Welcome to our annual engagement review for 2019
This report highlights just some of the engagement work we have done with you, our local population, throughout 2019.
Involving local people in commissioning is very important to us – by listening to your views, feedback, ideas, concerns and complaints, we can make sure we buy the best services for your needs, put them in the right place and help you access them at the right time.
Highlights Our local population has been involved in a lot of our work this year, which has been fantastic and really helped us commission services based on their needs. Highlights include:
- Engagement with mothers, mothers to be, families and carers about maternity and child health services, including in-depth engagement with seldom-heard groups; - Patient involvement in the opening of the new Brownsover Medical Practice in Rugby; - Community events raising awareness of diabetes; - Training events for our local GPs to help raise awareness of cancer and how best to support their patients; - Feedback on the future of health commissioning and the future of the Coventry and Warwickshire health and care system; - Working with community and voluntary sector providers, for example local Healthwatch engagement on the NHS Long Term Plan; - Feedback on proposals around the future of stroke services.
Working together Our Communications and Engagement team work across both NHS Coventry and Rugby Clinical Commissioning Group and NHS Warwickshire North Clinical Commissioning Group. We also work closely with our colleagues in NHS South Warwickshire Clinical Commissioning Group. As a result, this review contains a mixture of case studies: some that cover the whole of Coventry and Warwickshire and some for more specific areas and places.
Even when we’re engaging on something across the whole of Coventry and Warwickshire, we use data and information to help us target audiences to make sure that the voice of the people of Coventry, Rugby, Bedworth, Nuneaton, the north of Warwickshire, as well as south Warwickshire, are taken into account so that we can plan, prioritise and pay for services more effectively in those places.
Thank you Thank you to everyone who took part in engagement activity this year. Whether you attended an event, completed a survey or sent us an email, we appreciate your continued support and feedback – you are helping to make the health and care system in Coventry and Warwickshire even better for you, your friends and family and your local community.
Contents Welcome to our annual engagement report for 2019...... 1 Contents ...... Error! Bookmark not defined. About this report ...... 3 Terms used throughout this report ...... 3 A note on abbreviations...... 5 How we involve people ...... 5 Our statutory obligations for involvement ...... 5 Our involvement structures...... 6 Changing how we record equality and diversity in our engagement to better understand our population ...... 9 Our work this year ...... 10 Improving our engagement with seldom heard and hard to reach groups ...... 10 Case study – creating relevant messages for looked after children through co-production ...... 11 Case study – Understanding what matters most to local mothers, mothers to be, families and carers about maternity and child health services ...... 14 Case study - Community events to raise awareness of diabetes ...... 18 Case study - Using patient and public feedback to shape the future of stroke services – an update ...... 22 Case study - finding out what our population needs from planned care services ...... 23 Case study - Supporting Healthwatch to engage on the NHS Long Term Plan ...... 27 Case study - Working with our GP practices to make Coventry and Warwickshire an attractive place to live and work...... 35 Case study – promoting LGBT+ equality through the rainbow badge scheme...... 37 Case study – engaging our population on the future of health commissioning...... 39 Our annual report summary...... 44 Our annual general meeting ...... 45 Working with Healthwatch ...... 45
About this report This report highlights just some of the work people like you have been involved in to help improve the services you receive and the outcomes you experience.
Terms used throughout this report The NHS uses lots of different words to describe what it does, which can be confusing to people who don’t use those words every day or in the same way. Whilst we’ve tried to avoid using them wherever possible to make it easier for everyone to understand this report, sometimes we do have to use them. We’ve explained many of them below, which you may find useful.
Clinical Commissioning Group (CCG) – Clinical Commissioning Groups (CCGs) are NHS organisations which plan, prioritise and buy NHS services for the area they serve (in our case, Coventry and Rugby). Commissioning involves decided what services are needed for our diverse population and ensuring that they are provided. These decisions should be made with the involvement of the public wherever possible. Services the CCG commissions include:
Most planned hospital care Rehabilitative care Urgent and emergency care, including out of hours Most community health services Mental health and learning disability services Primary care services Commissioning – commissioning means planning, prioritising and buying health and care services for Coventry and Warwickshire, based on the needs of the people living here.
Consultation – A consultation, sometimes called a “public consultation”, is legal process through which we seek the public’s input on issues affecting them. Not all engagement leads to or requires a legal consultation.
Engagement/Involvement – Engagement and involvement in commissioning is about helping people to voice their views, needs and wishes, and to contribute to plans, proposals and decisions about services. Engagement and involvement are often used to mean the same thing.
Local authority – This is another name for the council, or the local government organisation which is responsible for providing public services and facilities in our area. Locally we have two main councils: Coventry City Council and Warwickshire County Council. We also work with smaller district and borough councils.
Outcome – an outcome is the result of a patient’s treatment and care. The NHS works to provide the most positive outcomes, such as through improvements in the length of quality of life for the patient. More and more, the NHS is changing the way it designs and contracts services based on outcomes delivered as opposed to number of patients seen.
Patient journey – this isn’t just about ambulance rides! “Patient journey” is the term used to describe how a patient moves through the health system once they become ill or require care and support. This often starts with a visit to the GP or pharmacist and may progress into a visit or stay in hospital. Understanding how a patient moves through the system, including who they speak to and which departments they visit, is important because it helps us to make sure we have the right services in the right place at the right time to make the journey as easy and smooth as possible.
Patient and public – we use the term “patient and public” to include everyone who uses NHS services or may do so in the future, including carers and families.
Patient experience – patient experience is a bit like customer service when you visit a shop: did you have a good experience? Did you get what you needed? What went well? What could have been better? We should always be looking for ways to make your experience better for you. Understanding a patient’s experience helps us improve our services. It is a key element of quality, alongside providing clinical excellence and safer care. Patient experience is also about listening to a patient’s needs and designing the experience to meet those needs to provide an environment where the patient feels cared for and supported.
Planned care - Planned care is the term that the NHS uses for any treatment which isn’t an emergency. This includes pre-arranged appointments at the hospital or within the community, which usually start with a referral from a GP. Planned care covers almost all NHS services, from minor operations and routine tests for treatment, to long-term conditions such as cancer or diabetes.
Primary care – Primary care services are usually your first point of contact in the health system. GPs, community pharmacists, dentists and optometry (eye health) services make up primary care.
Provider – Provider is the term given to an organisation that delivers services to patients. This could include hospitals, mental health, and community and ambulance services. Providers will have a contract with the CCG that states what the provider needs to do, the level of quality expected and how they should involve patients and the public in their work, amongst other things
Secondary care – Secondary care is also known as hospital and community care and includes planned care (see above) and urgent and emergency care.
Urgent and emergency care – these services provide a critical role in keeping the population healthy in an emergency. To help relieve pressure on A&E departments and to ensure patients get the right care, it is important to understand the difference between urgent and emergency care:
Emergency: life-threatening illnesses or accidents which require immediate, intensive treatment. Services which should be used in an emergency include an ambulance via a 999 call and accident and emergency (A&E) departments Urgent: an illness or injury that requires immediate attention but is not a life- threatening situation. Urgent care services can be a phone call to NHS 111, pharmacy advice or an out of hours GP appointment and/or referral to an Urgent Treatment Centre (UTC)
A note on abbreviations The NHS uses many abbreviations and our CCG is no exception! We understand these can be difficult to understand if you’re not familiar with them, so we always try to write them out in full but, just in case we miss any, here are the most common ones used, for reference:
First, there’s our organisation:
CCG – Clinical Commissioning Group, which you may sometimes see written as CRCCG for Coventry and Rugby Clinical Commissioning Group Then there are our local providers and hospitals:
CWPT – Coventry and Warwickshire Partnership NHS Trust GEH – George Eliot Hospital NHS Trust SWFT – South Warwickshire Foundation NHS Trust UHCW – University Hospitals of Coventry and Warwickshire NHS Trust WMAS – West Midlands Ambulance Service Then there are the local councils with whom we regularly work:
CCC – Coventry City Council WCC – Warwickshire County Council Finally, there are some organisations that provide assurance and oversight of our work:
HWB – Health and Wellbeing Board. There are two in our area: one for Coventry, and one for Warwickshire. NHSE or NHSEI – NHS England, who recently joined with NHS Improvement and you may see abbreviated as NHSEI.
How we involve people
Our statutory obligations for involvement Did you know the CCG must, by law, involve people in its business?
Under section 14Z2 of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), our CCG has a duty to involve the public in commissioning.
These legal duties are in place to ensure CCGs such as ours involve people in the planning, prioritisation and purchasing of health services for our area, particularly where there will be an impact on service delivery or the range of services offered to our population.
You can read more about our duty for public involvement and consultation as a clinical commissioning group by reading section 14z2, page 41, of the Health and Social Care Act 2012: http://www.legislation.gov.uk/ukpga/2012/7/pdfs/ukpga_20120007_en.pdf
To fulfil the public involvement duty, we must make arrangements for the public to be involved in the planning of services and the development and consideration of proposals for changes which might impact on services.
Our involvement structures Our CCG has a number of structures, processes and assurance methods in place which help us more effectively involve our population in commissioning.
In this section, we will outline some of those methods and demonstrate how the CCG has fulfilled its statutory duties of patient and public participation in commissioning health and care.
The CCG constitution Our constitution details the ways in which the elected and appointed representatives of the Clinical Commissioning Group organise and are accountable for the commissioning of health services for the population we service.
The constitution outlines in schedule 15, which details our principles in relation to patient and public involvement:
How we involve our population in our commissioning work The principles we follow to involve our population How we ensure transparent decision making Our constitution is available to read on our website: https://www.coventryrugbyccg.nhs.uk/About-Us/Publications-and-Policies/Our-Constitution .
Our Patient and Public Involvement Lay Person We believe it is crucial to good commissioning that the voice of the public is listened to and championed at every opportunity. For this reason, we have appointed a lay person specialising in patient and public involvement who sits on our Governing Body.
Our communications and engagement strategy Our Communications and engagement strategy, available on our website (https://www.coventryrugbyccg.nhs.uk/Get-involved/Our-strategy) , sets out the strategic vision for communications and engagement at our CCG. It outlines our long term approach to communication and involvement and details how we will meet our statutory obligations. It describes how we work to continuously improve our work, adopting new and innovative approaches that will support the CCG to meet the challenges it faces, as well as being tailored to meet the diverse needs of our population.
Patient and public participation in commissioning health and care: statutory guidance for Clinical Commissioning Groups and NHS England This guidance, available online on NHS England’s website, supports the CCG to involve patients and the public in our work in a meaningful way to improve services, including giving clear advice on the legal duty to involve.
The guidance sets out ten key actions for CCGs on how to embed involvement in our work:
1 Involve the public in governance 6 Feedback and evaluate Every CCG must have a constitution, which We want people to feel valued and is a legal document that describes how the encourage them to take part in CCG will carry out its work and be commissioning. One of the ways to do this is transparent in how and why we make to make sure that if people take the time to decisions about which services to buy. share their thoughts, opinions, ideas and concerns, we take them on board and We must also explain how we involve people explain how that feedback has helped shape in commissioning work, following a clear set services. of principles. Commissioning decisions are often very Our CCG Governing Body also must include complicated and it’s not always possible to at least one “lay person” who knows our local take on board every single bit of feedback or area and can make sure we are listening to idea for change and sometimes the decision the voice of our public and opportunities are we have to make might not be the one you created to help people be involved in what wanted – where this happens, we will always we do. try to explain why.
Explain public involvement in Implement assurance and 2 commissioning/business plans 7 improvement systems Every commissioning or business plan must We need to make sure we are meeting our explain how public involvement will be legal duty to involve. We want to make sure carried out. the ways we involve people help them share their views and feel like they’re being This means explaining how our priorities listened to. We’ll always look to improve how have been influenced by engagement and we involve people to make sure it’s as easy, planning and budgeting for future valuable and rewarding as possible for engagement activity. everyone.
Demonstrate public involvement in Advance equality and reduce 3 annual reports 8 health inequalities Every year we must present an annual report Our area is big and has a lot of different that explains how we have carried out our people, communities and groups within it. legal duties, including public and patient We need to make sure that as many people involvement. A large section of our annual as possible have the chance to share their report is dedicated to this, as well as this voice – especially if they’re from a report you’re reading now. community that struggles to do this, or find it hard to access health services for whatever reason.
When thinking about what we need to commission, we should be carrying out equality impact assessments to help identify those with the greatest health needs, those who face barriers to accessing services and
those who are protected under the Equality Act 2010.
Promote and publicise public Provide support for effective 4 involvement 9 involvement If we want public to be involved in our We need to make sure those working in the commissioning activity, we need to make CCG are given the right information, training sure people know how to be involved! and support to help them involve people in their work. We need to tell people about opportunities to get involved using many different “channels”, We also need to remember that CCG staff such as: are people too, and will have their own - Websites experiences of using our services, either as - Social media a patient themselves or through a family - Newspapers and the press member or friend. - Working with community and voluntary sector organisations
Assess, plan and take action to Hold providers to account 5 involve 10 Before we carry out any work we should, We often work with other organisations, such wherever possible, check to see what the as local hospitals, which provide services to benefits of public involvement might be, and our population. what our legal duties for involvement are. We need to make sure that our providers Examples of where we should involve the meet the standards set out in their contract public include: with us when it comes to communicating with and involving services users, the public - Changes to how services are and staff. commissioned - Buying new services through a NHS trusts and NHS foundations trusts have procurement exercise their own legal duty to involve the public, - Starting, changing or ending a which can be found under section 242 of the contract to provide services National Health Service Act 2006, as amended by the Health and Social Care Act 2012.
Our principles for participation We’ll come to you rather than expect you to come to us, and involve you in ways 1 that work for you We’ll promote equality and diversity, respect and encourage different beliefs and 2 opinions in order to better understand the needs of everyone who lives in Coventry and Warwickshire We’ll work hard to involve those who might otherwise struggle to have their 3 voices heard We’ll value your lived experience and use all the strengths and talents people 4 bring to work towards shared goals and improvements We’ll make sure information is clear and easy to understand, whilst recognising 5 that people may have different needs
We’ll plan and budget for involvement to make sure you’re involved as early as 6 possible We’ll be open, honest and transparent about how we work, tell you about the reason for decisions we make and be clear about any resource constraints we 7 have. Where we can’t tell you everything, because the information is confidential, we’ll explain why We’ll invest in our relationships and partnerships, have ongoing conversations 8 and provide the training, support and information to help all of us work, learn and improve together We’ll review the feedback we receive, both good and bad, and learn from it to 9 continuously improve how people are involved We’ll recognise and celebrate people’s contributions and explain how your involvement helped us improve services. Where your feedback can’t be taken on 10 board, we’ll always try to explain why, where possible.
Continuous improvement and evaluation When undertaking the development of service change proposals, commissioning new services, or working with providers to redesign services, we use a standardised approach to developing our engagement projects to provide assurance and consistency. These are detailed in our engagement strategy 2017-2020 but comprise of three main areas:
1. Understand the current position, national and local drivers for change and who is affected and impacted by any change. We also assess what we already know from other engagement work and what else we need to know; 2. What we do to involve patients, stakeholders, staff and members of the public to understand their views; 3. Translating the understanding into actions, developing outcomes, desirable criteria and solutions. We then support the commissioning team through the development of a case for change, business case and consultation where appropriate.
Through the use of a standardised approach, we are able to evidence our ongoing activities across multiple areas. This approach is demonstrated throughout this report, where we show what we understood, what we did, who we involved and how we translated the understanding into outputs, outcomes and impacts.
In order to demonstrate our activity and impact throughout the year, our engagement activities are reported on to the Governing Body through an engagement report, aligned to our statutory duties.
Changing how we record equality and diversity in our engagement to better understand our population During 2019 we made the decision to update our equality and diversity monitoring forms, which we use whenever we engage with the public, whether that be face to face, online or via surveys.
Why do we need to monitor equality and diversity? Understanding the diverse makeup of our local population helps us to identify their needs and whether the services we provide are right for our patients and communities. It also helps
us to know whether our services are provided fairly and equally, regardless of background. Finally, it helps us to ensure our services can be more accessible and inclusive to all.
What did we change? In recognition of the increasingly diverse society in which we now live, and acknowledging not everybody fits into a traditional “tick box” form, we added a “prefer to self-define” option to the gender and sexual orientation questions. This meant those who don’t define themselves using traditional terminology were able to use their preferred descriptions.
Did it make a difference? It did! Not only did we start to see people using the option to self-define, we had positive feedback from our communities about being given the opportunity to do so as it felt more inclusive. This will really help us ensure we commission services for our whole population.
Our work this year This section will highlight some examples of our work this year.
We were awarded “Green Star/Outstanding” for our patient and public involvement in commissioning This year we were awarded Green Star/Outstanding for our compliance with the statutory guidance on patient and public participation in commissioning health and care for 2018/19 as part of NHS England’s CCG annual Improvement and Assessment Framework audit.
The framework requires the CCG to submit evidence of how it has involved patients and the public in the commissioning of health and care services for that reporting year. The submission is split across a number of topics such as governance, day-to-day practice and how the CCG involves people to improve equalities and reduce health inequalities.
The evidence provided by the CCG is subject to a number of reviews before being given a final score. To achieve a rating of “Green star/Outstanding”, a CCG must score a minimum of 14 out of a possible 15. For 2018/19, NHS Coventry and Rugby CCG achieved the maximum score of 15.
We’re grateful to everyone who has worked with us this year and who have given their time and support to engage and improve health and care outcomes for themselves, their family and friends and their local communities.
Improving our engagement with seldom heard and hard to reach groups A big focus for us in 2019 was improving our engagement with seldom heard and hard to reach groups and communities. Typically these groups struggle to engage in ways that are meaningful, which can be for a variety of reasons such as language, culture or accessibility. This lack of engagement can also mean that the needs of those groups are not always taken into account, furthering the divide many already feel between their needs and the services we offer.
It is a priority of the CCG to ensure that all the voices of our diverse population are heard, and have a chance to input into our work. To achieve this we work closely with the voluntary sector proactively, attending targeted groups and events to ensure people are given the opportunity to make their voices heard.
During 2019, we really tried to improve our connections to these groups and our involvement with the community and voluntary sector organisations who represent them.
This effort was rewarded, as we saw some of our most informative, valuable engagement with our local communities on topics such as maternity and child health services and planned care, including many groups, helping us to understand the specific needs of those communities. This will really help us to commission services which truly meet the needs of our whole population in the future, improving accessibility, advancing equality and reducing health inequalities.
Our case studies Each piece of work is presented as a case study to show how the CCG, partner organisations and members of the public worked together to solve a problem, overcome a challenge and improve health and care services. To make it easier to follow, they are laid out with the following headings:
The challenge we faced – the local NHS faces many challenges, from funding to staffing to capacity to demand – sometimes all at once!
What we did – our response to these problems often involves trying new things, having health professionals work more closely together (which is sometimes called “multidisciplinary working”) or commissioning new services in order to improve outcomes for our population.
Who we worked with – partnership working is vital to the success of the health and care system across Coventry and Warwickshire and it is becoming more and more important to work across organisations and boundaries to make sure our population get the best care for their needs.
The outcome – it’s important to show how your feedback has helped to improve the services you use, or how by working more closely together between commissioners, service providers and the local authority, we have improved services more than we could have done alone.
Next steps – a commissioner’s work is never done! Some of the work in this report is just the start of an ongoing journey to improve services, and there is more work to do to continue to meet the needs of our population.
Case study – creating relevant messages for looked after children through co-production
The challenge It is a challenge to communicate key health messages to children and young people. Many looked after children have perceived problems with authority, and traditional communication channels are often not appropriate or relevant to them. Additionally, healthcare is often considered to be a low priority amongst children and young people.
What we did Working with a group of looked after children and young people, we produced four quick, animated videos, called “infotoons”, which look to raise awareness of how to access key primary care health services, such as how to register with a GP, registering with a dentist and understanding and getting immunisations. The children were involved throughout, helping to design, revise and approve the videos, and also provided voice overs for the content. This helped to ensure messaging was current and relevant to the audience.
The infotoons were developed to be:
Easy to follow, with simple messaging people could take on board quickly and clearly Attractive, to help draw the attention in a way that is pleasing to the target audience Social, explaining what most people do and what people should do differently Timely, ensuring the children had the right information when they needed it Novel, interesting and surprising, using imagery relevant to young people Informative, highlighting inconsistency with lifestyle choices Contemporary, helping to reframe health messaging Relatable and emotive, using emotional contrasts of fear and of pride We also developed, in collaboration with the children, a set of “grab guides” – illustrated information leaflets containing key messages, important information to remember and easy to follow, step by step guides on how to “grab control” of their health and wellbeing.
Who we worked with This work was led by Lyn Parsons, our Designated Nurse for Looked after Children and her team, to support some of the most vulnerable young people in our area.
20 looked after children and young people, and care-experienced adults, who were integral to the co-design of the content An artist who helped facilitate design sessions, getting everyone involved Doctors and nurses specialising in supporting looked after children; regional and local commissioners; Directors of Children’s Services for local authorities, all of whom helped develop key health messaging Coventry Voice of Care and Care Leaver’s Forum, which helped ensure the work was relatable and me the needs of the target audience Residential care home managers and the Foster Carer Forum
The outcome The project was delivered within budget and on time, with the planned implementation to align with the Local Authorities care leavers offer.
Following a successful launch in December 2019, the infotoons have been shared with other providers and NHS England as a trusted resource for looked after children’s teams to use nationally.
Social Worker Manager: “These are a fabulous engaging resource. We are going to embed them into the young people’s pathway plan to help guide them to meet their basic health care needs”
Social Worker: “I think they are great and the young people I have shown them to really get the messages”
Looked After Children’s Nurse: “These are brilliant. We are using them when we do the health assessments with all 15-18 year olds to help demystify registering with a GP, Dentist and Optician. The immunisations one is great as it’s a challenge to convince young people to get their booster injections and this helps to share the message really well in a way they will understand. Genius!”
Looked after Young Person: “It’s really great to see that the messages we worked on haven’t been changed….these are our ideas about what young people think are important and are not like the usual instructions and list of things we have to do. They show good choices and help us to make the best decisions”
Director of Public Health: “Wow! I took a bit of convincing about the cultural references, but they really hit the spot”
Next steps The programme will continue to develop the infotoons and share the content to help looked after young people better navigate the health and care system. We will continue to involve the young people in the development of this work and share it more widely to enable other areas to support their looked after children.
Case study – understanding what matters most to local mothers, mothers to be, families and carers about maternity and child health services Over the last year, the three CCGs across Coventry and Warwickshire have spoken with almost 1000 mothers, mothers to be, families, carers, frontline NHS staff and community and voluntary sector organisations to learn about their experiences of receiving, delivering or supporting maternity and child health services.
The challenge There is a lot of good work happening across Coventry and Warwickshire to deliver maternity and child health services, but we recognise we can do more to continue to make these services better.
We are facing a number of challenges, however:
- How we provide services now won’t meet the expected demand and requirements in the future - Our services aren’t as efficient as they could be - Our services don’t always meet the needs of our population Before we could start thinking about how services might need to change to meet these challenges, we needed to speak with our population and those using these services to understand what their experience had been, what was important to them, what they thought worked well and what they’d like to see improve.
What we did The engagement, led by the CCG Communications and Engagement team, looked to gather feedback from our population on maternity and child health services.
First, we did our research to understand what work had already been done at a national and local level to engage with people about maternity and child health. We reviewed feedback people had provided in previous engagement and looked at where we could learn new things and gather fresh insight. We wanted to avoid asking the same people the same questions again and again as we know they can find this frustrating.
We then identified our key audiences – those who are most involved with or most affected by maternity and child health services: mothers, mothers to be, carers, families, frontline NHS staff and community and voluntary organisations.
We looked at the best ways to involve these audiences in the engagement work: where could we find them? How could we make it easier for them to take part, and what was the best way of gathering their feedback? We adopted a mixed approach to engagement, conducting face to face sessions either one to one or in groups; we took part in telephone interviews and offered an online and paper survey for people to complete.
We worked with local children’s centres and hospitals to go out and meet people on their terms and in surroundings they felt comfortable in to help us:
Listen to their experiences of receiving, supporting or delivering these services; Acknowledge what they think works well currently, and see how we can build on it Understand what they think needs to improve and look at changes we can make to meet their needs
Once we had gathered a significant amount of feedback, we started to see common trends and themes in the feedback, so we began a process of gathering the feedback under a number of key headings such as “access” and “person-centred care”, based on what people had told us. Once this was complete, we went out and spoke to people again to make sure we were on the right track, check that our suggested themes still reflected what they had told us and to see if there was anything else they wanted to add. Everyone we spoke with agreed that the themes were the things that were most important to them, and that they appreciated being involved so heavily in the development of the themes, which was really positive.
Throughout our engagement we had spoken to a wide variety of the population including those from seldom heard and hard to reach communities, but we recognised there were more opportunities to speak with people from these groups to ensure their voice was heard.
To address this, we looked at the data of who we had already spoken with, identified groups or communities where additional feedback would be valuable and then set out to do further engagement with them. This approach enabled us to speak with over 200 people from a variety of groups and communities who might have otherwise struggled to have their say:
- People living in communities with high levels of deprivation - Black, Asian and Minority Ethnic groups, with particular focus on refugee and asylum seekers - Teen parents - Parents of children with additional needs - Rural communities - Fathers and male carers - Gypsy/traveller communities - Vulnerable young parents (i.e. those suffering abuse) “I feel we get really personalised care, staff talk to my son, and they make sure they are facing him when they talk to him – we’ve had to fill out forms before about additional requirements and so the doctors and nurses understand what’s important to him”.
Who we worked with We were very lucky to be supported by a number of local community and voluntary sector organisations, parent and toddler groups, refugee centres, and children’s centres, which helped us reach more people than we would have been able to alone:
Camp Hill Children’s Centre George Eliot NHS Trust Archie’s Smile Grapevine Atherstone Parent and Toddler Healthwatch Coventry group Healthwatch Warwickshire Boughton Leigh Children’s Centre Kairos – Women Working Together (Barnardos) Kingsway Children’s Centre Bulkington Disability Sports New Family Social Session Parents in Mind (NCT) City Pink Pathlow Traveller site Claverdon Parent and Toddler Pink Parents Group Proud2b Parents Coventry and Warwickshire Queen’s Rd Baptist Church Friend/Stonewall Rainbow Families Coventry and Warwickshire MIND Riversley Park Children’s Centre (Mums in Mind) (Barnardos) Coventry Comfort Carers Roots to Branches Autism Network Coventry Haven Rugby Young Parents Group Coventry Lesbian and Gay St Margaret’s Church Christian Movement Stratford Children’s Centre Coventry LGBT Stratford upon Avon LGBT Coventry Prism South Warwickshire NHS Coventry Refugee and Migrant Foundation Trust Centre The Parenting Project (Stratford Edward St Community Centre District) Entrust Care Partnership The Roma Project FWT/Mamta The Ups of Downs
Tredington Traveller site Valley House University Hospitals Coventry and Warwickshire Gypsy and Traveller Warwickshire NHS Trust Support Service Valley House Warwickshire Pride
The outcome This engagement has helped us identify what matters most to people when it comes to maternity and child health services, which has been summarised below. Our targeted approach has meant that the feedback has come from those most involved in or affected by these services. Our additional engagement with seldom heard groups has made sure our work is as robust and inclusive as possible.
Overall we have spoken to almost 1000 people about their experiences and feedback on maternity and child health services. There were some really positive, inspiring stories of excellent care and support being offered to people, and some less positive ones of how services hadn’t met the needs of that individual or family. With all this in mind, we can begin to consider how our maternity and child health services can build on the excellent work already taking place and work to improve services to meet the needs of our population in a consistent, safe, equitable way.
The picture below shows the key themes and what they mean to people:
Next steps Now that we’ve gathered all this really useful feedback, we need to work with our local providers and public to think about how maternity and child health services might need to change to meet the needs of the people living in Coventry and Warwickshire and meet national and local guidance.
This is just one part of an ongoing journey and we want to bring you with us every step of the way. There is still a lot to talk about and there will be plenty of opportunities to shape and influence the future of maternity and child health services.
Case study - community events to raise awareness of diabetes We’re always looking for new and exciting ways to involve patients and the public in our work and this was seen in our recent community diabetes events and empower them to become advocates for health and wellbeing.
The challenge Diabetes is a serious long term health condition, with many people in our area at risk of developing the condition due to diet and lifestyle. Diabetes is particularly prevalent to the South Asian community, who are up to six times more likely to develop type 2 diabetes than Europeans. In fact, whilst South Asians make up just 4% of the UK population, they account for 8% of all diagnosed cases of diabetes1.
What we did One of our recently trained ‘Diabetes Community Champions’ was keen to get the diabetes awareness message out to the congregation at his local temple in Coventry (GNP Gurdwara), so contacted the CCG and local Lions Club charity to organise a community diabetes event to mark world diabetes day.
We also worked with the Head and Neck Consultant Surgeon at University Hospitals Coventry and Warwickshire NHS Trust, who approached the CCG about planning a diabetes awareness event at the Ramgharia Gurdwara, in collaboration with the Lion’s Club.
The two events were supported by the CCG to bring together a range of local support services, such as the Healthier You prevention team, Diabetes UK, Prostate Cancer UK and local volunteers.
The CCG worked with the local community and young people from across Coventry and Warwickshire to produce type 2 diabetes BAME community awareness videos, which were launched at the events – the video can be viewed on YouTube here: https://youtu.be/LDPiz20l7Yg?list=PL_66SBBBrM4SovJTYCifL1EOOZaeS1xmM
A joint press release was issued to local, regional media and Asian news outlets such as; Radio Panj and World News Television Network (WNTV) News Channel, we included a quote from NHS Coventry and Rugby CCG, George Eliot Hospital NHS Trust and The Lions Charity Club. Posters and flyers were distributed at local businesses and places of worship in the Foleshill and Hillfields area, this was be led by the Lions Club. The Communications and Engagement team at the CCG led on the social media messages via Facebook and Twitter.
Facebook activity: @HealthcareCovRugby People reached – 42,521
1 https://www.diabetes.co.uk/south-asian/
Likes – 17 Engagements – 136 Shares – 8
Who we worked with These events were truly collaborative, with many members of the NHS, local community and voluntary sector coming together.
Diabetes UK George Eliot Hospital NHS Trust GNP Gurdwara Lion’s Club of Godiva Coventry charity organisation National Diabetes Prevention Programme Prostate Cancer UK Ramgharia Gurdwara Sikh Channel UK University Hospitals Coventry and Warwickshire NHS Trust
The outcome The events were highly interactive, fun and engaging. Over 250 people attended GNP Gurdwara, and over 350 attended the event at Ramgharia Gurdwara.
Diabetes screening was offered at the event, with 211 taking part to have their HbA1c blood glucose levels checked. Blood pressure checks were also carried out by NHS volunteers, along with height, weight and waist measurements to help determine people’s body mass index (BMI) to help determine whether they were “at risk” of developing diabetes. One in ten people were diagnosed on the spot as being pre-diabetic, and given expert advice on next steps on how to manage their lifestyle to avoid developing diabetes.
The CCG were also featured on a TV show highlighting its work in the community and advising people on how to prevent getting diabetes. The show was a live interview and broadcasted across the world. The interview was conducted in both Punjabi and English to accommodate the viewers. So far there have been 4,700 views, 130 comments/likes and 20 shares of the live footage.
Our sincere thanks and gratitude to the members of Coventry Mercia Lions Club, especially Lion President Karam Bhairaj (NHS Diabetes Community Champion), Lion Vice President Davinder Prasad, Lion Rakesh Sachdev and Lion Ravinder Sandhu who were instrumental in organising the event in partnership with the NHS.
Next steps The CCG will continue the positive work and community engagement and we have already planned a number of community initiatives to take place over the coming weeks and months.
We are now joining forces with the local Langar Aid Team in Coventry and Warwickshire to help us maximise our reach into our community, with a focus on the homeless, rough sleepers and those living in temporary accommodation as we know their ability to access health information is limited and fragmented.
We have also delivered face to face sessions with a women’s only group at the Ramgharia Gurdwara and will be arranging sessions with the Nepalese community, the Gujarati community, the African Caribbean community and those with learning disabilities during 2020.
Case study - using patient and public feedback to shape the future of stroke services – an update We have reported on our engagement on stroke services in previous reports, so this serves as an update to activity over the last year and demonstrates how engagement has continued to help shape our thinking and proposals for the future of stroke services.
The challenge Current stroke services in Coventry and Warwickshire are providing a good standard of care, but they are not meeting national guidance. They can also offer different levels of care depending on where a person lives. Initial engagement around improving stroke services in the area had taken place previously, and some key themes had come out of that, such as the need for a greater focus on rehabilitation and to minimise any impact of changes to travel.
We want to improve stroke services for local people. To make this happen we know we need to change services and invest in specialist rehabilitation, ambulance transfers and medicines. We feel that it is important to make this investment in order to reduce the chances of people having a stroke and the disability resulting from a stroke.
Over the past five years we have listened to feedback from our extensive public engagement and taken this into account in our final proposals for public consultation. Our proposed options were developed with local clinicians, patients, carers, community groups and our dedicated patient and public advisory group.
What we did Our engagement focus on stroke services during 2019 has covered a number of topics including staff levels, the importance of rehabilitation and transport, all in response to public feedback at previous engagement opportunities.
On 9th October 2019 we launched a formal consultation with the public to have their say on our proposals, which had been changed and refined to reflect the feedback we’d been given and make sure they meet the needs of our population.
As part of the consultation process, we have offered stakeholders and members of the public a variety of ways to share their feedback and find further information. This has included an online and paper survey and a series of community events, held at various times and locations across Coventry and Warwickshire, to give people the chance to review, feedback on and ask questions about our proposals. Events have been publicised online via websites and social media, as well as through the local press and community and voluntary sector organisations.
We used a market-stall approach to the events, where each aspect of the proposal, such as clinical models and finance, had its own stand. We found this allowed people to pick and choose the aspects they were most interested in discussing, rather than adopting a more typical “town meeting” approach and presentation. It also gives more time for questions and feedback and gives those who might not feel comfortable asking a question in front of a
large crowd an opportunity to have their say in smaller groups or one on one with the clinicians, stroke survivors and others involved in the transformation project.
We also publicised our stroke consultation document across the area, printing 5,000 copies for distribution across public libraries, community centres, local hospitals and GP surgeries, as well as via our colleagues in the community and voluntary sector.
Who we worked with The key partners in this work are:
NHS Coventry and Warwickshire CCG NHS South Warwickshire CCG NHS Warwickshire North CCG University Hospitals Coventry and Warwickshire NHS Trust South Warwickshire NHS Foundation Trust George Eliot NHS Trust Coventry and Warwickshire Partnership Trust Warwickshire County Council Coventry City Council West Midlands Ambulance NHS Foundation Trust We have worked extensively with local patients, carers, clinicians, community groups and a dedicated Stroke Patient and Public Advisory Group.
The outcome Our engagement work to date has led to the proposed options being reviewed as part of the consultation. The input we have received has made a real difference in the production of our plans and we would like to thank everyone that has contributed.
Next steps The feedback gathered during the consultation will be collated and reviewed and presented to the CCG Governing Bodies following a period of reflection and due regard, after which a decision on the future of stroke services for Coventry and Warwickshire will be made.
To keep up to date with the latest news on our plans to develop stroke services in Coventry and Warwickshire, visit our website: https://www.strokecovwarks.nhs.uk/Home
Case study - finding out what our population needs from planned care services Planned care is the term that the NHS uses for any treatment which isn’t an emergency. This includes pre-arranged appointments at the hospital or within the community, which usually start with a referral from a GP. Planned care covers almost all NHS services, from minor operations and routine tests for treatment, to long-term conditions such as cancer or diabetes.
The challenge The NHS has recently published a “long-term plan”. This plan sets out how, over the next ten years, the NHS will use extra funding to focus on things that can make a real difference to the health and wellbeing of our population.
In order to do this, we need to make sure that planned care services being delivered across Coventry and Warwickshire are the best they can be; high quality, safe, effective and delivered in the right place by the right health professional.
We need to recognise what we’re doing well, celebrate and share success and look for ways to improve to make sure we have a good quality of care being delivered to everyone.
What we did Between April and July 2019, the local Clinical Commissioning Groups went out and spoke to hundreds of local people, frontline NHS staff and community and voluntary sector workers and asked them:
What do you think is working well? What would you like to see? Is there anything you think could be improved? Have you ever faced any barriers or difficulties to accessing healthcare? What could you do differently to improve your own health and wellbeing? We spoke with hundreds of people across Coventry and Warwickshire, with a particular focus on those who might typically find it difficult to access health services or have less opportunity to give their feedback on their experiences.
Key audiences we engaged with included:
Youth audiences Elderly BAME audiences Homeless and vulnerably housed Gypsy and Traveller community Carers LGBT+ audiences Those with disabilities/long-term health conditions Those with mental health issues Employed people Community and voluntary sector groups representing all of the above General practice A wide range of health professionals from a number of roles and departments working in hospital planned care services across GEH, SWFT and UHCW
In addition to the questions above, those working in hospital planned care services were also asked:
What are your thoughts and ideas generally around the topic of Planned Care to gain a better understanding of what ‘good’ Planned Care looks like and areas that could be built upon in the future How can the NHS provide the best Planned Care experiences for patients? How staff see their role in influencing and providing the best experiences for patients? Looking at referrals for appointments – what works now, and is there anything that could be improved or built upon? Thinking about information included in referrals received, what works? And is there anything that could be improved? If referring onwards…What works well? Is there anything that could be built upon or improved? What do staff hear about that is perceived positively by patients and service users? Which aspects of the service do patients feel could be improved? What outcomes should be aimed for in terms of providing the best Planned Care services for patients? What do staff think patients would be looking for to create a positive experience / positive journey through the care pathway? After analysing all the feedback received, a number of key themes were identified as being the most important to people and would work well as the key outcome framework domains:
Access – easier access to services where access means the ease of making and booking appointments, the availability of appointments, the types of appointments available, the convenience of appointments, the ease of getting to and from services; getting the right information, advice and guidance to help make choices about care; consideration of how travel and transport can impact access. Communication - with and between patients, families and between organisations, departments and staff. Empowered and supported workforce - best staff to support patients, good customer service; every contact counts; access to the best services no matter where a person lives or their personal history; services which react and develop to provide the best possible outcomes for patients and their families. Patient journey - a seamless patient journey through all treatments and interventions, underpinned by joined up working between teams. Person-centred care – services which understand a person’s needs, wishes and history; services delivered with compassion, empathy and understanding; feel listened to and respected; involved in decisions about care; services delivered closer to home; don’t always want to go to hospital for routine appointments Prevention – support to help people manage a healthy lifestyle and improve wellbeing; support to avoid getting ill in the first place; education and awareness raising of key health topics; how to better manage a long-term condition when required. In addition to the more general feedback, we also gathered a range of feedback specific to certain groups or communities including the elderly, young people, BAME communities, homeless and vulnerably housed; gypsy and traveller communities, carers, LGBT+ and
those with mental health or additional needs. This feedback does fit into the key themes above, but it is important to note that it is feedback that needs to be given due consideration to ensure services are planned, prioritised and delivered to reach our whole population, reduce inequalities and improve outcomes for all.
Who we worked with University Hospitals Coventry and North Warwickshire College Warwickshire NHS Trust (Nuneaton Campus) Hospital of St Cross, Rugby Warwickshire College (Leamington George Eliot Hospital NHS Trust Campus) South Warwickshire NHS Foundation Trust (via earlier engagement, Summer-Autumn 2018) Hill Street Over 50’s Club, Rugby Bedworth Older Peoples Club (and Food Bank) The Roma Project, Coventry Hope in Unity, Coventry Edward Street Elder Asian Group, Nuneaton Nepalese Community, Nuneaton ESOL class, Sydni Centre, Leamington Baitul Ehsan Mosque, Leamington The Jesus Centre, Coventry Salvation Army, Nuneaton Helping Hands, Leamington Woodside Traveller Site, Rugby Corley View Traveller Site, North Warwickshire Carers Trust, Wellesbourne Carers Trust, Hartshill Carers Trust, Coventry The Gap Community Centre, Warwick Coventry Pride (Trans and Gender Variant Group) Warwickshire Pride Coventry and Warwickshire MIND, Rugby Coventry and Warwickshire MIND, Mancetter Springfield MIND, Leamington Spa Coventry railway station Nuneaton railway station Leamington Spa railway station Coventry College Rugby College
The outcome Overall we received some fantastic feedback. Taking the opportunity to go out and speak with those who might traditionally struggle to have their voices heard was a really valuable experience and helped us build stronger links with these communities and groups.
Getting an idea of what our population wants and needs from planned care services will really support us in how we plan, prioritise and deliver those services to improve health outcomes.
Next steps We will continue to analyse the feedback we received and group it into the common themes above (creating additional ones, if necessary). We will then use this information to start drafting desirable criteria and outcomes, which we will take back out to these audiences to check and challenge.
Once complete, we will present the findings to our providers to help them start thinking about the future of planned care services.
Case study – new practice in Rugby opens thanks to patient involvement
The challenge The CCG took responsibility for the Brownsover Medical Centre development programme in October 2017. The original Brownsover surgery on Bow Fell closed in 2015 and the development of a new practice had been long-delayed. This had understandably frustrated local residents, so the CCG took a very proactive approach to involving patients in the commissioning process.
What we did The CCG set out a clear engagement strategy that put local people at the heart of the process to provide GP services at the practice. This process took place over a couple of years and concluded in 2019 with the successful opening of the practice.
In 2017-18 we asked for volunteers to take part in a Patient Advisory Forum. This group were involved in the procurement of a new provider of medical services for Brownsover Medical Centre and included local residents, the Brownsover Community Association, the Brownsover Patient Action Group as well as representatives from Healthwatch and the voluntary sector.
In 2018-19, this group formed an instrumental part of the procurement for the new service Some members of the group were asked to be involved in the following activities, for which we gave them special training and support:
Helping draft the invitation to tender, specifically the patient engagement and involvement questions Reviewing and scoring the submissions we received Interviewing the final candidates Local residents were also heavily involved in the practice development, helping to ensure the medical centre was developed based on the needs and expectations of local people, and much of their feedback has been taken on board and incorporated into the new medical centre as part of a positive investment for the local community. For example, members of the community helped chose the interior paint scheme, inspired by Rugby Golf Course.
The group were able to join a tour of the site whilst it was still under construction in November 2018, prior to the opening of the site in January 2019.
Who we worked with Local residents helped lead the charge on this work, with involvement from:
The Brownsover Patient Action Group Brownsover Community Association Healthwatch Warwickshire Warwickshire Making Space Health and Social Care Warwickshire Community and Voluntary Action Warwickshire Equality and Inclusion Partnership Local primary care staff Rugby Borough Council
The outcome The keenly anticipated Brownsover Medical Centre opened its doors to local residents on Monday, 28th January 2019, conducted by the Mayor of Rugby, Mark Pawsey, MP for Rugby and Jake Stevenson, local resident and Chair of the Brownsover Patient Action Group and Andrea Green, Accountable Officer for NHS Coventry and Rugby CCG at the time.
The new, £2.3 million investment, purpose-built centre covers 624 square metres and includes five consultation rooms, two treatment rooms and a waiting room which can seat up to 34 people. It has been designed to support up to 10,000 patients by 2030, based on expected population growth for the area over the next decade.
By being so heavily involved in and vocal about the development, local residents have ensured the practice has been designed to meet their needs and the needs of the future population of the area.
The approach we took to involve local residents has since been used to similar positive effect for a number of other primary care projects, helping us continue to improve what we do and build on best practice.
Case study – providing hope to families through coproduction: together for autism conference 2020
The challenge Autism is an area of commissioning that needs regular attention and service development to effectively meet the needs of the population.
A cross-sector, all-age strategy is due to be published in 2020, with the aim of improving the lives of people with autism across Coventry and Warwickshire. The strategy was coproduced with Grapevine, a local charity supporting local people tackle issues such as isolation, poverty and disadvantage, through a series of multi-agency partner events. At one of the coproduction events the idea of organising a conference to support local people was discussed, and all agreed it would be a fantastic way to support local people.
What we did The CCG supported Act for Autism, a Warwickshire-based social enterprise that draws on personal experience, extensive training and research to educate, coach and support young people, families and professionals about autism, to organise a conference which would:
Address the difficulties in navigating available support Raise awareness of the support available Help those who feel alone in trying to understand information and advice Turn information and advice into practical support Acknowledge and address parents’ experience that less information/training is available to them than is available to professionals Address the experience of being “left” whilst waiting a long time for a diagnosis The organisation and running of the event was led by Act for Autism, and the CCG supported by sending out conference information so that services would be represented. The act of coproduction for the autism strategy meant that a shared understanding of principles and objectives are already in place and commissioners could step back and encourage individuals and organisations with creative approaches to solving problems and achieve excellent results for the people of Coventry and Warwickshire.
The conference brought together families, children and young people with autism alongside those already providing support and advice in local communities. The purpose of the conference was:
To highlight the help already available to children and young people To give hope to families who are waiting for or have received a diagnosis of autism To offer practical strategies and advice to help families from day to day One of the conference organisers said “I wanted to organise the conference I would have wanted when my son was six. We know that parents need this information”.
The conference covered some of the most important issues for parents and stalls were used to provide advice and support, not sell services or products.
Who we worked with This was a truly collaborative process, and the CCG was proud to be a part of it. There were dozens of organisations involved, including:
Act for Autism Grapevine Coventry and Warwickshire Partnership NHS Trust Warwickshire County Council Warwickshire SEND Information, Advice and Support Services (SENDIAS) The Girl with the Curly Hair Coventry and Warwickshire MIND
The outcome Over 300 families attended the event and accessed the advice, support and workshops. Parents appreciated the timing and content of the event, and valued that it was available for free. They felt their issues were seen, and were important to the conference organisers and funders. They were really keen that there would be more of these events in the future.
The conference provided:
Peer support for families and young people Opportunities to access local early help to support self-management Access to information to help them understand what works for them Networks and connections between services, charities, parents, young people and commissioners Practical tools to help parents and young people manage their challenges and build on their strengths The conference also helped to foster the hope that people with autism can have a good life. It provided a sense of community that is made up of services, charities, parents, young people and commissioners, coming together to improve the lives of families and young people with autism.
Next steps
Case study - patient involvement helps influence GP contracting decisions
The challenge Our CCG is committed to ensuring that patients have access to high-quality general medical services. Our goal is to make sure that we provide the right services for our entire population, which make the best use of the resources available to us.
There are currently a number of General Practices in our area which are procured through an Alternative Medical Service Contract. These contracts are time-limited, and we had four practices whose current contracts were scheduled to expire on March 31 2020. The CCG needed to consider how general medical services should be provided when these contracts expire, to ensure that we are commissioning high quality services for our entire population, which make the best use of the resources that we have, both now and in the future. A number of factors were part of this decision process, including finance, performance, sustainability, practice size, other local provision and local patient need.
We were not able to keep things as they were as the CCG has a legal obligation to offer the chance to bid on any new contract to all interested providers, including the existing provider, to ensure services continue to improve and offer the right support to their patients.
What we did We conducted an engagement exercise to understand the needs of patients at the practices, and consider how the practices are currently used, how many patients are registered at the practice, and the capacity of other practices in the area to take on more patients if required.
Patients were asked to give their views via a survey on what they thought their practice was doing well, anything they are not satisfied with and what was most important to them in the GP services that they received. It also explored the impact any changes to, or closure of, their current GP services would have, and what travel distance they considered reasonable to access GP services.
The survey was available online and in-practice, and also promoted through the CCG website, social media and local press, as well as through our contacts in the community and voluntary sector. We also spoke with a number of seldom heard groups who were representative of the practice profile, supporting them to fill in the survey where requ ired, because we knew they might not always get the opportunity to share their views and make their voice heard. The results of the survey were cross referenced with the results of the national patient survey results for each practice.
The CCG also tested the market to understand if there was interest from providers for taking on the practices. Once we identified that there was sufficient potential interest, we put the contracts out to tender for potential providers to bid on.
To assist us with this and ensure we kept patients at the heart of the procurement process, we worked with local community and patient representatives, as well as Healthwatch Warwickshire, and invited them to take part. We used questions previously developed with
patient groups for the procurement of GP services, which included questions on how the practice would keep patients at the heart of service delivery and how they would involve the patient groups, particularly seldom heard and vulnerable patients, in practice business. The group supported us by evaluating the patient experience elements of the responses.
Who we worked with We made contact with a number of local community and voluntary sector organisations to gather feedback and local views.
Foleshill Women’s Training (BME Women) Ekta Unity (Older Asian women) Hope Unity (Afro-Caribbean community inc dementia and carer support) Carer’s Trust Family Information Hubs (Coventry area) Coventry Older Voices Healthwatch Coventry Healthwatch Warwickshire Coventry Pride
The outcome Our engagement with patients at each practice helped us to decide to put the contracts out to tender for providers to bid on, meaning patient feedback directly influenced our decision making.
Once the decision to proceed with the procurement was taken, we worked to set up a smaller patient reference group which included representation from local BAME communities, someone living with a long-term condition and a community and voluntary sector representative, who have been trained and supported to take part in the procurement exercise by helping review the patient and public involvement questions in the bid and review and score the bids we receive.
By following this process, local patients have had a say in who wins the contract to deliver services at the practices.
Next steps Once the procurement exercise is complete, and if a provider is successful in bidding for the contracts, they will be awarded the contract to provide general medical services at the practices.
Case study - supporting Healthwatch to engage on the NHS Long Term Plan Healthwatch is an organisation which works to ensure the voice of patients is heard in every decision that affects them. Their sole focus is on understanding the needs, experiences and concerns of everyone who uses local services, so that they can provide the public with relevant information on how to access services. We work closely with both Healthwatch Coventry and Healthwatch Warwickshire to ensure our work takes their feedback into account, and they support us in making sure our engagement meets the needs of the population.
The challenge In 2019, the Government announced that the NHS budget will be increased by £20 billion a year. In January 2019, the NHS in England published an ambitious ten-year plan showing how this extra money will be spent.
What we did From March to April 2019, we supported Healthwatch Coventry and Healthwatch Warwickshire, who led an engagement exercise get people’s feedback on the NHS Long Term Plan and what mattered most to them.
Healthwatch launched two surveys: a general survey, which asked how to make care better, and understanding what changes are needed to get people the support they need, and; a specific conditions survey, which asked about the health and care support that people received and what could be improved. The surveys were available and promoted online and were also used to engage with local people face to face. Healthwatch also ran focus groups to gain insight on people’s thoughts on how to age well and the use of digital technology in supporting health and social care.
The findings from both surveys were supported from the discussions in the engagement work we collectively undertook and the Healthwatch Warwickshire’s Wellbeing report.
Who we worked with This engagement was led by Healthwatch Warwickshire and Healthwatch Coventry. The CCG supported by helping to promote involvement and participation.
The outcome The General Survey illustrated that respondents in both Coventry and Warwickshire would like to see improved access to healthcare and would like to feel like they have been listened to. People continued to tell us that they have problems with transport and would like to have more choice when it comes to when and where they receive treatment.
The Specific Conditions survey told us that cancer services were good when it came to support, seeing a specialist, and getting good timely communications. Specific conditions such as autism clearly indicated that they felt waiting times were too long and that they received little or no support. A large proportion of respondents told us that waiting times continued to be a problem as well as accessing ongoing support.
Next steps The feedback has been taken on board and helped to inform the Coventry and Warwickshire Health and Care Partnership’s new system plan, which will launch early in 2020 to outline the priorities and actions the local health and care system will take over the next 5 years to improve outcomes for our population.
Case study - Working with our GP practices to make Coventry and Warwickshire an attractive place to live and work
The challenge Recruitment of GPs, nurses and practice managers for primary care is becoming more and more difficult. In Coventry and Warwickshire we are seeing fewer new GPs and nurses enter primary care, and more and more reaching retirement age or otherwise leaving the profession. This places additional pressure on primary care services and can impact access, quality and positive outcomes for our population.
What we did We worked with local practices to come up with a compelling campaign to try and showcase Coventry and Warwickshire as being a great place to live and work to attract new, existing or returning primary care staff to the area.
We created a series of videos, each from a different perspective, to showcase what is great about primary care in this area:
A local GP talking about the opportunities for career advancement and benefits to family and home life A practice manager discussing the difference a patient focus can have on the care patients receive A practice nurse talking about how more nurses should consider primary care as it is fun, challenging and rewarding, with plenty of opportunities to train and develop specialities
We also created a website which has sections dedicated to new jobs, training and information about Coventry, Nuneaton and Bedworth, Rugby, Stratford and Leamington to help people discover the area and learn more about the most popular spots to visit and live, with natural beauty, bustling towns and thriving cities to explore.
Because of how much work is happening in primary care workforce, we decided to expand the scope of the #careforyourcareer campaign to include a number of other workforce initiatives, such as GP mentoring and First 5, which support new GPs in the first five years of their career.
Who we worked with We have worked with a number of local GPs, practice nurses, practice managers and local patients across Coventry and Warwickshire to support us in developing this campaign.
The outcome The #careforyourcareer website and campaign now covers far more than just recruitment, with a focus on peer to peer mentoring, support in the early years of a new career, mental health and wellbeing support and more for our primary care staff.
Next steps The #careforyourcareer campaign is launching early 2020 and will hopefully demonstrate an impact on recruitment and retention for primary care in our area.
Case study – promoting LGBT+ equality through the rainbow badge scheme
The challenge A healthcare survey undertaken by Stonewall (UKs largest LGBT Charity) in 2018 showed that one in five LGBT+ people are not out to any healthcare professional about their sexual orientation when seeking general medical care, and one in seven LGBT+ people avoid treatment for fear of discrimination. This was undertaken as a project from the ED & I network to raise awareness of LGBT+ Issues within the healthcare setting.
What we did The Equality, Diversity & Inclusion Group have recently launched the Rainbow Badge Initiative which is a nationally recognised NHS Scheme, which gives NHS healthcare staff a way to show that they offer open, non-judgemental and inclusive care for patients and their families, who identify as LGBT+.
This has been promoted at an awareness event, Protected Learning Time sessions and Practice Manager meetings within Coventry, Rugby and Warwickshire North. As well as promoting the badges the group have compiled a directory of LGBT organisations that GPs can refer to for support on specific matters nationally and locally including Gender Identity/ Trans as well as faith based groups and specifically aimed at young people.
The scheme and directory have now been added to GP gateway website, which is an information and resource site for local GPs to support them.
By choosing to wear this badge, the healthcare professional is sending a message that 'you can talk to me'. NHS staff aren’t expected to have the answers to all issues and concerns but to be a friendly ear, and will know how to signpost patients to the best support available for their particular needs.
Who we worked with We worked closely with our colleagues in primary care, both through the Primary Care Networks and through individual practices, to raise awareness of this scheme.
The outcome The response so far has been very positive with surgeries as well as PCNs committing to the scheme and supplying the badges to their staff.
Feedback received from GPs has been very useful as many have admitted that they do not know where to turn for specific advice of patients who are transitioning or who have specific issues relating to their sexual orientation.
We have already heard from several GPs who have a large number of University patients who receive many LGBT+ related queries and the signposting advice is very helpful.
The initiative supports the CCG in caring for its population by creating partnerships with specific LGBT+ support organisations, which promotes inclusivity within its demographic and reducing inequalities.
Next steps We are planning on receiving statistical impact 3 months following the launch to see impact that there has been on patients within the PCNs/ Surgeries that have engaged.
This initiative will show those from the LGBT+ community that there are NHS staff trained to support them and sensitive to their needs, as well as support available within their local community. This will hopefully lead to a reduction in mental health crisis referrals related to LGBT+ issues.
Case study - supporting our GPs and patients through cancer awareness training
The challenge More people are surviving cancer than ever before, but we know that we can save even more lives by catching more cancers early and starting treatment fast. One in every two people in this country will be told they have cancer at some point in their lives.
The NHS Long Term Plan sets a new ambition that, by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients. Achieving this will mean that, from 2028, 55,000 more people each year will survive their cancer for at least five years after diagnosis.
What we did To support the ambitions of the Long Term Plan in our area, we are helping to raise greater awareness of symptoms of cancer; lower the threshold for referral by GPs to better support their patients; accelerate access to diagnosis and treatment and maximise the number of cancers identified through screening programmes.
Cancer diagnoses and treatment methods are changing rapidly, so it is important that our GPs and practice nurses, who are often the first person someone will see when they are feeling unwell, are kept up to date with the latest advancements, methods of best practice and opportunities to support their patients.
In November 2019, the CCG organised a Cancer Protected Learning Time (PLT) event for all GPs and nurses in Coventry and Warwickshire. The event was an opportunity for our GPs and nurses to develop their learning and professional development needs and was a good opportunity to learn new skills, network with other GPs and nurses and attend lectures with cancer specialists. It was also an opportunity to listen to patient stories about their experiences of receiving cancer treatment and support.
Local cancer and support services, including community and voluntary sector organisations, were able to speak with the GPs and nurses to provide information and resources, as well as raise awareness of the various support groups in local communities which can be very beneficial and helpful to anyone diagnosed with or living beyond cancer, as well as their families.
Who we worked with This event was a truly collaborative effort, involving a wide range of organisations which were instrumental to the success of the event:
GP Primary Care Cancer Leads (CRCCG, WNCCG and SWKCCG) Coventry and Warwickshire Health and Care Partnership West Midlands Cancer Alliance
Cancer Research UK Macmillan Cancer Support University Hospitals Coventry and Warwickshire NHS Trust Public Health Warwickshire
The outcome The Cancer PLT event was very successful, with over 500 GPs and practice nurses from across Coventry and Warwickshire attending. The feedback is encouraging and has highlighted the following points:
The patient story was a highlight and very inspirational, thought provoking and promoted the importance of mental health and wellbeing as part of the patient journey; The presentations from cancer experts were very well received, with lots of opportunities for learning which will better support patients. Our partnership working was really important in helping achieve this positive outcome, ensuring local GPs and nurses can take responsibility for cancer care that will make a real difference to the people living in Coventry and Warwickshire.
Next steps Going forward, we will:
Develop a primary care cancer education programme across Coventry and Warwickshire, based on feedback from those attending the event. A variety of learning tools will be considered, in order to make it as convenient as possible for GPs and nurses to take part. Work more closely with our colleagues in hospitals and community services to discuss the development of new cancer pathways utilising transformation funding Focus on improvements for cancer pathways that are currently under-performing against the national 62 day waiting time target to make sure patients are receiving the right level of care when they need it most.
Case study – engaging our population on the future of health commissioning
The challenge Health and social care services across Coventry and Warwickshire are working together to look at better ways of improving the health and wellbeing of our population. Local health commissioners believe that they need to change to meet the opportunities and challenges of the future.
Local commissioners have developed a number of scenarios to determine the best way of organising health commissioning going forward, making the best use of resources and working more closely with providers and the community and voluntary sector.
What we did Before any decisions are made on the future of health commissioning for Coventry and Warwickshire, it was important to find out what people thought about the proposals. A number of stakeholder events were held with staff, CCG GP membership, the CCG
Governing Bodies and key stakeholders, including representatives from our patient groups and the community and voluntary sector, as well as colleagues working in health and social care.
The purpose of the engagement activity was to bring together a wide range of key stakeholders from across Coventry and Warwickshire, including colleagues working in health and social care, voluntary and community organisations, councillors, carers and patients and their representatives with the aim of:
Giving attendees background information and putting things in context to help them understand why local commissioners are considering changing; Presenting a number of potential scenarios for consideration and the assessment criteria against which they would be measured; Capturing attendee’s initial thoughts and reactions to this information; Providing clarity that this piece of engagement was specifically around the future of health commissioning as it pertains to meeting the needs of a future integrated care system for Coventry and Warwickshire.
These events were not:
A platform for us to persuade people of our thinking; it was a listening exercise and was part of our engagement process; Aimed at the wider public; rather, they were targeted and focused events with CCG staff, CCG membership and representatives from various key stakeholder groups, including patient and public representation and advocacy groups, from across Coventry and Warwickshire; A platform to make decisions; instead they were a chance for people to further inform our thinking.
The events were an essential part of our process and, by taking the time to listen to and fully consider the views of patients, carers, staff, our membership and other key stakeholders in all engagement activity, as well as giving due regard to equality and diversity in our engagement activity, the CCG Governing Bodies were better able to make an informed recommendation of the preferred option for the future direction of the organisations.
The key findings which have emerged from the all of the engagement events are set out below:
Support for change
The vast majority of those engaged were in agreement that there was a need for change to both an Integrated Care System (ICS), but also that health commissioning needed to change to help enable development of the ICS.
A full merger was the most preferred scenario
At each session, most agreed that a full CCG merger was the most logical scenario for achieving the objectives set out in the future model of health and wellbeing for Coventry and Warwickshire, though it was widely recognised it would not be an easy, quick or cheap process.
Some of the potential benefits of a merger, as put forward by our staff and governing body during the engagement exercise
Possibility of implementing a joint management team across three CCGs first before moving to full merger
At each session, questions were raised over whether, due to the tight timeframes, there was a possibility of doing a “best of both worlds” approach, which would involve first moving to a joint management team to build the foundation of the new commissioning structure before eventually moving towards a full merger. It was felt this approach would see the quickest impact whilst mitigating potential disruption to the system.
Building robust “places” – and not losing local identity – is critical to success
All were in agreement that success or failure of the health and wellbeing system was dependent on building and supporting strong “Places”, which we described as Coventry, Rugby, Warwickshire North and South Warwickshire. Loss of local voice and identity were highlighted as being a concern when thinking about moving to a single commissioning structure. The need to maintain strong links between the Places and the single commissioner was repeatedly raised as a point of importance.
Involving the local population and their representatives is seen as a another critical measure of success
During our stakeholder engagement, the message was heard loud and clear that local people, and those that represent them (whether that be in the community and voluntary sector or elected officials) were eager to be involved as much as possible in the future development of a system which improves the health and wellbeing of our entire population. Transparency, openness and the opportunity to feed into and influence planning and delivery were considered of vital importance in order to both make an integrated care system successful, but also to get buy in and enable population behaviour change.
Supporting our staff is vitally important
It is recognised that any change to the status quo will introduce uncertainty, worry and potential changes for CCG staff, and all stakeholders agreed that the importance supporting staff during any changes was something that couldn’t be overstated. Understandably, amongst our staff groups, job security was a significant concern for the proposals, although the majority were in favour of changing the commissioning structure.
The potential risks of a single CCG, as put forward by our staff and governing body during the engagement exercise
“Do nothing” was not a viable scenario
All but one person was in agreement that do nothing was not a viable scenario, either due to pressures from NHS England or for achieving the aspirations of the future model of health and wellbeing for the area.
Improving clinical quality, making better use of resources and improving access to services were seen as the most important assessment criteria
Although it was widely recognised that all of the assessment criteria presented had value, the majority of attendees agreed that improving clinical quality, making better use of resources and improving access to services were the most important.
This feedback was included in a case for change document, outlining the proposed options and all the various components for consideration. This document was submitted to the CCG Governing Body in May 2019 to support them in making a recommendation to the CCG membership on the preferred option.
Who we worked with A number of engagement sessions were held across Coventry and Warwickshire:
The Governing Body for each of the three local CCGs; Each CCG’s membership, which is comprised of the local GPs for each CCG; Local health and wellbeing leads, such as Chief Executives of the local NHS providers, leaders of the local GP federations/alliances and Local Medical Committee Chairs; CCG staff; Patient and public representatives; Voluntary and community sector representatives; Local councillors and elected members; Both local Healthwatch organisations
The outcome Overall, the overwhelming majority of those engaged agreed change to the commissioning structure was needed in order to support the development of an integrated care system and improve the health and wellbeing of the population of Coventry and Warwickshire. The majority also agreed that a full organisational merger and move to a single commissioning
group was the most logical decision, but that maintaining strong “Places” and ensuring those Places had a voice and equal representation was of paramount importance.
How CCG staffed ranked the importance of the criteria the proposed options would be measured against
Next steps The CCG membership will take part in a vote, as per the CCG constitution, to decide on the future of health commissioning for Coventry and Warwickshire. The outcome of the vote will be known in February 2020.
Our annual report summary This year we have once more produced a summary annual report covering the key highlights for the year, such as our performance, how we manage our budget and significant pieces of work which have had a positive impact on patient outcomes across our area. Providing a summary report allows us to make this important information accessible to more people.
Our annual general meeting Our annual general meeting took place in July 2019 in Coventry. Local people were invited to join us to give us their views on the priorities of the NHS Long Term Plan and how we could best implement them in our “place”. Attendees were split into groups to tackle the following topics:
Joining up the NHS so patients don’t fall through the cracks, such as by breaking down the barriers between GP services and those in the community. Helping individuals and families to help themselves, by taking a more active role in preventing ill-health, such as offering dedicated support to people to stop smoking, lose weight and cut down on alcohol. Tackling health inequalities by working with specific groups who are vulnerable to poor health, with targeted support to help homeless people, black and minority ethnic (BAME) groups, and those with mental illnesses or learning disabilities. Backing our workforce by increasing the number of people working in the NHS, particularly in mental health, primary care and community services. We will also create a better working environment by offering better training, support and career progression and we’ll crack down on bullying and violence at all levels. Bringing the NHS into the digital age, rolling out technology such as new digital GP services that will improve access and help patients make appointments, manage prescriptions and view health records on-line. Spending this extra investment wisely, making sure money goes where it matters most. The NHS will continue to reduce waste, tackle variations and improve the effectiveness of treatments.
The feedback from these sessions is being used to help the system prepare its response to the Long Term Plan, which will be published during 2020, as well as inform our local plans and priorities.
Working with Healthwatch This year we have continued to work closely with both local Healthwatch organisations in our area. Healthwatch are able to act independently to gather local intelligence about what people think of local services. Their feedback and information is a key part of our engagement activity and helps us to ensure we have a solid foundation of evidence and insight prior to undertaking any engagement work. We also meet regularly with both Healthwatch organisations to discuss our work.
Supporting our staff to understand and action involvement Through the communications and engagement team, we champion the importance of patient and public voice and ensure that it is reflected in commissioning activities. A member of the communications and engagement team is assigned to key teams within the CCG, such as Commissioning, Nursing and Quality, Primary Care and Continuing Health Care. These representatives attend regular team meetings, providing updates on communication and engagement activities and identifying opportunities within the work of the team for engagement.
CCG staff are regularly supported by the communications and engagement to deliver engagement activities, with the team suggesting appropriate mechanisms, facilitating engagement and supporting effective involvement.
We support our staff to engage with the public via the communications and engagement team, or supporting them through their own engagement initiatives. We also highlight the importance of the patient voice within the CCG, regularly reporting to teams at all levels of the CCG on the results of our engagement and how to use that feedback within their work.
We have organised engagement training for our executives to help them work more effectively with the media.
We also support our staff to deliver internal communications messaging via newsletters, intranet portals, meetings and videos. We sit on the staff forum and take an active part in the “Wellbeing Warriors” work, which seeks to promote health and wellbeing in the workplace.
Our plans and priorities for the next year Over the coming year we will:
Continue to build on the work achieved during 2019; Continue to used targeted engagement to ensure we speak to the people who are most affected by our services; Continue to build strong links with our community and voluntary sector colleagues, especially those representing seldom heard groups and communities; Continue to work more closely with our colleagues Seek to establish a place-based communications and engagement network for both Coventry and Rugby, working with multiple organisations to deliver engagement campaigns; Look for more innovative and exciting ways to encourage involvement in commissioning work; We look forward to working with our public even more in 2020!