Joint committee will only look at some issues -the stuff done with LA MAY WELl be retained locally -

CV/Car: has to be understanding - areas by Joint committe political interest by certain boroughs - is it with JOSCH or local committiee

SB: This will impact on the LOcal scrutiny committee will stream internal diecsion making but still have to go to the all the LA. AND HW

VD: SPECIAL measures in Harrow not officially - if commissioning decisions are made beyond the envelope

BW: financial framework- risk show arrangement- what is the requirement of the other CCGs to help Harrow - if variable impact how is that managed - not decided on

SO: Patient Voice - how is the PV gonna be heard? When some boroughs are at different starting points

BW: if we get to the joint committee without knowing we have failed

Car: the PV has to be local and travel up

SO: patient voices will be different due to cultural differences

TL: JJ report needs to otllin the impacts and what they are and to make judgements - there is local clarity for decisions

SB: the PV isnveer all one even in the one borough - we need t give the right time to the engagement reporting needs to be done. Then u should challenge us

JW: Engagement strategy - 4 objective how do we get to the outcomes? The 4 principles is the same for everyone whatever the borough but the action plan maybe different - that allows for local response

SB: having single GB is not a one size fits all -

TL: build in the decision for all

SO: how are we going to mange the resources?

VD: Pwisley 3 or 4 interactions - the service for Brent is very different for Harrow due to affordability

JW: not allows the provider to divide and rule

Car: local services are going to remain local - may have the same suppleier but the specifications locally vary.

SR: waiting to speak for long time - getting fed up and frustrations - why we are looking across the 8 - look at all the individual contracts - this happens at the acute Equality of access we do not have - joint approach could - postcodes lottery has to stop -

TL: the whol thing about consistent standards has been the driving force

BW: Practical - make sure the local voice gets heard - but it si reflected and we will know what people think - better outcomes and equality of access

BW: can set miminmum standards

TL: i want your views on accountability what it be good enough in public - streaming - is it good enough or not - i need help

SO: it is not sufficient - we need to know the engagement that leads up to it - how we gonna deal with questions - because they will be longer

SB: will they be held in different locations - CHaring X hospital not in Brent

VD: I watch NHSE board meeting streamed live is it accessible? it is more a stage show - the accountability starts diluting

CV: ON HWEngland - the day before seminar that local area had thrown up but put into he committe SR: How many people Car: always turn up SR: what has been put forward is baseline but not sufficient SO: what are mini expectations about how these things gonna work? GF: Only recently by change that public can participate at CCGmeetings - how can CCGs make it more widely known that the public are welcomed JW: If we want people to participate we need to promote better SB: we dont do that - we do press re;eases send out to all Partner organisations - budget is zero - we need to be more inventive - the big problem is that that media dont care - unless there is fight

GF: GPs is where the consumers really go SB: how do we get more people involved SO: stream on TV screeen SB: expensive - 15k across 3 SO: amazed plug live - cant be expensive Car: Ealing has centralised system cant change too often because of the cost.Flu jabs etc TL: admitted to BW suammry of decisions one version of the truth immediately after the meetings SB: Peadtrcts and Maternity at Ealing pushed for public facing documents - summary decisions - what does the clinical care model of pathway - what does that mean? People then understand even what they might not agree with

SB: Shared folder - how can u access papers - the website NWLondon Patient Representatiion - enter password - - all different - different folders - papers have been uploaded - other papers u need can - papers not ready for public consumption - dont share the password Car: one element that needs to be discussed - can we put them up? - send them to me - Collabration boards - GB etc - papers can come out so late JW: abacus monthly - papers for information - non - monthly papers TL: to pass on papers PWisely - to look at the subject area - subject folder for abacus SB: we can change the folder - indexing and using a code -methodology STP we all follow it - coding - exact addressthe link and password separately SO: this is personal to u as an indivdiaul

TAask & Finsh - Young People

Carers BME Explaining the role - strategic and not an agenda raised role- once we invite you that is it Make sure two meet up we new JW: how long - for membership Continuity is important for this group - there is a committement Your support for the proposals - you would volunteer VD: Mental health SB: Conversatin waiting for the new provider T&F for reporting a template -action

Workforce - Team meeting - if internal team no need - programme boards VD: BME in diabetes is not heard - we need someone

AoB: GP appt online - a list of things TL:Clinical review of the service - allof our surprise - would have massive implications Co-produced - recommendations us and the comms to sit down about what went wrong - we have our principle

T&F Group JW, VD, - meet with AP,

Review the Engagement and Communication for S&T comms dont exist - comms for the different projects - we just promote to the public - we can bring our plans?

PW is not a document that is pretty sparse

TL: finance paper - community needs to understand Tried get a paper

End of meeting

1. Welcome and apologies

TL opened the meeting welcomed all and highlighted the apologises

2. Minutes

There were no minutes from the previous meeting

TL informed to the group that following the cancellation of the last ILPG meeting, a joint letter from the Chairs, with assistance from Ray, was sent to Clare Parker outlining that the ILPG need for the promised support. Since the formation of the ILPG the support required has not been adequate. Without appropriate internal support the group is unable to function as effective lay partners. Secondly, following the departure of Alistair the question is who from senior management will attend and respond to the ILPG meetings?

This generated further discussions about what was required –

TL pointed out that she was provided with assurance that JJ would attend the next meeting to talk about the STP and to answer further points for clarification

CCa: suggested that the ILPG should all receive a copy of the Abacus and the highlight report

CV: We are still waiting the forward plan out of the Choosing wisely and this isn't the first time of asking

MM: Suggested that it needs to be made clear that ILPG role is that of influencing – providing expertise and potentially enabling NWL to make the right decisions

CCa: Without the support of the patients and lay representatives it is like the organisation going into darkened room without any input

ACTION: RJC to access the Abacus and Highlight Report to send to ILPG?

3) ILPG Action log

Outstanding actions

1. The EQIA report – (on the agenda) 2. Prescribing wisely lessons learned – (on the agenda) 3. Remuneration policy – (on the agenda) 4. Task & Finish group: ‘How to attract and recruit new members from diverse backgrounds onto ILPG? 5. Task & Finish group? ‘How do we generate better feedback’?

Action: RJC to organise Task and Finish groups

4) Remuneration policy

AP: presented the updated the remuneration policy to the group – all agreed that the policy has been dragging on for a considerable amount of time but it is essential for the policy to be consistent across NW London CCGs. The process after agreement is that the policy will have to go through each CCGs Governing Boards for sign-off.

AP: Asked the group for questions and feedback

JW: Suggested that the policy needs to be clearer between the meaning of expert and volunteer and who qualifies for what? And do we monitor to we make sure that the 8 are consistent?

AP: Following feedback from participants, it would be well-worth monitoring the policy through the first 12 months,

MM: verified that the role of the lay member sitting of the GB does receive a small remuneration. Would this have an effect?

JN: if a CCG disagrees with the proposals, what will happen to the policy?

AP: agreed that the success of the policy is largely dependent on all the CCGs’ GBs supporting the policy. But added that even in this time where money is tight, the amount is relatively small, around 5k for each CCG. If a GB fail to support to the policy then further changes will have to be made

TL: suggested that you can’t talk about being patient focused without offering money

GH: £10 hour is half of what it should be

CV: pointed out that on page 7 it states up to maximum of £26 per hour will be paid, when it should be inclusive of the London Living Wage. This is also unfair on people with childcare they will not spend an average of £60 on childcare to get £26 back.

JN: the wording explaining the categories are not very clear, could this part be re-written into simple language.

TL: suggested that you couldn’t expect people to submit receipts from TFL as it is not straightforward or easy to claim receipts and the CCG need to take the person at their word.

Following further discussion AP said he would aim to include all of the comments made but stated that this policy needs to be completed sooner rather than later it has been dragging on for over two years - All agreed

Action: AP to make further changes to the remuneration policy, present back to the ILPG before submitting to CCG GBs.

5) Working Collaboratively in NWL

TL: Introduced BW to the group. TL assumed that there had been an opportunity to look at the paper ‘Developing further collaborative working across North West London CCGs’

BW: said he would not to talk through the paper but provide an overview. The paper essentially outlines how the 8 NWL CCGs will work more collaboratively than at any other stage before. By sharing one clinical strategy with one single commissioning voice, which in theory, should generate better staff and a better mixture of offers for providers across NWL. Around 80% of our population receives care within and by the providers in NW London.

The features of this Collaboration Board Joint Committee should also ensure greater clarity - moving from two accountable officers to one. Five questions were identified that we need to answer in order to make progress: 1. Is there a case for changing our commissioning arrangements to better improve health and health outcomes? 2. What joint decision-making do we need to have in place to deliver the STP and our other shared objectives? (i.e. how do we make commissioning decisions once across the eight CCGs) 3. What are the services we would want to commission once across the STP? 4. What would the governance structure? 5. What would the management structure look like to support 2 and 3?

JN: suggested that until governance is clarified how can it be possible to provide a balanced response? Surely there is the fear of losing the local input? For example, Harrow doesn't define NWL as local – how will this be resolved in an acceptable way? The other big sticking point is financial control, who would be the lead?

TL: said it is important to know how the local voice can be heard in one commissioning voice? How will the local voice involved in the collaborative structure?

BW: In terms of making changes many of those proposed can happen even with the existing constitutional structure. Our proposals are for joined up and shared governance, systems and processes the aim is to secure system wide delivery through the STP that would be reflective of all 8 CCGs local voice.

JW: the rationale is clear, but surely there are some constitutional issues for the committee – how can one Healthwatch Representative reflect the views of 8 boroughs? Particularly, when 8 one considers what resources are available or unavailable depending of the financial position of the borough.

MM: asked, what are the differences? To what extent are the 8 boroughs so different?

JN: If this is workable then maybe the Healthwatch/s could generate their own collaboration?

CV: One rep is not sufficient seeing as no one, as yet, understands the current structure

TL: suggested that the quality of our services, the way of feeding in our or patients’ concerns, we must not lose this ability, we must be able reassure public accountability

BW: asked for the group’s comments on the Design Group

CCa: It depends on the governance structure of the design group, it shouldn’t just be financially orientated – there needs to be equal emphasis on a more clinical and patient experience focus

JW: it unrealistic for one or two people to know what people want at each level or what local people think or want. The only way to get buy in from local people is to be honest about what is working, what is not and what changes are likely to be proposed.

TL: added that engagement cannot all be done in paper and must be undertaken in public. It would be at a great lose locally if there is a lack of opportunity to discuss in these changes public

BW: would welcome representative at the design group meetings – he asked the question? Where does the ILPG fit into the new structure? He added that he would be happy to provide further updates to the ILPG.

6) ILPG senior management support

CC: explained why the previous meeting was cancelled following the departure of AR from his position. There was no appropriate senior manager who was available to attend in his place and no one in a position to explain and discuss the possible next steps.

CC added that he was aware that AR offered support which unfortunately for various reasons hasn't happened. Administrative commitments made to the group and to Ray also did also not materialise. CC apologised to the group but added that we are looking to resolve this. Administrative support for Ray has been identified and allocated a new member of the team Engagement Assistant will provide engagement support for Ray and administrative support for ILPG, we would that this person should be starting in the next few weeks.

In terms of senior management support JJ as agreed that she will definitely be attending the next meeting and then we will access thereafter.

JN: asked if there will be a direct replacement for AR?

CC: not a like for like replacement but Jo Olsen from NHSE will be covering some of those day to day STP duties. We intend to pause and assess the structure before looking at an exact replacement.

SA: in terms of going forward for the ILPG could there be a senior management rotation, providing a constant live thought from the different delivery area perspectives

TL: thought that it would perhaps be more beneficial and strategic to have continuity, not constant changing. JJ participation makes much more STP sense

MM: thought that it would be good idea each month to have one of the leads from each of the areas to update us.

7) Prescribing wisely

TL: asked CC when the ILPG could expect to receive the EQIA report and the lessons learned?

CC: The timetable for the journey of the EQIA report is that it is due to go to the lawyers for final sign off. Following sign-off CC promised the group that they would receive the EQIA report before the next meeting.

TL: asked what protection is in place for people cannot afford the medication or are vulnerable?

CC: said that Mark Jarvis MG is going through the mitigation purposes. Any individual is exempt if they have a:

 funded care packages where a carer is required to administer a medicine or product  School age children, if the product needs to be given at school.  Care home residents  Anyone officially homeless  People with a diagnosis of dementia  People with a diagnosed learning disability

Action: CC/RJC to send the full EQIA to ILPG before the next meeting

8) Planned Procedure with a limited threshold (PPwT)

CC: the timetable for PPwT is presently in state of flux – ‘Removal of benign skin lesions’ the view is that this is more to do with providers than patients. In other words, to move the procedure from acute to community settings, which in some cases is already being undertaken at a number of GP surgeries

TL: asked about the rumours around IVF treatment, and knees and hips replacements. Where are with these proposals?

CC: the considered opinion for both areas is that they have essentially moved into ‘the long grass’. The potential save on the money is now being considered as perhaps too small. Presently, there is little to report but the ILPG will be the first to know when there is

9) AOB: SA: informed the group that she was recently offered the position as the Diabetes Workforce Transformation lead in the NWLSTP Diabetes Transformation Programme. SA has accepted the post but that would mean, therefore, that she will have to vacant her place in the ILPG.

All congratulated SA and thanked her for her wonderful commitment to the development patient engagement and experience throughout the NWL CCGs.

SA: identified that there would be a need for a lay representative/s to sit on the Workforce Transformation Delivery Board and the Workforce Transformation Advisory Council group. SA would be happy to provide support and information for any interested lay member

CCa: informed the group that both CCa and SA successfully presented at the recent NHSE Lay Member/NEDs event. It was quite clear from their presentation that the ILPG have much greater involvement in NWL CCGs than the majority of representatives attending the event. However, it was worth noting and or learning from Frimley and East Sussex CCGs’ lay representatives, who have a far great level of co-design and co-production and also are much further along the involvement journey

TL: closed the meeting the date and time of the next meeting 14 November 2017 from 6 to 8pm