NHS Southwark Clinical Commissioning Group Engagement and Patient Experience Committee Minutes of meeting held on 20 November 2014 5-8pm Room GO2B, 160 Tooley Street SE1 2QH PRESENT Jacques Mizan JM GP Clinical Lead/ NHS Southwark CCG – Acting Chair Rosemary Watts RW Head of Membership, Engagement and Equalities NHS Southwark CCG Abimbola Puddicombe AP Borough and Walworth Locality Patient Participation Group Ela Kwasny-Spechko EK-S Peckham and Camberwell Patient Locality Participation Group Nadia Crichlow NC Bermondsey and Rotherhithe Locality Patient Participation Group John King JK Dulwich and Nunhead Patient Locality Patient Participation Group Barry Silverman BS Borough and Walworth Locality Patient Participation Group Malcolm Hines MH Chief Financial Officer – NHS Southwark CCG Obi Ezeji OE GP Clinical Lead/ NHS Southwark CCG Rhiannon Hughes RH Blackfriars Advice Centre IN ATTENDANCE Nina Martin (minutes) NM Locality Programme Support Officer, NHS Southwark CCG Nigel Smith NS Head of Pathway Commissioning Laura Brannon LB Membership and Engagement Manager – NHS Southwark CCG APOLOGIES Rosemarie Barber RB Bermondsey and Rotherhithe Locality Patient Participation Group Diane French DF Peckham and Camberwell Locality Patient Participation Group Andrew Rice AR Forum for Equality and Human Rights in Southwark Andrew Bland ABl Chief Officer – NHS Southwark CCG Yvonneke Roe YR GP Clinical Lead/ NHS Southwark CCG Adam Bradford ABr GP Clinical Lead/ NHS Southwark CCG Paul Jenkins PJ Director of Integrated Commissioning - NHS Southwark CCG
1
1. Introduction and Apologies
The Committee was advised that Jacques Mizan (JM), clinical lead and member of the Governing Body will chair today’s meeting as apologies received from Diane French (EPEC Chair).
Meeting Chair welcomed members and attendees to the meeting and all apologies were noted. The process and the ground rules for the meeting were explained. All were reminded that they could make comments or feedback on ‘Post It’ notes if there was not enough time to ask questions when discussing an item. These would be collected at the end of the meeting and incorporated into the minutes.
All members were asked to declare any conflicts of interests relating to the business on the agenda or changes to the conflict of interest register. The declaration of interest register was circulated for members to update as necessary.
No conflicts of interests were declared to any of the business on the agenda.
2 Minutes and Matters Arising: Our healthier South East London Malcolm Hines (MH) advised that a new format for logging and tracking actions has been developed and this will be used from today and for future meetings.
The minutes of the meeting were agreed subject to the following corrections: P2 Introduction and Apologies - Declarations of Interests updates– Barry Silverman is now a member of the NHS England London Primary Care Transformation Board P2 – Introduction and Apologies – Last line of last paragraph to read: “BS expressed concerns that this way forward had previously been proposed but had not had too much support”.
Health and Wellbeing Board - Rosemary Watts (RW) updated that she will soon be making contact with the new Officer leading the 1000 lives project. She advised the Committee that the new Head will be invited to present at either the January or March EPEC meeting.
Post-it note comment on ensuring patients’ rights are fed into the review of the patient referral service– BS enquired of the timescale for presenting of this review to EPEC.
Pursuant to discussions, MH assured that the report will be presented to EPEC and further clarification will be provided if needed.
2
Actions: Circulate the review of the patient referral service accompanied by an executive summary to EPEC (CCG).
Invite Jill Solly – Head of Primary/Secondary care interface to EPEC – The Committee was updated that this action has been postponed as it was felt that a broader understanding of the issues needed to be more fully explored. The Committee was informed that a discharge audit is presently being conducted at King’s. We are presently awaiting the findings and actions which may arise from the audit. If after reviewing the findings there are still issues, Jill Solly will be invited to the meeting.
All agreed that the main issue around discharge summaries relates to variation in the correspondence between primary and secondary care and that the communications trail should end with patients being informed of all aspects of their care and discharge.
Developing the patient voice in Southwark – RW advised that dates will soon be agreed to resume this training and the aim is to carry this out in either February or March.
BS suggested opening up the training to sixth formers in order to motivate and equip a younger audience to lend their voice to shaping health services.
RW updated that outreach is part of the remit of the new Membership and Engagement Manager, Laura Brannons’ (LB) workplan who will explore how to engage with younger people
Rhiannon Hughes (RH) put forward some suggestions for reaching out to younger audiences. She advised that Blackfriars Advice Centre (BAC) have recently started producing radio programmes with the aim of giving their clients a voice to speak out and educate and inform the general public. BAC works with resonance radio 104.4 http://resonancefm.com/
For engaging with younger people she also suggested Reprezent radio http://www.reprezent.org.uk/,.
Other suggestions she put forward for reaching out to a younger audience included via art colleges and the Peckham Platform. She also added that the South London Gallery engages with young people through a variety of youth work programmes that they run and it may be worth linking in with this organisation as well.
3
Action: CCG Engagement team and BAC representative to meet to discuss ways of taking these suggestions forward (LB, RH)
John King (JK) also suggested targeting young people contemplating healthcare as a profession. 3. Issues from member groups and organisations. 3.1 Dulwich and Nunhead and Peckham and Camberwell JK updated on the key discussions and observations at their last meeting The last meeting was not very well attended. There are still two south locality vacancies on EPEC. The aim was to hold elections at the September locality meeting, but due to low attendance there was not a wide enough practice representation to make this feasible. The group received an update on neighbourhood working and the extended access service from David Pink – Operations Manager of Improving Health Limited. A representative from Improving Health will again update at the South Southwark Locality PPG on 25 November 2014. The key issue for the locality is increasing its EPEC representation.
Ela Kwasney-Spechko (EK-S) updated as follows: There remains the ongoing concern about practices not notifying patients of results of tests when these come back negative. EK-S expressed concern that her practice does not notify patients when tests return normal or negative. There was a general consensus from the group that patients would like to be notified either way.
Obi Ezeji (OE) updated that general practice will find it highly resource intensive to notify patients when results are normal.
A robust discussion ensued around this matter. Patient representatives agreed that all tests should not be treated the same. The meeting agreed that clinicians need to see this issue from the patients’ perspective as waiting for certain test results can provide some anxiety to patients. Not hearing back either way only serves to prolong this anxiety.
The Chair advised that this concern forms part of the on-going discussion on out of hospital diagnostics and further advised that a system is presently being rolled out that will allow patients to access their test results online. He updated that Patient Online will soon be rolled out in Southwark.
4
BS cautioned about patients who may not be able to use the electronic system.
3.3 Bermondsey and Rotherhithe NC fed back the key discussions at the 12 November joint north Southwark locality PPG. The Committee was updated that the Bermondsey and Rotherhithe and Borough and Walworth localities will be meeting jointly going forward. Key messages from the this meeting: Low turnouts at PPGs remain a prime concern. Strategies for increasing participation at PPGs were discussed. The group continued discussion on electronic and virtual engagement. Discussion ensued around this and committee felt that this might encourage participation from a younger age group. The group received an update on neighbourhood working and the extended access service from Carol McPaul, Quay Health Services representative. The joint north Southwark locality has agreed to meet four times per year rather than six.
3.4 Healthwatch Southwark RW updated on behalf of Healthwatch and advised as follows: Healthwatch are holding their public forum meeting on Saturday 22 November and advised that both herself and Paul Jenkins, the CCG’s Director of Integrated Commissioning will be attending. The event is entitled ‘Healthwatch Southwark: One Year On’, the venue will be Pembroke House, 80 Tatum Street, SE17 1QR.
Post meeting note: Healthwatch Southwark submitted update on present and future work via email post meeting: Aarti Gandesha the new Healthwatch Southwark Manager has started HW Southwark hosted a public forum event in November to mark ‘Healthwatch One year On’. This was well attended with great feedback on our work and our priorities. Priorities: around GP access to wind down report due. We are carrying forward our other priorities: o Mental Health (with a focus on CAMHS) o Sexual Health and HIV testing and care o Social Care We have been targeting engagement activities borough wide by holding information stalls in different localities, promoting HW Southwark and inviting members of the public to share their experiences of using health and social care.
5
Our engagement plan includes an engagement event once a week, a focus group once a quarter and Public Forums once a quarter. Regional representation with South East London Healthwatch is continuing and we are collaborating on training with Lewisham. Our Enter and View training for CAMHS is scheduled for 17 January 2014. Two clinicians from overseas who are currently students at the South Bank University will be joining us for a placement in February and will support us in our engagement work. Our next Focus group will be in January around social care and issues carers have regarding health and social care services.
4 Patient Experience deep dive report
The Planning and CCG Assurance Manager, Omar Al-Ramadhani (OA-R) presented and led discussion on the final draft of the Patient Experience deep dive report that went to the Integrated Governance and Performance (IGP) meeting. He advised that the aim of the report is to review how the CCG uses patient experience information to inform service design and improve the quality and safety of NHS services used by Southwark patients. He drew the Committee’s attention to the report’s recommendations (p 24) and asked for the Committee’s endorsement of these recommendations and its suggestions on how to take these forward.
BS commented that while potentially useful, at present it seems impractical as no mention is made of patient complaints. He expressed concern that quality reports tend to highlight only what aspects of a service are working well and feels it is important to include and incorporate whether incidents in hospitals are reported to commissioners and how these are addressed. He proposed that presenting a few examples of this to the Committee will be helpful.
In response, OA-R updated that a patient experience dashboard is presently being developed and also informed that quality review meetings are carried out. Nigel Smith (NS) also advised that once poor performance is identified and reported providers are required to prepare remedial action plans to address this.
MH further reassured that the Clinical Quality Review Group (CQRG) meets regularly for each provider Trust, chaired by CCG clinical lead. He advised that at these meetings, cases of poor performance are dealt with in detail.
OE further added that quality assurance is also dealt with at a broader level at Governing Body meetings with the setting of performance indicators.
6
Actions: A review and report on actions taken to be brought to the committee in six months London Patient insight dashboard to be added to the agenda of March EPEC.
5. Engagement and Programme Board update Meeting Chair updated that the first meeting of the Engagement Board was held on 16 October and comprised a multi-disciplinary group.
By way of context, RW further updated that in order for the CCG to better streamline its portfolio of work it has developed six programme boards: Building resilient communities and prevention, Integrated care and neighbourhood working, Mental health and parity of esteem, Primary and community care delivery, Quality, safety and performance (QSP) and Engagement to shape and improve services. QSP reports to the Integrated Governance and Performance Committee (IGP). The Engagement Board to EPEC and the rest report to the Commissioning Strategy Committee (CSC)
The committee was asked to review and agree the intended areas of focus of the Engagement Programme Board and to provide some suggestions on innovative methods of engagement which can be potentially used in future work and sources of community expertise that might support this work.
RH suggested exploring forums such as the Peckham Platform and Art Assassins. Pursuant to discussions it was agreed that the CCG Engagement team and RH would meet to take this forward.
Action: Further explore and discuss platforms that the Engagement Board could use in taking forward engagement work (CCG and BFC rep)
BS commented that the paper focusses on how the work will go forward but feels it is unclear on what the deliverables and outcome of the programme of work will be. He also raised the issue of appointments to the programme boards and suggested a system of democratic appointment similar to that of NHS England.
Other Committee members added that even though different groups appoint and recruit differently, they can still achieve their outcomes and deliverables.
7
MH further added that the CCG approach is to get people engaged and advised if Committee members know of people who would like to get involved, please feed this back and they can be followed up and be encouraged to engage.
Regarding the programme aim of “Connecting” – Item c - “We will work actively to identify not only those who are least heard but those who are least heard and have most need”, John King (JK) asked how will this group be identified.
RH suggested linking in with those groups that her organisation works with. These include people in temporary housing finding it hard to register with a surgery, people who are in overcrowded accommodation and do not receive bills in their names finding it hard to access services. She also added that they see multiple clients who live in the same location who have similar health issues such as damp which cause breathing issues.
Discussions ensued around least heard groups and it was agreed that discussions will continue outside this meeting between the CCG and the Blackfriars Advice Centre about identifying and listening to those who are least heard. 5 Engagement in Commissioning Intentions – 2015/16
Nigel Smith (NS) – CCG Head of Pathway Commissioning, presented and led discussion on the paper. The Committee was asked to make proposals on how to get meaningful patient engagement on the proposed CCG commissioning intentions.
BS advised of the need to be clear on objectives and affordability.
The Committee was advised that each of the previously mentioned programme boards is currently developing their commissioning intentions and work programmes for 2015. Once these are confirmed the expertise of the Engagement Board will be required to ensure there is a high standard of engagement To provide assurance of engagement, EPEC will be updated on progress.
OE suggested accessing patients at locality level to get their views on proposed commissioning intentions. Others commented that given that attendance at locality meetings varied, it might be useful to engage people at the practice level.
8
The Committee agreed that the language used needs to be simplified and presented in a more straightforward manner as this will facilitate easier conversations.
6 Co-commissioning Primary Care MH updated the Committee on progress to date and asked the Committee to make suggestions on ways in which to engage with patients. He advised that the Department of Health has proposed that CCGs work with National Health Service England (NHSE) from April 2015 to co-commission primary care. The options suggested are:
Greater involvement in NHSE decision-making Joint decision making by NHS England and CCGs CCGs taking on delegated responsibilities from NHS England.
He added that to date engagement has focussed on member practices via a discussion board on our members and staff zone, a September Council of Members meeting, practice locality meetings and a practice engagement event on 11 November. An additional practice engagement meeting is planned for December 10 at the Millwall Football Club.
BS advised of the need to make the distinction between primary care and general practice.
MH confirmed that though the proposal says “co-commissioning of primary care”, it actually refers to general practice. He emphasised that the performance management of general practices will not come back to the CCG but rather only the day to day contracting.
8 Any Other Business
The Committee’s attention was drawn to the NHS Confederation’s poster on “What the public thinks about the future of the NHS”. EK-S commented that it would be useful to have information such as this translated into different languages.
Flyers promoting the “Our Healthier south east London” engagement event on 3 December were circulated to the Committee as well as a write up entitled “You said, we did”. Date of next meeting 16 January 2-5, Room GO2B, Tooley Street.
9
Outstanding Actions from 20 November 2014 EPEC meeting
Date to be Agenda item Action Point Update Lead Status completed
Minutes and Matters arising: Post it note Circulate the review of the comment on ensuring patient referral service Action in patients’ rights are accompanied by an executive January 2015 CCG progress fed into the review of summary to EPEC. the patient referral service
CCG Engagement team and Minutes and Matters BAC representative to meet to Action in arising: Developing discuss ways of taking this January/ LB, RH progress the patient voice in forward February 2015 Southwark
A review and report on actions taken to be Action in brought to the committee May 2015 progress Patient experience in 6 months O-AR deep dive report London Patient insight dashboard to be added to March 2015 the agenda of the March EPEC.
10
Date to be Agenda item Action Point Update Lead Status completed
Further explore and discuss platforms that the Engagement Engagement and Board could use in taking Action in Programme Board Ongoing LB forward engagement work (CCG progress Update and BFC rep)
11
Agenda item Action point Timescale Responsibility Status Matters arising Urgent care: PJ and JK to liaise outside of this meeting October PJ/JK Open to incorporate patient’s perspective on the urgent care work.
Engaging and Test and capture patients’ view on their understanding October HS Open communicating with of the extended service pathway. patients about the development of extended primary care access Developing Integrated Re-visit the 2015/16 delivery/implementation timescale. October JY Open services
Developing Integrated Circulate plan of work to take the integration agenda October JY Open services forward and ensure that the voluntary sector informs the dialogue
Developing Integrated Link the integration work to the Carer’s strategy October JY Open services Developing Integrated Information and best practice examples on social October DF Closed services prescribing to be circulated to JY and RW
Next Meeting date Re-schedule November meeting date October NM Closed
12
Introductions Representative from Community Action Southwark / September RW Closed voluntary sector to be confirmed to replace Andy Boaden. Carry forward Action Health and Well Being Board – work so far and plans for September RW Open the future to be a future agenda item Post it note comment JH reported discussion at the Governing Body meeting. September RW Closed from previous meeting- It was agreed that this action is kept open to ensure that BS comments on BS comments are fed into the review RW will forward ensuring patients rights BS comments to AY. are adhered to be fed into the review of the patient referral service Mental Health Strategy Under review September RA Closed Healthwatch representation on Mental Health Programme Board Issues from member Jill Solly Primary/Secondary care Interface to be invited November RW Closed groups to a future meeting. Developing the patient Details of anyone requiring training to be notified to NM September ALL Open voice in Southwark
13