12Noon Healthwatch Norfolk Boardroom Suite 6, Elm Farm Dairy

+ p

Healthwatch Norfolk Board 16th April 2018

10.00 – 12noon

Healthwatch Norfolk Boardroom Suite 6, Elm Farm Dairy, Norwich Common, Norfolk, NR18 OSW

AGENDA

No. Item Time Mins. Page A,I,D Items for Action (A), Information (I), Discussion (D), Presentation (P)

Part I – Public Board Meeting

1. Questions from the general public 10.00 5 D 2. Apologies for absence 10.05 I 3. Declarations of Interest 10.05 I 4. STP Update – Antek Lejk (STP Executive Lead) 10.05 D 5. Minutes of the meeting held on 15th January 2018 10.35 5 A (paper attached) 6. Matters arising not covered by the agenda 10.40 5 D • Enter and View Reports • Use of Volunteers • Survey of working age people understanding social care

7.1 CEO Report (Incorporating STP Update) (paper attached) 10.45 10 P/I/D

7.2 Communications & Engagement Strategy 2018-9 10.55 10 I (paper attached)

7.3 Intelligence Report (paper attached) 11.05 10 A

7.4 Updated risk register (paper attached) 11.15 10 I

7.5 Quality Control Sub Group Draft Minutes (paper attached) 11.25 5 I/A

7.6 Finance Sub Group Draft Minutes (paper attached) 11.30 5 A/I/D

7.7 Mental Health Sub Group Minutes (paper attached) 11.35 5 A/I/D

8. Co-option of potential Trustee (paper attached) 11.40 5 A/I/D 9. Any Other Business – Please provide the Chair with Items for 11.45 AOB prior to the Meeting’s commencement. 10. Dates of future Board meetings

Monday, 16th July 2018 – HWN Offices, Wymondham Monday, 15th October 2018 – HWN Offices, Wymondham

Part II – in camera

The Chair asks that representatives of the press and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest. Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

1. Staffing update 11.45 5 A/I/D

2. Any Other Business 11.50 30 D

Apologies should be sent to Healthwatch Norfolk Administration Officer, [email protected], telephone 01953 856029 Distribution: Trustees For information William Armstrong Ceri Sumner Robert Ashton Maureen Orr Dianne Butterfield Linda Bainton Diane DeBell Tom McCabe Ann Donkin Graham Dunhill Helen Jackson Mary Ledgard David Trevanion

Minutes of Board Meeting – Part I Monday, 15 January 2018

Attendees: William Armstrong (WA) – Chair Robert Ashton (RA) Diane DeBell (DDB) Ann Donkin (AD) Graham Dunhill (GD) Helen Jackson (HJ) Mary Ledgard (ML) David Trevanion (DT)

Officers in attendance: Judith Bell (JB) – Operations Manager Chris Andrews (CA) – Engagement Manager Sonia Miller (SM) - Minutes

F Gibbs (FG)- item 6.2 only

1. Questions from the general public No questions were submitted from the general public. 2. Apologies for absence Apologies were received from Alex Stewart and Dianne Butterfield

3. Declarations of Interest None

4. Minutes of the meeting held on the The minutes of the Healthwatch Norfolk (HWN) Board meeting held on were agreed as a correct record.

5. Matters Arising (not covered by the agenda)

Admiral Nurses JB reported that Zena Aldridge had advised that there are Band 6 Admiral nurses in South, North & Norwich CCG’s funded 50% from CCG and 50% from Dementia UK. This will be in place until October 2019. It is proposed to appoint someone soon for the Great Yarmouth & Waveney area, but nothing has yet been planned for the West. HWN were thanked for their interest and support of the project.

HJ asked that HWN contact Zena Aldridge again in the summer of 2019 to discuss the continuation of this service.

ACTION – JB diary note re Admiral Nurses summer 2019

GP Phase 2 Project JB reported that responses had been received from Antek Lejk, James Paget, Michael Scott (NSFT). Copies of the responses are available.

ACTION – JB to circulate copies of the responses to the Board

CEO Report Work on finalising the PNA project has been taken over by Ed Fraser and the final meeting took place last week to conclude this work.

STP meetings WA asked Board members if they had any comments regarding the meetings hosted by HWN.

AD felt that the STP Chief Executive should have been in attendance at all meetings so it was not perceived to be a HWN meeting.

Concern was expressed that these meetings distracted from the main purpose of the STP due to very specific types of work being discussed.

GD said that models emerging for each geographic area were different and questioned whether this work was progressing to be effective.

WA said it is taking time to impart the information about the progress and detail.

Chris Williams has just taken over the role of Communications and Engagement for the STP and CA is meeting with him next week. WA asked him to report back to the Board on how things are moving forward.

ACTION – CA to report back to Board re meeting with Chris Williams

AD said that it would be helpful for each CCG to highlight 5 key proposals and 7 ways forward to address these proposals and their impact.

The Board agreed that the STP Sub Group would meet (in the next few weeks) to discuss future STP meetings, HWN independence at STP Stakeholder Board meetings and business support for the meetings. Graham Creelman (Chair – STP Stakeholder Board) and CA will be invited to this meeting and the outcomes of the meeting will be disseminated to the Board.

ACTION – WA/JB to set up STP Sub Group Meeting SM to ensure that CA & GC invited

Multispeciality Community Providers ML had received a DoH paper explaining how this fits together (from the Your Norwich Programme Board) and MCP’s may or may not be part of accountable care organisation.

Mental Health Crisis Conference (7 11 17) - HJ said that she felt the conference was constructive and led to good networking, presentations were very good, but it was disappointing to see who did/did not attend.

Enter & View Visits JB reported that a programme of visits is ongoing and the focus was on the wellbeing of residents. Visits have been made to those homes with an CQC overall rating bordering on good/require improvement. HWN have visited homes who have recently been inspected and improvements have been made and it was felt that they appear to have responded to the CQC inspection well. HJ suggested that HWN could possibly “drop down a level” and therefore add more value to our visits. JB said that we are learning from these visits and this issue. WA suggested E & V visits be put on the agenda for discussion at the next meeting.

DT said that we have had a few comments re care homes and asked whether these are acted on. JB confirmed that intelligence recorded is used and visits planned to these homes when possible.

HJ said that on occasion the home itself has been good, but comments have been received about adult social care. JB said that she will talk to NCC at the Information Sharing meeting next week and these comments will be added to our database and as necessary issues reported to the appropriate people. Volunteers should be made aware of this and advise staff of any comments received.

ACTION – E & V Visits agenda item for April meeting ACTION – JB to share information with NCC & add to Volunteer meeting agenda in March

WA said that HWN need to look at the whole issue of recruitment of volunteers for Enter & View and other activities, i.e. meetings, engagement, patient view point.

RA suggested that we should circulate information regularly to volunteers about the work HWN are doing and keep them informed and also feed in their knowledge and expertise.

ACTION – Agenda item for next Board meeting - review Volunteer Policy/use of volunteers

6. 6.1 CEO Report

JB reported in AS absence.

Staffing – since Sam Revill’s departure in December, JB advised that in the light of proposed funding cuts to HWN, Sam is not currently being replaced and there is a recruitment freeze. This work has been allocated to the project teams and Line Management of staff has been allocated.

Huntercombe Hospital – this has now been closed and beds have been found elsewhere for all the patients.

NSFT Improvement Board – HWN are attending the Oversight & Assurance Improvement Board monthly meetings where large action plans are being reported on. A large number of ligature points have been identified, and although overall staffing levels appear in line with national averages, “hot spots” are hidden in certain establishments. Resourcing is a concern and there is a need to look at issues for the long term as well as day to day shortages.

WA said that we need to ensure that our contribution to the Board remains focussed. HJ said that at the last Mental Health Sub Group meeting the issue of personal care plans was highlighted as an initiative and how HWN could do some more focussed engagement work with service users to talk about this and work with the NSFT Improvement Plan programme. The next meeting with NSFT is in early February and HWN will clarify its role at this meeting.

HMRC/VAT JB confirmed that HWN do not need to register for VAT unless we take on more externally commissioned work over VAT threshold of £85k.

WA wished to record the Board’s thanks to JB for her work in the absence of Alex.

6.2 Intelligence/Engagement Report (FG joined the meeting) FG said that the report showed intelligence for the last three months and the year to date (2018). It looks at numbers for general engagement/priority projects and website reviews. The number of reviews has consistently increased, in part due to the greater number of events attended.

Reviews on the priority projects – Autism/Out of Hours and GP Services are expected to increase.

Figures for website reviews, although small, have increased due to a higher social media presence. It was suggested that Board members could add a review of their own experience to the website, which would also help them understand the process.

A new question has been added to the surveys regarding how people have heard about HWN and this information is recorded to enable us to see where HWN is reaching. The maps show a good overall coverage of Norfolk for engagement, although there is still less in the Breckland area.

A comparison of capture of reviews for the same period last year (with changes in staffing) shows a large increase in engagement and reviews collected. 79 in Oct – Dec 16 and 769 in Oct – Dec 17.

Reviews from patients coming through the kiosk installed in a surgery in Thorpe are unfortunately still low, but working is ongoing with the Practice Manager to improve this.

Equality & Diversity – increased completion of this form shows our reach and helps us identify the areas where there needs to be more focus.

The report shows the themes which have emerged from the reviews, which are staffing/access to services, treatment/care received and commissioning/rights.

RA asked if we could carry out a survey of working age people, through the workplace (large employers etc), about social care in Norfolk from a patient viewpoint and also experiences of those who look after people who receive care. This would give HWN a different perspective on what people think social care is. The Board agreed to take this forward and CA and FG will look at this

ACTION – CA/FG to consider survey for working age people via the workplace.

FG said that she had recently spoken to the CQC regarding dental services and they have agreed to inform HWN when an inspection is due to take place and FG will send through our intelligence re dental services. This will also help inform us for our outcomes.

The Board recorded its thanks to FG for a comprehensive report which shows the robustness of the data and the useful explanation of the report.

6.3 Register of Interests The current list of interests for the Board had been circulated and JB asked that Board members informed SM of any amendments/changes and the list will be updated for future reference.

ACTION – All Board members to review their interests on the form

6.4 Updated Risk Register (paper attached) JB reported that there had been no changes since the last meeting.

ML pointed out that HWN do have a process for employing sub-contractors and that if this situation arises in the future the Board should review the process. This was agreed.

6.5 Quality Control Sub Group (draft minutes)

The QC Sub Group minutes (8 1 18) were approved.

DT said that this group wanted to review its role. There is likely to be fewer projects for HWN and the group will need to evaluate any newly commissioned work coming in to see if it is appropriate in relation to the charitable objectives and also issues of finance andl risk.

The Sub Group looked at a pro forma to complete for projects and had made some amendments. Both the QC and Finance Sub Groups feel it is important that all new projects should be evaluated to confirm acceptance of the work.

The recommendation is that each new project needs to be assessed using the form, which should be completed and put to the QC Chair and one other member for approval (via email).

HJ asked that all Board members be informed when new work is taken on.

The Board agreed to the evaluation of new work using the new form.

ACTION – JB to circulate the revised form to the Board.

6.6 Finance Sub Group (draft minutes) The Finance Sub Group minutes (8 1 18) were approved.

JB reported the Communities Committee are due to meet this week and Fennie Gibbs will attend to feedback any decisions made concerning future funding.

DDB said that the letter from WA was very good and she had also sent a letter regarding the reduction in funding. DDB also said that there is a new public health function in the county and HWN need to be aware of this.

DT said that the Finance Committee were happy with the budget proposed at this stage, but that each quarter needs to be reviewed carefully because if no additional income is received from funding bids or external commissions we forecast a deficit of £147,000 at the year end. Board members should be aware of this.

6.7 Mental Health Sub Group (draft minutes) The Mental Health Sub Group minutes (21 11 17) were approved.

WA confirmed that the Carers Charter was general and not specific to mental health.

Items were covered earlier under 6.1

7.0 General correspondence No correspondence had been received.

8. Any Other Business

GD pointed out that the Operations Plan is for the current year 2016/17) and will need to be reviewed at the April Board meeting. This plan will roll forward. It was agreed that in future the Plan should be discussed at the January Board meeting prior to the beginning of the new financial year.

It was agreed that the Plan can be circulated, at is developed, for comment.

It was agreed that the Board would send a letter of thanks to Sam Revill to acknowledge her contribution to HWN since its inception.

ACTION – SM to prepare a letter for WA to sign to Sam Revill

DT said that a decision had been made to appoint another Board member to lead on diversity issues. Following the last meeting between WA/AS/DT a senior lecture from the UEA, Dr Katherine Deane, has been approached, who is a specialist in disability and LGBT issues, and a meeting will be set up for her to meet with and DT and WA in the near future with a view to assess her appointment as a new Trustee.

ACTION – Set up meeting with WA/DT/Dr Deane

HJ pointed out that it would also be useful to look for a representative of the BME community in the future. The Board agreed to take this on board.

9. Date of Next Meetings

Monday, 16thth April, 2018 – HWN Offices, Wymondham Monday, 16th July 2018 – HWN Offices, Wymondham Monday, 15th October 2018 – HWN Offices, Wymondham

W J Armstrong …………………………………………… Date…………………………………. Chair

Distribution: For Information Trustees Ceri Sumner William Armstrong Maureen Orr Robert Ashton Linda Bainton Dianne Butterfield Diane DeBell Ann Donkin Graham Dunhill Helen Jackson Mary Ledgard David Trevanion

Agenda item: 7.1 Report on: CEO Report Author: Alex Stewart Date: 16th April 2018

1.0 Introduction

1.1 The purpose of this report is to provide Board Members with a range of information on matters which are pertinent to Healthwatch Norfolk. This report is providing updates on the following: -

• Appointment of Chair for HWN and Ex Officio Appointment of Honorary President • Operations Plan 2017/18 and Operations Plan 2018/19 • NSFT Improvement Board • Expression of Interest to become an Integrated Care System

2.0 Appointment of Chair 2.1 With the impending retirement of the current Chair, it is imperative that the Board in conjunction with the CEO secure a new Chair to continue to drive the organisation forward. 2.2 The incumbent Chair has indicated that he wishes to stand down after the AGM in July 2018. On behalf of the staff, the CEO would like to express his gratitude and thanks for the tireless work that has been undertaken since Mr Armstrong (Bill) took up his position some 5 years ago. Bill has been a huge support to myself especially but also to all Team Members. He has successfully steered the Board and has brought gravitas to the organisation resulting in HWN being highly regarded locally, regionally and nationally. 2.3 In order to preserve the integrity of the post, it is considered that it should be advertised utilising a mixture of methods that would include NEDonBoard, NHS Jobs, EDP 24, The Guardian on-line and our own website. The costs associated with this are in the region of £3,500. 2.4 The revised “Job Description and Person Specification” are attached as Appendix One. Potential applicants would be asked to submit a CV with an accompanying letter demonstrating what they would bring to HWN and the post. Shortlisted candidates would be invited to meet with the HR Sub-Group, the current Chair and the CEO – should any members of the HR Sub-Group wish to stand, another Board Member would be asked to stand in their place. 2.5 It is proposed that this group be given delegated authority to make an appointment which would be adopted formally by the Board at its next meeting on the 16th July prior to the AGM which will be taking place on the 24th July. This would enable a seamless handover at the AGM.

2.6 Proposed Timetable

Monday 16th April Board sign off recommendation Wednesday 18th April Post advertised Monday 14th May Closing date for Expressions of Interest Monday 21st Shortlisting completed and applicants notified Monday 4th June Interviews with HR Sub-Group, Chair and CEO Monday 16th July Decision formally ratified by Board Tuesday 24th July Handover following AGM

2.7 Ex Officio Appointment The Board is also asked to consider creating a new Ex Officio of Honorary President for the outgoing Chair in recognition of the contribution that has been given to Healthwatch Norfolk which has been above and beyond the call of duty. 2.8 Recommendations: - It is recommended that the Board agree to: -

a. Endorse the attached Job Description and Person Specification b. Give the HR Sub-Group delegated authority to formally offer the post with formal ratification being given by the Board in retrospect at its meeting on the 16th July c. Endorse the creation of an Ex Officio title of Honorary President for the outgoing Chair

Operations Plan

3.1 The Board have already agreed a 2 year-strategy (2017-2019) which is available to view on our website. In order to achieve the strategy, an Operational Plan is produced by the CEO in conjunction with the Senior Management Team to demonstrate how HWN will fulfil its strategic objectives. The Operational Plan is for Information only.

3.2 Appendix Two provides an overview of the work that has been undertaken over the past 12 months. Appendix Three provides an overview of the work that has been undertaken by Carers Council for Norfolk on behalf of HWN and Appendix Four provides an overview of the Operational Plan for 2018/19.

4.0 NSFT Improvement Board 4.1 The Oversight and Assurance Board meet on a monthly basis. The headlines from the meeting held on the 13th March are as follows: -

• In the worst winter for decades, staff excelled themselves in getting to work, staying longer and making sure the most vulnerable service users got the support they needed • Paul Lumsden has been appointed as Nursing and Quality Advisor • The Trust submitted its response to the CQC on the 9th March – the submission incorporated information on:-

Systems to monitor and learn for quality and performance information Ligature point management and environmental risks Seclusion environments and seclusion practice Accommodation for men and women Staffing Management oversight and governance to ensure staff have regular supervision, appraisal and training Access to services Risk assessment and care planning Clinical records Access to alarms and emergency equipment

• The Council of Governors formally approved the appointment of Antek Lejk as NSFT’s Chief Executive designate on the 8th March 2018.

The April Meeting is being held on the 10th April - a verbal update will be provided at the Board Meeting.

5.0 Expression of Interest to become an Integrated Care System

5.1 NHS England sees becoming an Integrated Care System (ICS) as an evolution of the Sustainability and Transformation Partnerships. An ICS enables a system to become a system which is jointly responsible for creating integrated health and care services for their local population within the available budget. Becoming an ICS gives a local system more flexibility to manage resource across local services, improved access to NHS transformation funding opportunities and engagement with NHS regulation in manner which enables local flexibility and integration. Overall, it is seen to be an enabler to accelerating the improvement of Norfolk and Waveney’s health and care system. 5.2 The criteria for becoming an Integrated Care System are:

• Effective leadership and relationships, capacity and capability • Track record of delivery • Strong financial management

• Coherent and defined population • Focused on care re-design

5.3 NHS England considers that eight areas are currently in this position, with a second wave of areas to be approved in March. The Norfolk and Waveney Sustainability and Transformation Partnership (STP) has been invited by NHS England to bid and an expression of interest was submitted on 16th February with the agreement of the STP executive members, including the Managing Director, Director of Adult Social Services and the Director of Public Health. The expression of interest will be reviewed by NHS England and NHS Improvement during March. A successful outcome would see Norfolk and Waveney become a shadow ICS from April 2018.

5.4 The benefits which have been identified in Norfolk and Waveney STP expression of interest to becoming an ICS include: - Enabling a stronger focus on prevention and the whole population’s health to improve the health of the population of Norfolk and Waveney. - Integrating more health and care pathways in the community wrapped around primary care, building upon existing services to provide more seamless care. - Support the integration and closer working across the three hospitals. - Enable a whole system approach to supporting challenged services - Reduce unwarranted variation across the whole population - Working more closely as regulators, commissioners and providers to provide better consistency. - Make Norfolk and Waveney a more attractive place to work - Enable a fundamental shift in culture across services. - Enable the “Norfolk system” to make better use of its health and care resources which total £2.6billion

5.5 The results of the application are expected in May 2018

Appendix One Chair of Healthwatch Norfolk

Role Description

Having overseen the organisation for the last 5 years, the incumbent Chair has reluctantly decided to step down. This, however, provides an exciting new opportunity to continue the work of Healthwatch in these challenging and changing times in the world of health and social care.

The Chair, with the Chief Executive Officer (CEO), will lead the Healthwatch Norfolk Board, give strategic direction to the organisation and ensure that Healthwatch remains the consumer champion for health and social care services.

The Healthwatch Norfolk Board comprises of 8 community members, and the option to co- opt up to 4 additional members to ensure that the board members among them have all the skills necessary to oversee Healthwatch Norfolk. The Chair has, since inception, be an independent paid appointment.

The Chair works closely with Chief Executive to guide the organisation’s strategic direction and the relationship between the Chair and Chief Executive is crucial as it ensures the ongoing effectiveness of Healthwatch Norfolk.

The Chair ensures that there is clarity about what the Board expects Healthwatch Norfolk to achieve through the Strategic Plan whilst the responsibility for the implementation of the Strategic Plan and all operational and organisational management rests with the Chief Executive.

The Chair and CEO will ensure that the organisation delivers on organisational performance and efficiency targets agreed with Norfolk County Council as the Commissioning Body.

Further information on Healthwatch Norfolk including the papers of all Board meetings are available at www.healthwatchnorfolk.co.uk

Overall responsibilities of the Board and its Chair

In summary the responsibilities of Trustees are to:

• Safeguard and promote the values and mission • Determine, with the CEO, the strategy and structure • Be effective, responsible and accountable • Make sure that the board of Trustees functions effectively

We expect this role to require a commitment in the region of 1 day per week but there will be a need for flexibility. Initial appointment will be for 3 years with a process of annual review and the possibility to reappoint for an additional term. This post is remunerated at £8,000 per annum plus expenses.

Role description for the Chair

Leadership role

The Chair will be the leader and spokesperson of the HealthWatch Norfolk Board and is expected to fully understand and represent HealthWatch Norfolk and its activities. In particular this means:

1. Contributing actively by :- • giving firm strategic direction to the organisation • determining mission and strategy • setting overall policy • setting and evaluating performance against agreed targets 2. Providing leadership to the board and ensuring that Trustees fulfil their duties and responsibilities for the proper governance of Healthwatch. 3. Acting as a spokesperson and figurehead, representing Healthwatch at various functions and outside events.

Ensuring involvement and accountability

The Chair will have a responsibility to deliver accountability through:

4. Ensuring that the Board, and Healthwatch generally, respond to the voices and views of key stakeholders. 5. Ensuring that Healthwatch Norfolk fulfils its responsibility to help reduce health inequalities 6. Ensuring that there is a systematic, open and fair procedure for the recruitment of the Chief Executive, Trustees and future Chairs 7. Being accountable (with other board members) for the actions of the organisation

Line Management of the Chief Executive on behalf of the Board

The Chair will have line management responsibility for the Chief Executive. This includes: 8. Ensuring there are clear and open processes for the recruitment (and if necessary dismissal) of the chief executive 9. Setting and reviewing the remuneration package of the chief executive. 10. Managing the performance of, supporting, and where appropriate, challenging the chief executive and ensuring clear expectations and targets 11. Ensuring the opportunity for professional development

Ensuring the effective management of the Charity’s business The Chair will have duties (shared with other board members) to ensure effective management of Healthwatch through:

12. Safeguarding the good name and values of Healthwatch Norfolk 13. Ensuring that Healthwatch Norfolk • Complies with its articles of association

• Complies with charity law, company law and any other relevant legislation or regulations • Ensuring that it pursues its objects as defined in its governing document • Ensuring the organisation applies its resources exclusively in pursuance of its objects 14. Ensuring the effective and efficient administration of HealthWatch Norfolk 15. Ensuring that Healthwatch Norfolk delivers on performance and efficiency targets agreed with the commissioning body, Norfolk County Council 16. Where appropriate, work with Healthwatch England and the Care Quality Commission (CQC) 17. Ensuring the financial stability of the organisation 18. Protecting and managing any property of Healthwatch Norfolk and to ensure the proper investment of the charity's funds

Efficient conduct of Board meetings The Chair will also have responsibility for ensuring the proper and efficient conduct of board meetings, including holding them in public, through:

19. Chairing Board meetings effectively, seeking consensus, balancing the need for full debate on key questions with the expeditious despatch of business 20. Ensuring that board decisions are made in the best, long-term interests of the charity 21. Ensuring that the board focuses on its governance role and does not drift into a management role 22. Encouraging all Trustees to participate and to feel free to challenge constructively both the chair and the chief executive 23. Ensuring that decisions taken at meetings of the board are implemented 24. Additionally, the Chair in conjunction with other Board members will make decisions on any matters that cannot be progressed without authorisation by the Board, but cannot wait until the next Board meeting.

Person specification Knowledge and experience

• Able to demonstrate good awareness and understanding of the current environment in Norfolk and how local health, and social care and wellbeing services are delivered • Good understanding of health, social care and wellbeing policy issues/challenges facing NHS and Local Authorities • Good understanding of the Voluntary and Community Sector • Leadership experience - of an organisation, department or team • Experience of being a board member or chair • Experience of high level governance, including strategic planning, financial management, commissioning skills, risk management, performance management and business growth • Experience of, or good understanding of, working with member/customer focused organisations and a commitment to high standards of customer care • Understanding and acceptance of the legal duties, responsibilities and liabilities of being a Trustee

• Understanding of the role of Healthwatch locally and in relation to Healthwatch England, and the Care Quality Commission (CQC) and Norfolk County Council as commissioner.

Skills and abilities

• Able to lead the organisation through periods of change • Ability to develop the vision to raise standards across Norfolk • Strong strategic planning and implementation skills • Able to challenge and hold the Board, staff team and providing consortium members to account • Strong communication and interpersonal skills, able to liaise effectively with a wide a range of stakeholders and audiences • Skilled at bringing people together to generate a strong team spirit to work collaboratively and build consensus • Excellent negotiating and influencing skills • Ability to think creatively.

Personal behaviour and style

• Passionate about promoting better outcomes in health and social care for all and ambitious in championing Healthwatch Norfolk’s role • Understanding and ability to follow the Nolan principles of public life: selflessness, integrity, objectivity, accountability, openness, honesty and leadership; leading by example and personal credibility • A diplomatic and sensitive approach • Proactively demonstrates strong commitment to equality and diversity • Listens to others and provides decisive leadership when it is required • Good, independent judgement and willingness to speak their mind.

Other requirements

• Has a commitment or connection to Norfolk • A willingness and ability to devote the time and effort required to discharge the duties of this role • ICT literate.

HWN Operations Plan 2017-2018 – version 1.6 Appendix Two

Activity Timescale Resources Outcome Performance Lead Complete Measure Action Ongoing 1. Representing local people by becoming the leading source of feedback on health and social care, for both local people and professionals in Norfolk Intelligence Reports Produce quarterly Quarterly Staff – Info Analyst Clear summary of HWN Board Engagement On-going intelligence reports for HWN activity confirm their Mgr Board (including you understanding of said we did section) people’s experience Use intelligence report Ongoing Staff/volunteers/Board/memb Identification of Board sign off Board/CEO 3 projects as the process to ers of the public significant HWN reports identified – identify specific HWN themes/trends going projects for approval by through due HWN Board process (maximum 3 per year) 2 completed – final project in relation to autism will be completed end June 2018 Enable local Ongoing Staff Demonstration of Evidence as to Project Mgr All providers commissioners & (cost of refinements to IT how feedback is how professionals and providers to access systems?) used have used the commissioner feedback on HWN feedback now have website and ability to demonstrate their provide response to feedback direct feedback to

comments received on website Feedback Kiosks: Ongoing Staff & LHM Facilitation of Evidence of Project Mgr Toolkit Develop an in-surgery getting feedback additional developed kiosk tool that will Kiosks set up in GP feedback with LHM and enable patients to leave Practices and gathered through being piloted anonymised feedback working well. kiosks. by upon using the service, Supporting Thorpewood adding further practices to gather Surgery – comments to our feedback more pilot due to database. effectively end August ‘18 Feedback Ongoing Staff & LHM Facilitation of Evidence of Project Mgr Widget Widgets: Provide an widgets being used additional developed online tool (widget) and accessed on feedback and being containing our logo, GP practice gathered through piloted by which will be hosted on websites. widgets. Ludham & GP practices websites to Stalham Raised awareness Surgeries gather patient feedback. of Healthwatch Norfolk. Share intelligence data Ongoing Staff – Info Analyst Clear process to Number of Project Mgr Info Analyst reports with CQC share feedback reports to CQC & building links its response with each CQC Inspector and Inspection Manager in area to develop working/shar ing Website

Regular review of HWN Six monthly Staff/Board/Volunteers to help Easy to use & Comments on Comms On-going – website to improve with review informative quality of Officer changes are accessibility and content website website & made as and number of hits when required/req uested Posting of news items to Ongoing Staff/Volunteers/stakeholders Helping to Take up of Engagement On-going – website to inform local inc HWE/NHSE/CCGs facilitate informed services/events Mgr frequent use people and professionals choice on health etc posted of press and social care releases from services partnering organisations to help inform public about choices available Critical friend, facilitator, scrutineer Ongoing input as critical Ongoing Staff & volunteers Ensure patient Quality of Ops Manager HWN is well friend/facilitator/scruti voice is meeting reports represented neer through staff & represented across at a range of volunteer representation all forums meetings – on details can commissioner/provider be found in patient representative both the groups annual report and on the website Assist providers with Mar – Jun 17 Staff (Ops Mgr and Admin Ensure patient Improvement in Ops Mgr A dedicated PLACE inspections officer) & volunteers voice is published PLACE team of represented scores volunteers have been trained in order to help

facilitate PLACE inspections. Commentary on provider Apr – Jun 17 Staff (Ops Mgr), Board & Ensure document Published Quality Ops Mgr All Quality Quality Accounts volunteers is user friendly & Accounts Accounts meaningful have been responded to.

2. Meaningful engagement by working efficiently and effectively to reach diverse communities across the county Timescale Budget/Resources Outcome Performance Lead Measure

Engagement Plan Produce a community Publish mid Staff/volunteers Engagement across Know who we Engagement Staff changes engagement plan for March 17 the county have engaged Mgr resulted in 2017-18 (following with & their this being review of 2016-17 profile severely engagement) delayed. An Engagement Plan has been completed for 2018-19 Identify where April 17 Staff, Board & volunteers All events are Number and Engagement As above and additional staff appropriately variety of Mgr on-going resources/kit needed to manned engagement implement engagement events plan for 2017-18 Engagement Activity

Actively work with Ongoing Staff Sharing of HWN Number of Engagement HWN actively stakeholders to offer engagement stakeholders Mgr seek advice and expertise on expertise seeking HWN opportunities how to engage expertise to partner effectively with other organisations , e.g., CCGs, NSFT, Active Norfolk etc. Organise annual Showcase All staff to input Showcase HWN Attendance at Ops Mgr & Event showcase event (plus ad Sept 17 showcase events Engagement organised for hoc HWN events as Mgr 3rd October required) 2017 to piggy back AGM Produce annual report Mar – June 17 All staff to input Showcase HWN Feedback from Ops Report 2016-17 stakeholders on Mgr produced by annual report Info Analyst and forwarded to DH as per legislative requirement STP Form STP Board Sub Recommendati Board & staff Focussed Number of Senior Group Group to steer HWN in on to Jan 17 discussions & comments Mgment formed – its role to support the Board followed demonstrate how received on STP Team facilitated STP engagement by monthly engagement has public activities. (see note 1 meetings informed STP meeting on below) decisions 17/07/17 at Blackfriars Hall and further public events in Nov and Dec 2017.

Research & review data Ongoing Staff Ensure the format Feedback on Senior HWN attend as part of STP of engagement is format of Mgment engagement engagement to ensure appropriate and engagement Team meetings insightful knowledge of relevant facilitated by the service the STP Exec’s Comms and Engagement Director Lead role in STP As from Jan 17 Staff Stakeholder Board Feedback from CEO Stakeholder Stakeholder Board enables members of the Board with meaningful public public cross sector engagement representatio n established – facilitated by HWN. Meetings occur monthly and are well attended. To be reviewed in spring 2018. Media Engage with the media Ongoing Staff (input on specific Raise public Number of media Engagement Regular press (reactive and proactive) projects from relevant project awareness of HWN interviews Mgr releases are – press releases, media officer) and its role issued when interview/log and where appropriate Frequent interviews given to both Radio and TV stations.

Comms. and Engagement Mgr updates with regard to “reach” at all Board Meetings. Signposting Record signposting Ongoing Staff – administrator & Info Accurate Number of Ops Mgr Signposting activities accurately, Analyst signposting signposting activity identify themes referrals reported via and trends, review the Board accuracy of signposting Intelligence directory on an ongoing Report on a basis quarterly basis.

Information Gathering Identify key issues from Ongoing Staff – Info Analyst Improved level of Stats on data Senior System all sources of knowledge from sources Mgment developed information gathering - collated sources Team and public engagement/on implemented line surveys and present for every findings to quarterly project Board meetings undertaken

PPGs Engage with PPGs via Ongoing Staff (Administrator, Improved network Number of PPGs Engagement Following the networks established Engagement Officers and of engagement actively engaged Mgr & GP Project – through GP project Project Officers) with service users with HWN Project Mgr engagement with PPGs has improved Enter & View

Develop & implement April 17 Staff & volunteers Full complement Improvement in Senior Rolling rolling programme of onwards of trained E&V services Mgment programme E&V visits authorised Team of care representatives homes began Autumn 2017. 10 reports completed and published on website. 3. Real improvements through an intelligence driven approach to making recommendations for local services 4.

Performance Activity Timescale Budget/Resources Outcome measure Lead Intelligence reports As in 1. above publish Quarterly & Staff – Info Analyst Improved Who has Project Mgr Report quarterly intelligence annually understanding of participated in provided to reports and annual peoples’ projects and Board at report analysing local experience of local their profile every data on local people health and social meeting. using health and social care services Analysis has care services become more refined – this will be ongoing into 2018-19 Scrutinise national, Ongoing All staff to input Accurate picture Feedback from CEO & Ops On-going and regional and local of local services in Board on reports Manager highlighted data/research reports context of to Board if regional/national pertinent. Provide regular Ongoing All staff to input Evidence based Improvement to CEO & Ops On-going. reports/escalation as reports on health health & social Manager Attend every appropriate to HOSC and and social care care services HOSC and HWBB user perspective HWBB

meeting and associated sub-groups 2016-17 Projects completion Sign off CAMHS Tier 1 & April 17 Board Evidence based Improvement in External Completed 2 report on CAMHS service consultant and Tiers 1 & 2 published Complete phase II of May 17 Staff and external stakeholders Evidence based Improvement in Project Mgr Completed – primary care report on primary relationships final Board relationships care relationships sign off 17/07/17 Complete work on April 17 Staff and external stakeholders Evidence based Acceptance of Project Mgr Completed – analysis of dementia report to for analysis report by signed off by training (SNCCG) SNCCG SNCCG SNCCG and paid for Community Patient June 17 Staff, volunteers and public Evidence based Feedback from Project Mgr HWN have Transport report for use in users of ‘one stop contributed setting up NCC shop’ to NCC ‘one stop shop’ project as required. Awaiting NCC launch of online tool. Carers telephone March - Nov 17 Staff, volunteers and public Evidence based Feedback from Project Mgr CCN/HWN assessments report for use in service users report improving completed. assessments

2016-17 Commissioned Projects (new) UEC Network project Jan – May 17 Staff and stakeholders Evidence based Improvement in Project Mgr Completed, report for use by service report the UEC Network accepted by

UECN and published on website – extra monies provided to host conference in Autumn 2017.

Swaffham Provider Jan – Aug/Sep Staff Evidence based Improvement in Project Mgr Project did Partnership (Careology) 17 report for use by service not run to Careology full completion. Paid for work that was done. Stand Easy service April 18 Staff Evidence based Improvement in Project Mgr On-going. evaluation report for use by service Data Stand Easy and collection British completed. Acupuncture Analysis will Council (BAcC) result in final report to BAcC in May 18.

Follow up on 2016-17 projects 6 month follow up on May 17 Staff Publish you said Improvement in Project Mgr Chased recs recommendations in we did outcomes service and reported Access to services by in Annual those with physical Report which disabilities report will go to Board

12 month follow up on July 17 Staff Publish you said Improvement in Project Mgr Chased recs recommendations in the we did outcomes service and reported MAP report in Annual Report which will go to Board 12 month follow up on July 17 Staff Publish you said Improvement in Project Mgr Chased recs recommendations in the we did outcomes service and reported End of Life report in Annual Report which will go to Board Review response to July 17 Staff Publish you said Improvement in Project Mgr Chased recs recommendations in we did outcomes service and reported report on Equipment in Annual Service Report which will go to Board 12 month follow up on July 17 Staff Publish you said Improvement in Project Mgr Chased recs recommendations in the we did outcomes working and reported Phase I report on GP relationships in Annual Practices in Norfolk: Report which Relationships will go to Board 6 month follow up on Sept 17 Staff Publish you said Improvement in Project Mgr Will report to the recommendations in we did outcomes service October the CVD report board meeting 6 month follow up on Oct 17 Staff Publish you said Improvement in Project Mgr CAMHS recommendations in the we did outcomes service restructure Tiers 1 & 2 report currently in progress. Review on funding/take Oct 17 Staff Publish you said Improvement in Project Mgr Exception up of Reablement we did outcomes service/maintain reports to Service service

Board if required 12 month review of Nov 17 Staff Publish you said Improvement in Project Mgr Exception outcome of report on we did outcomes services reports to Access to Services by Board if those with Physical required Disabilities Review take up of Jan 18 Staff Publish you said Improvement in Project Mgr Exception pressure ulcer training we did outcomes numbers trained reports to by NCHC Board if required Carers Council for Norfolk Review output of work Jul 17 Staff Improved Positive feedback Project Mgr Recommend with CCN as funding knowledge from from CCN that funding ends carers perspective continues to April 18. Funding to be granted from grant income generated through UECN – amount required £5625 Final report attached for information as Appendix Three.

2017-18 Focussed time Project scope to include completion of engagement proforma template, allocation of resources in terms limited projects (see of staff hours (for finance sub group reports), consideration of volunteer resource (e.g. E&V), completion note below) of EQIA template. Project scoping papers to be approved by QC Sub Group and progress reports on project to be presented to QC Sub Group

Focussed project 1 - Aug 17 to Mar Staff, volunteers, public Feedback from x Improvement in Project Mgr Project in Autism (time limited) 18 service services progress and (See Note 2 below) users/carers final report Enter & View to QC reports subgroup June 18 Focussed project 2 - July to Mar 18 Staff (Info Analyst), volunteers, Feedback from x Improvement in Project Mgr Draft report Dentistry (time limited) public patients services shared with (See note 2 below) Enter & View QC subgroup reports and Board April 18. Focussed project 3 – Out June to Dec 17 Staff, volunteers, public Feedback from x Improvement in Project Mgr Final project of Hours Service (time patients/carers services report to be limited) Enter & View finished by (See note 2 below) reports end May 18. Delayed by PNA and also loss of Project Manager. 4.Providing a sustainable service by maintaining the funding and expertise required to provide an independent and effective local Healthwatch Activity Timescale Budget/Resources Outcome Performance Lead Measure HWN Consultancy

Develop HWN Ongoing Budget tbc/Staffing Additional income Repeat work CEO & Ongoing as Consultancy to cover shortfall commissioned Project Mgr commissione in funding d works are undertaken Governance Provide finance sub Ongoing Staffing (Ops Manager) Transparent, Board acceptance CEO & Ops Completed group with quarterly accurate reporting of reports Mgr and on-going financial reports to Board Ensure quality of HWN Quarterly Sub Staffing/Board Evidence based Positive CEO & Ops Completed reports(in house & Group reports Feedback on Mgr and on-going commissioned meetings Reports by externally) through QC Stakeholders Sub Group Complete all reporting Ongoing Staffing/Accountants Reports submitted Reports accepted CEO & Ops We are to comply with on time Mgr compliant as governance e.g. Charity per Commission, Companies legislative House, Health & Safety requirements Audit, Annual Return to DoH & HWE Staffing Ensure all staff April-May All staff Appraisal Retention of Line 100% appraisals are paperwork all motivated staff Managers compliant undertaken including completed discussions on personal development plans/training Hold at least one away Summer 2017 All staff Cohesive, Retention of CEO & Ops Away day day to enhance team motivated staff motivated staff Mgr held in May working and staff team 17 development Volunteers Ongoing recruitment Ongoing Staff (Ops Mgr) Trained volunteer Increase in Ops Mgr On-going (targeted when base number of

25 appropriate) induction, volunteers, management & training representative of Norfolk residents 360 degree appraisal Undertake 360 degree July-Aug (Every Staff and all stakeholders Good Stakeholders CEO & Ops July 2018 if appraisal other year – understanding of confirm added Mgr considered commencing in HWNs public value of HWN appropriate 2018) reputation amongst stakeholders 5.Influencing locally and nationally by working with other organisations to ensure services are safe, effective, compassionate and high-quality

Activity Timescale Budget/Resources Outcome Performance Lead Measurement Local Input to provider Quality Ongoing Staff Ensure Local partners Ops Mgr This is Lead meetings independent state HWN achieved patient feedback is through perspective is constructive, attendance included in independent & at a range of commissioning/ser clear about minuted vices provision rationale for meetings evidence used

Regional Reports to QSG Bi monthly Staff Local issues are Action taken to CEO & Reports included in address issues Project Mgr provided to discussions every QSG and regular

attendance at QSG meetings Pursue working Ongoing All staff Ensure best use of Examples of Senior Meet on a relationship with resources & working with Mgment 1/4ly basis to neighbouring local HW sharing of another local HW Team discuss information opportunities Nominated for national award for our collaborative approach to working with other local HW Work with NHSE as As and when Staff (CEO & Ops Mgr) Ensure Acknowledgemen CEO & Ops HWN independent patient required independent t of HWN input Mgr represented voice on procurement patient voice is at GP panels included Procurement Veterans Mental Health Services, and Public Health Procurement since April 17 National Escalate to HW England As and when All staff Raise awareness of Issues resolved CEO HWE assisted unresolved local issues necessary unresolved issues with NCC funding issue. Contributed to all national

requests and submitted information for Parliamentar y Select Committees Submit HWN published As and when Staff Contribute to Feedback from Ops Mgr On-going – all reports to HWE published national picture of HWE & reports HW activities improvement in forwarded to services HWE to help inform national picture in relation to service provision. Submit E&V reports to As and when Staff Contribute to Improvement in Ops Mgr 100% HWE completed national picture services compliant

Safeguarding Report all safeguarding Ongoing Staff/volunteers Clear process to Positive feedback Ops Mgr Regular incidents to NCC/CQC ensure all possible on referrals to attendance plus quarterly report to safeguarding issues NCC/CQC at HWE are appropriately Safeguarding reported Meetings. In dialogue with NSAB to work more closely with each other.

Appendix Three

THE VOICE OF ALL CARERS IN NORFOLK.

Carers Council for Norfolk Report for Healthwatch March 31st 2018

WORKING WITH HWN TO REPRESENT LOCAL CARERS IN SERVICE DESIGN AND DELIVERY BOTH LOCALLY AND NATIONALLY

WITH HWN STRATEGIC PRIORITIES OF MEANINGFUL ENGAGEMENT, MAKING REAL IMPROVEMENTS TO PROVIDE A SUSTAINABLE SERVICE

Background and Vision

Carers Council for Norfolk (CCN) is a user-led organisation providing the independent voice of carers. Its vision is to ensure that unpaid carers throughout Norfolk are valued, recognised and supported; with equal access to a good quality of life that is not prejudiced by their caring role. Through partnership working, CCN ensures the voice of carers is heard and listened to, enabling support and services to be designed and delivered that reflect carers’ needs and interests. It facilitates 5 locality groups where carers are able to discuss what matters to them as well as local and national issues. Wherever possible the voice of carers is used at an early stage

to ensure that new initiatives or changes within the health and social care system are co- produced. It runs a Countywide Strategic Partnership group bringing together key strategic organisations to ensure a cohesive approach across the county to carers issues where the voice of carers can be heard and listened to by the county’s key decision makers. Equally Carers are able to cascade issues from the grass roots locality groups up to the countywide partnership. CCN and HWN have continued a programme of joint, collaborative and co-ordinated work which allows both organisations to function more fully. HWN has access to CCN’s expertise and carer led structures and channels while HWN offers statutory powers, expertise in analysis and reporting and improved access to the wider health and care system.

OUTCOMES 2017 - 18

1. Share with HWN evidence of improved awareness of carer’s issues across the Health and Care System in Norfolk in terms of both commissioners and providers.

CCN & HWN Joint Survey

The primary piece of work undertaken with Healthwatch Norfolk during the year 2017 – 18 was the survey report. The survey has been widely promoted and distributed through the carer and community networks, and adult health and social care. We have also heard that the report has been used at Member Committees to illustrate the importance of supporting carers and that the findings of the report were taken up by the High Sheriff of Norwich, James Bagge, to evidence carers’ needs on his fund-raising walk for carers from Norfolk to Santiago de Compostela! Incidentally, the report was subsequently sent to all those attending these promotional events.

The report was a joint project with Healthwatch Norfolk leading on Carers Assessments and Carers Council for Norfolk leading on questions regarding the health and wellbeing of carers and what would give carers greater confidence to continue in their caring role to ensure that the newly commissioned service to support carers was directly targeted to what carers need and want.

Carers told us that they wanted to be involved at every stage of the process and at the heart of a responsive service. CCN took this to the Commissioners and through extensive constructive dialogue became part of the newly commissioned service ensuring the voice of carers was at the heart of the design and delivery of the service. A new model of support for carers has been designed with carers having active involvement throughout the service with user involvement groups for community support including Volunteers and Education and Training; Advice Line, Online Services and Counselling and Communications, Awareness and Engagement. Carers Co-Chair the Performance and Development Group and are fully represented on the Partnership Steering Group.

The full recommendations from the survey are attached as an appendix at the end of this report and a strategic action plan is being developed through CCN Countywide Strategic Partnership Group which will ensure improved awareness of carers issues across the Health and Care System in Norfolk. The three key points to note for Healthwatch Norfolk going forward (subject to appropriate funding being available) are those below:

1. Carers Council for Norfolk and Healthwatch Norfolk to co-develop a health and wellbeing strategy for carers with Norfolk Public Health to increase self- management and resilience. 2. Carers Council for Norfolk and Healthwatch Norfolk to work with Norfolk County Council and NHS CCG commissioners to ensure that carers are included and prioritised where appropriate within service/contract specifications for tenders such as those relating to Social Prescribing and Loneliness and Social Isolation projects and services. 3. Monitoring and evaluation of outcomes: Carers Council for Norfolk and Healthwatch Norfolk to monitor and evaluate the progress towards achieving these outcomes through the Carers Council Countywide Strategic Partnership Group. CCN very much hopes that it will continue to work with HWN on these key priorities for carers going forward.

2. In collaboration with HWN, produce recommendations for improvements to accessing support services.

CCN Strategic Partnership

The remodeling of the CCN Countywide Strategic Partnership meetings has continued with higher level strategic inclusions of members from across adult health and social care, county, district and borough councils and wider voluntary and third sector involvement together with carers. The locality groups are being widened to increase access for carers ensuring that the most comprehensive methods of communication are being used to enable carer involvement in local and national issues as well as those that matter to them personally.

Membership

The 500 plus members of CCN are all being contacted individually to update their involvement, interests, skills and experience and to ensure the service is offering the support required for unpaid carers. All members have been given the details of HWN. The website and feedback process for HWN has been promoted to each member. CCN continues to be the trusted expert organisation for carers in Norfolk.

Volunteers

Ex carers are some of the most skilled advocates of carer support and these are being actively recruited as volunteers for the new service.

Group Grants

CCN is, within the new service, administering the carer group grants. It has identified almost 150 groups, contacting them individually, identifying the accuracy of information and ensuring there is access to support for the groups and also that the groups feed in the skills and knowledge of their members and that they are aware of the new service and what it offers together with membership of CCN.

Emergency in my Place

The Emergency in my Place scheme is being refreshed with Norfolk County Council with the input of carers and CCN.

Carers Passport

CCN and carers have been working with Norfolk and Norwich University Hospital to pilot a Carers Passport in three wards which will be going live across the hospital in Carers Week in June. CCN has been involved in assessing how the Carers Strategy can be implemented across the hospital.

Norfolk County Council Champion for Carers

CCN continue to work with Julie Brociek Coulton to promote carers and carers issues/awareness to be at the forefront of councillors minds during debates. The CO of CCN briefs the NCC Champion before the AHSC committee meetings.

Making it Real

CCN has worked with this user group on council consultations, budget setting discussions with James Bullion, promoting independence, personal budgets, scie review, IAA, care provider staff training and housing support.

CCN has worked regionally with the NHS to improve provision and information for carers.

3. In collaboration with HWN, produce recommendations and present to commissioners for inclusion in decisions affecting carers services and local implementation of the Care Act and the Children and Families Act.

The Care Act came into force on 1 April 2015 and gave carers rights on an equal footing to the people they care for. Their rights include taking into consideration the carer’s health and wellbeing, family relationships and their need to balance their home life with their education or work. Norfolk County Council has undertaken a commitment to produce a Carers Charter with three definitive strands.

Carers Charter Task and Finish Group CCN is key partner leading on the development of a Carers Charter through a Task and Finish group resourced by Norfolk County Council. This is a unique opportunity for carers to be involved in shaping the future landscape for carers through this Charter. William Armstrong is the Independent Chair and the group comprises 4 carers, 5 member councillors and is supported by officers from Norfolk County Council adult and childrens services with Debbie Bartlett, Assistant Director for Strategy and Transformation as its lead. This Charter is looking at support that can be given to employers throughout Norfolk to help support carers in the workplace. This work is continuing and bringing to fruition the valuable work undertaken between CCN and HWN following the original survey in 2015 around carer friendly employers and the development of a carers policy. NCC has taken out umbrella membership of Employers for Carers so that good practice throughout Norfolk can be established and maintained.

Secondly the Charter is looking at ways to support young carers and young adult carers in school and educational establishments so that they are not disadvantaged because of their caring role and looking at supporting the whole family. CCN is working to ensure that Parent Carers are included within the commissioned service as well as raising awareness of young carers and young adult carers. From April 1st, the commissioned support service will be providing targeted information, advice and guidance to young carers and their families funded by Childrens Services. Thirdly the Charter will be investigating what support Norfolk County Council can give to community organisations to ensure that carers can access respite and social activities given their caring responsibilities. Sustainable Transformation Partnership CCN has been active on the STP Stakeholder Group to ensure that Carers are represented. As there is increased recognition that there must be transfer from service into communities, unpaid carers who are already under strain must be equipped and empowered to fulfil the expectations that will fall on carers. CCN is working to ensure that carers are part of the Workforce Development and have equal access to IA/Training and Skills development as well as being part of the hospital discharge process where support is required to reduce carer breakdown for the prevention agenda. The lack of the Carers Strategy for Norfolk which is also a key recommendation from the CCN/HWN survey report has been highlighted through the STP engagement. In summary Carers Council for Norfolk have deeply valued the shared working with Healthwatch Norfolk and look forward to continued development together.

Appendix for Outcome 1

2017 - 18

CCN & HWN Survey Report

Information and support for unpaid carers in Norfolk: feedback from local carers NEXT STEPS

1. The importance of respite in supporting carers to manage their health and wellbeing needs to be better recognised through both cared for and carer’s assessment and personal budget processes. a. Carers to be involved in co-producing a review of the respite and social activity offer from Norfolk County Council, other statutory providers and the voluntary and community sector. b. A Norfolk County Council, Member led, Task and Finish Group to review the Council’s role in enabling the voluntary and community sector to respond to the needs of carers for social inclusion and respite. c. Carers Matter Norfolk to co-produce and co-deliver awareness training sessions for Integrated Health and Social Care teams. 2. All carers are supported to have plans for the future and emergencies. a. Carers are involved in co-producing a revised Carers Emergency Card scheme with Norfolk County Council. b. Carers Matter Norfolk to co-produce a carers emergency plan toolkit and raise awareness with statutory, voluntary and community partners of the need to support carers to plan for emergencies. c. Carers Council for Norfolk and Carers Matter Norfolk to work with Acute and Community Hospitals to ensure that emergency planning is embedded within discharge processes. 3. Working with home care providers to improve outcomes for unpaid carers a. Establish a pathway for unpaid carers to be involved with co-producing and co- delivering training of home care providers. b. Norfolk and Suffolk Care Support (Carers Matter Norfolk) to undertake a programme of awareness raising with home care providers equipping them to identify hidden carers and signpost them to appropriate support.

4. Supporting carers to manage their health and wellbeing. a. Carers Matter Norfolk to work with statutory, voluntary and community providers and commissioners to improve the provision of information and advice and support to carers in navigating the health and social care system. b. Carers Council for Norfolk and Healthwatch Norfolk (subject to appropriate funding being made available) to co-develop a health and wellbeing strategy for carers with Norfolk Public Health to increase self- management and resilience. c. Carers Matter Norfolk in partnership with Public Health to devise and implement a public health campaign around caring and its impact on health and wellbeing. d. Carers Matter Norfolk in partnership with Norfolk Local Pharmaceutical Committee to develop a carer friendly pharmacy training programme, working with community pharmacies to pro-actively identify carers and signpost or refer them to appropriate support. e. Carers Council for Norfolk and Healthwatch Norfolk (subject to appropriate funding being made available) to work with Norfolk County Council and NHS CCG commissioners to ensure that carers are included and prioritised where appropriate within service/contract specifications for tenders such as those relating to Social Prescribing and Loneliness and Social Isolation projects and services. 5. Monitoring and evaluation of outcomes: Carers Council for Norfolk and Healthwatch Norfolk (subject to appropriate funding being made available) to monitor and evaluate the progress towards achieving these outcomes through the Carers Council Countywide Strategic Partnership Group.

Sharon Brooks Chief Officer Carers Council for Norfolk March 31st 2018

HWN Operations Plan 2018-2019 Appendix Four

Activity Timescale Resources Outcome Performance Lead Complete Measure Action Ongoing 5. Representing local people by becoming the leading source of feedback on health and social care, for both local people and professionals in Norfolk Intelligence Reports Produce quarterly Quarterly Staff – Info Analyst Clear summary of HWN Board Engagement intelligence reports for HWN activity confirm their Manager Board (including you understanding of said we did section) people’s experience Use intelligence report Ongoing Staff/volunteers/Board/memb Identification of Board sign off Board/CEO as the process to ers of the public significant HWN reports identify specific issues themes/trends Raising to alert NCC, CCGs NHSE issues/reporting etc. to accountable organisations advising where further investigation is warranted Enable local Ongoing Staff Demonstration of Evidence as to Comms & commissioners & how feedback is how professionals Engagement providers to access used have used the Mgr feedback on HWN feedback website and demonstrate their response to feedback

Review Feedback Kiosks September Staff,LHM, GP Practice Mangers Potential Evidence of Asst.Project 2018 expansion of additional Mgr service thereby feedback supporting

practices to gather gathered through feedback more kiosks. effectively Review of Feedback December 2018 Staff, LHM & Practice Managers Facilitation of Evidence of Asst. Project Widgets widgets being used additional Mgr and accessed on feedback

GP practice gathered through websites. widgets. Raised awareness of Healthwatch Norfolk. Share intelligence data Ongoing Staff – Info Analyst Clear process to Number of Operations reports with CQC share feedback reports to CQC & Mgr its response

Website Regular review of HWN Six monthly Staff/Board/Volunteers to help Easy to use & Comments on Comms website to improve with review informative quality of Officer accessibility and content website website & number of hits Posting of news items to Ongoing Staff/Volunteers/stakeholders Helping to Take up of Comms & website to inform local inc HWE/NHSE/CCGs facilitate informed services/events Engagement people and professionals choice on health etc posted Mgr and social care services Critical friend, facilitator, scrutineer Ongoing input as critical Ongoing Staff & volunteers Ensure patient Quality of Ops Manager friend/facilitator/scruti voice is meeting reports neer through staff & represented across volunteer representation all forums on commissioner/provider

37 patient representative groups Assist providers with Mar – Jun 18 Staff (Ops Mgr) & volunteers Ensure patient Improvement in Ops Mgr PLACE inspections voice is published PLACE represented scores Commentary on provider Apr – Jun 18 Staff (Ops Mgr), Board & Ensure document Published Quality CEO / Ops Quality Accounts volunteers is user friendly & Accounts Mgr meaningful

6. Meaningful engagement by working efficiently and effectively to reach diverse communities across the county Timescale Budget/Resources Outcome Performance Lead Measure

Engagement Plan Production of Publish April 18 Staff/volunteers Engagement across Know who we Comms & Engagement Plan for the county have engaged Engagement 2018-19 with & their Mgr profile Identify where April 18 Staff, Board & volunteers All events are Number and Comms & additional staff appropriately variety of Engagement resources/kit needed to manned engagement Mgr implement engagement events plan for 2018-19 Engagement Activity Actively work with Ongoing Staff Sharing of HWN Number of Comms & stakeholders to offer engagement stakeholders Engagement advice and expertise on expertise seeking HWN Mgr how to engage expertise effectively Organise annual Showcase All staff to input Showcase HWN Attendance at Ops Mgr & showcase event (plus ad July 18 showcase events Engagement Mgr

38 hoc HWN events as required) Produce annual report Mar – June 18 All staff to input Info analyst to Showcase HWN Feedback from CEO / Ops 2017-18 produce using InDesign stakeholders on Mgr software this year. annual report STP Review ToR of STP Board September 18 Board & staff Focussed Number of Senior Sub Group to (see note 1 discussions - comments Mgment below) demonstrate how received on STP Team engagement has informed STP decisions. Steer HWN in its role to support the STP engagement activities. Research & review data Ongoing Staff Ensure the format Feedback on Senior as part of STP of engagement is format of Mgment engagement to ensure appropriate and engagement Team insightful knowledge of relevant the service Review role in STP September Staff Stakeholder Board Feedback from CEO Stakeholder Board 2018 enables members of the meaningful public public engagement Media Engage with the media Ongoing Staff (input on specific Raise public Number of media Comms & (reactive and proactive) projects from relevant project awareness of HWN interviews Engagement – press releases, media officer) and its role Mgr interview/log Signposting Record signposting Ongoing Staff – administrator & Info Accurate Number of Ops Mgr activities accurately, Analyst signposting signposting identify themes referrals

39 and trends, review accuracy of signposting directory on an ongoing basis

Information Gathering Identify key issues from Ongoing Staff – Info Analyst Improved level of Stats on data Senior all sources of knowledge from sources Mgment information gathering - collated sources Team public engagement/on line surveys and present findings to quarterly Board meetings PPGs Engage with PPGs via Ongoing Staff (Administrator, Improved network Number of PPGs Engagement networks established Engagement Officers and of engagement actively engaged Mgr through GP project Project Officers) with service users with HWN Enter & View Continue rolling April 18 –Aug Staff & volunteers Full complement Improvement in Operations programme of E&V visits 18 of trained E&V services Mgr in Care Homes - authorised representatives Explore a shift in focus Sept 18 – Mar Staff and volunteers Full complement Improvement in Operations of E & V visits to look at 19 of trained E&V services Mgr Learning Disability Care authorised Homes representatives 7. Real improvements through an intelligence driven approach to making recommendations for local services

Performance Activity Timescale Budget/Resources Outcome measure Lead Intelligence reports

As in 1. above publish Quarterly & Staff – Info Analyst Improved Who has Comms.& quarterly intelligence annually understanding of participated in Engagement reports and annual peoples’ projects and Mgr report analysing local experience of local their profile data on local people health and social using health and social care services care services Scrutinise national, Ongoing All staff to input Accurate picture Feedback from CEO & Ops regional and local of local services in Board on reports Manager data/research reports context of regional/national Provide regular Ongoing All staff to input Evidence based Improvement to CEO & Ops reports/escalation as reports on health health & social Manager appropriate to HOSC and and social care care services HWBB user perspective

2018-19 Commissioned Resources Outcome Performance Lead Projects * See Notes Measure EEAST – Evaluation of April 2018 Staff and EEAST data provided To be determined Delivery of report CEO / Asst. Early Intervention by Commissioner by agreed Project Mgrs Vehicle Service deadline North Norfolk Primary April 2018 Staff To be determined Delivery of report CEO / Asst. Care Ltd by Commissioner by agreed Project Mgrs deadline Stand Easy acupuncture April 18 Staff To be determined Delivery of report CEO / Asst. service evaluation by Commissioner by agreed Project Mgrs deadline SNCCG Dementia- Feb 18- end Staff and InDesign Software To be determined Delivery of report CEO / Asst. Friendly GP Services June 18 and training by Commissioner by agreed Project Mgrs Guide deadline

6 month evaluation at end Dec 18

Norwich CCG re CHC May 18 – end As per request from HOSC Evaluate and Delivery of report CEO / Asst. Jan 19 support by agreed Project Mgrs improvements in deadline verbal and written communication Follow up on previous March 19 All staff Provide overview Outcome Opps. Mgr HWN projects since to demonstrate improvements for inception where HWN has patients/carers made a “difference” 4.Providing a sustainable service by maintaining the funding and expertise required to provide an independent and effective local Healthwatch Activity Timescale Budget/Resources Outcome Performance Lead Measure HWN Consultancy Ongoing To be agreed By Board at Additional income Repeat work CEO meeting on 16/04/18 to cover shortfall commissioned in funding Governance Provide finance sub Ongoing Staff (Ops Manager) Transparent, Board acceptance CEO & Ops group with quarterly accurate reporting of reports Mgr financial reports to Board Review ToR of Quality September 18 Staff/Board Board sub-group fit Completed within CEO & Ops Sub Group for purpose timeframe Mgr Complete all reporting Ongoing Staffing/Accountants Reports submitted Reports accepted CEO & Ops to comply with on time Mgr governance e.g. Charity Commission, Companies House, Health & Safety Audit, Annual Return to DoH & HWE VAT registration and May 18 Increased accountancy cost Compliance with Quarterly VAT Ops Manager processes established onwards anticipated and work for Ops VAT legislation returns Manager successfully

completed and submitted Recruitment of new May-June 18 Recruitment costs and Appointment of Completion of CEO/Board Chair of the Board staff/Board input new Chair process by AGM 24 July 18 Staffing Ensure all staff April-May All staff Appraisal Retention of Line appraisals are paperwork all motivated staff Managers undertaken including completed discussions on personal development plans/training Hold at least one away Summer 2018 All staff Cohesive, Retention of CEO, Ops Mgr day to enhance team motivated staff motivated staff & Comms working and staff team and development Engagement Mgr Volunteers Ongoing recruitment Ongoing Staff (Ops Mgr) Trained volunteer Increase in Ops Mgr (targeted when base number of appropriate) induction, volunteers, management & training representative of Norfolk residents Refresh Strategy for 2019-2021 Prepare a draft strategy January 19 Board / all staff Strategy approved Fit for purpose CEO for Board approval and endorsed by and helps to Board contribute effectively in the health and social care landscape Appointment of new Trustees

The term of office will October 18 – Chair / CEO & Opps Manager New Trustees Trustee CEO/Opps be coming to an end for March 19 Advertising costs will need to inducted and in appointments Mgr three trustees be considered place for start of reflect the needs new financial cycle of HWN to ensure sustainability 360 degree appraisal Undertake 360 degree July-Aug (Every Staff and all stakeholders Good Stakeholders CEO & Ops appraisal other year – understanding of confirm added Mgr commencing in HWNs public value of HWN 2018) reputation amongst stakeholders 5.Influencing locally and nationally by working with other organisations to ensure services are safe, effective, compassionate and high-quality

Activity Timescale Budget/Resources Outcome Performance Lead Measurement Local Input to provider Quality Ongoing Staff Ensure Local partners CEO / Ops Lead meetings independent state HWN Mgr patient feedback is perspective is constructive, included in independent & commissioning/ser clear about vices provision rationale for evidence used Regional Reports to QSG Bi monthly Staff Local issues are Action taken to CEO included in address issues discussions Pursue working Ongoing All staff Ensure best use of Examples of Senior relationship with resources & working with Mgment neighbouring local HW another local HW Team

sharing of information Work with NHSE as As and when Staff (CEO & Ops Mgr) Ensure Acknowledgemen CEO & Ops independent patient required independent t of HWN input Mgr voice on procurement patient voice is panels, CCG Assurance included etc. National Escalate to HW England As and when All staff Raise awareness of Issues resolved CEO unresolved local issues necessary unresolved issues Submit HWN published As and when Staff Contribute to Feedback from Ops Mgr reports to HWE published national picture of HWE & HW activities improvement in services Submit E&V reports to As and when Staff Contribute to Improvement in Ops Mgr HWE completed national picture services

Safeguarding Report all safeguarding Ongoing Staff/volunteers Clear process to Positive feedback Ops Mgr incidents to NCC/CQC ensure all possible on referrals to plus quarterly report to safeguarding issues NCC/CQC HWE are appropriately reported NOTES

*Commissioned Projects – it has been recognised that HWN will need to undertake a range of commissioned work in order to remain financially viable. All projects will be consistent in their approach and the Senior Management Team will ensure that any work undertaken is compliant with HWN Articles of Memorandum, Charity Commissioners requirements, Companies House legislative and associated HMRC VAT regulations.

Healthwatch Norfolk

Communications and Engagement Strategy 2018-20

1.0 Introduction

Healthwatch Norfolk is the consumer champion for health and social care. It is one of 152 local healthwatch organisations set up as part of the 2012 Health and Social Care Act to give patients and services users an independent voice in the running of health and social care services.

Healthwatch can only be successful by working with local communities and a range of partner organisations. A strong, coordinated Communications and Engagement Strategy is essential to ensure that our wide variety of stakeholders are well informed and fully involved, whilst maximising opportunities for publicity.

These activities will support our overall strategy for 2017-2020 and help ensure that we meet our statutory obligations, as set out in our contract with Norfolk County Council.

2.0 Background

An aging population and increasing pressure on all health and care services in our region means the need for independent patient representation has never been greater.

A reduction in our own funding means that we need to work smarter and find new ways of reaching our target audience. We need to be realistic about what we can achieve and allow enough flexibility in our plans to support ad hoc objectives that arise through our commissioned work and support of the Norfolk and Waveney Sustainability and Transformation Partnership (STP).

We will utilise our existing intelligence to identify any gaps or areas of particular concern, focusing more targeted communications and engagement around these key areas. Where possible, this focus will be aligned with the shared priorities of our health and social care partners to maximise our effectiveness.

3.0 Our vision, mission and values

Our Communications and Engagement Strategy will be underpinned by our vision, mission and values.

We are working to shape a community where people’s health and social care needs are heard, understood and met.

Being an effective consumer champion requires us to listen to all sections of the community, especially the most vulnerable. We seek to influence those who have the power to change services for the better and we strive to keep local people well informed at all times.

Healthwatch Norfolk prides itself on being an organisation which is inclusive, influential, independent, credible and collaborative.

4.0 Strategic priorities

Our strategic priorities are to:

- Represent local people by becoming the leading source of feedback on health and social care in Norfolk - Reach diverse communities across the county through meaningful engagement - Improve services through our intelligence - Maintain the funding and expertise to provide an independent and effective local Healthwatch - Influence at a local and national level to ensure services are of the highest standard.

5.0 What we mean by communications and engagement

Communication relates to an exchange of information in order to produce desired outcomes (which may range from raising awareness to changing behaviour). Good communication is based on a clear understanding of the desired outcome. This should encompass what your intended audience should know, think or do differently, as a consequence of that communication.

There are many communication tools that can be used to deliver our message and our engagement programme of public events forms part of this.

Engagement seeks to establish a two-way dialogue, which has traditionally taken place through face to face events marketing but is increasingly taking place online.

Engagement takes place at a corporate or organisational level and with the general public. We engage key target audiences in all of our day to day work (see appendix 2). Communications and engagement is intrinsic to the whole organisation and applies to everyone, not just the communications and engagement team.

6.0 What we want to achieve

The main objectives of our communication and engagement activities are as follows:

• Increase brand awareness of HWN and its role as an independent consumer champion with providers and the general public • Drive increased traffic to our website and feedback centre • Publicise our achievements to demonstrate our effectiveness • Publicise opportunities to be involved • Utilise appropriate methods of communication to maximise our reach • Engage key audiences across all areas of the county and all sections of the community, including those who are vulnerable, groups with protected characteristics and the seldom heard • Influence the public to share their views on services in general, as well as in relation to specific topics or projects • Develop and maintain a positive profile as a well-connected player in health and social care • Provide clear and accessible information in a variety of ways to meet all needs • Inform commissioners, regulators and providers of the views of local people at a local/national level through a variety of means • Influence local commissioners and providers to make service improvements based on patient/service user views

• Influence commissioner, provider and VCSE organisations to encourage greater collaboration with HWN • Inform local people by raising awareness of the services, advocacy and advice available to them (signposting) • Actively engage with Healthwatch England and the wider Healthwatch network.

Our performance will be measured against these objectives and reported to our board and funders using the key indicators described in the evaluation section of this strategy.

7.0 Who we need to communicate with

Our target audiences are divided between key demographic and hard to reach groups within Norfolk’s general population and our strategic relationships with other stakeholders who have an ongoing interest in our work.

We must be firmly rooted in the communities we serve to understand their interests and influence, so that we can communicate and engage effectively, harnessing the power of VCSE networks to extend our reach further into the community.

Healthwatch recognises the importance of keeping our stakeholders informed of developments within the health and social care sector. We will continue to utilise and extend our range of communication methods to nurture and build upon established relationships.

A full breakdown of all stakeholders and our current engagement plan can be found in the appendices.

We will continually monitor our performance in relation to the hard to reach groups listed in Appendix 2.2 utilising any opportunities for further engagement as they arise.

8.0 What we need to communicate

Our current low levels of brand awareness mean that first and foremost we need to communicate who we are and what we do to as wider audience as possible.

Our audience insight analysis (appendix 6) shows that over a third of people are interested in sharing their experiences with us ‘if they feel it will improve care’ so we must demonstrate our impact wherever possible and sell the benefits of our independence and statutory powers. We need to show how people can make a difference and demonstrate the action taken by service providers to overcome people’s barriers to engaging with us.

Lack of time is another major barrier so we need to highlight quick and easy ways in which people can get involved or provide feedback and be mindful of the language used when engaging the public (see appendix 8).

We need to ensure that our messages are targeted and relevant in order to gain people’s interest. We should highlight the wide range of people and services we represent and the areas we cover, demonstrating our inclusivity and tapping into people’s sense of community on a highly localised or condition specific level.

We also need to communicate any changes to the future delivery of services and actively promote opportunities for the public to be involved in shaping them, as well as signposting people to further sources of help and advice.

The success of our existing collaborations should be publicised wherever possible to enhance our credibility and drive further collaboration.

9.0 How we communicate

We will communicate and engage with each of our key target audiences using a variety of methods which can be shown in appendix 2-3.

9.1 Meetings Our attendance at various meetings, steering groups and panels forms a large part of our engagement with stakeholders at a professional level (appendix 2). All staff are encouraged to publicise their involvement either directly on social media or through the communications and engagement team.

9.2 Events A wide programme of public events is planned each year to reach all of our key demographic groups (appendix 3) and an engagement protocol has been put in place (appendix 8) to maximise the effectiveness of each event. Surveys will also be used to reach those who are ‘time poor’ in order to gather further intelligence on key topic areas.

9.3 Media We will send out our own pro-active media releases as well as reacting to breaking news. Piggy backing where appropriate and providing quotes when requested. A full analysis of the local media landscape and most appropriate channels to use can be found in (appendix 5).

Staff guidance around media releases is covered in our communications protocol (appendix 7).

9.4 Social Media Staff who wish to/where relevant are encouraged to talk about their work through their own personal social media accounts and should periodically log into HWN accounts to talk about their work/areas of interest and engage/build links with relevant organisations, both locally and nationally.

We will carry out our own pro-active programme of posts/tweets utilising current projects, our events, meetings and days to day activities. We will use the HWE communications calendar and carry out desktop research to identify key dates to pro-actively promote relevant work, target key groups and signpost information i.e. Carers Week, World Mental Health Day etc.

We will also re-actively engage with the posts of others and piggy back on topical stories around provider performance where appropriate i.e. EEAST. Using the public’s top engagement trigger of ‘recent experience’ (see audience insight) to gather further feedback.

We will seek to trial the use of more engaging video content on our social media platforms. Any such video will be short in length and posted natively to each platform to maximise reach.

Facebook groups will be used to target specific geographic areas/hard to reach groups and we will seek to engage at times when our audience is online i.e. evenings.

Further guidance on the use of each social media channel can be found in the communications protocol (appendix 7).

9.5 Website All HWN news will be published to the website under latest news. Our full programme of public events will be available on the events calendar, which will be checked and updated regularly.

Details of our attendance at professional events/networks and closed group sessions (e.g. Parent & toddler groups) can be included to demonstrate the breadth of our work providing it is made clear they are not open to the public. Public engagement events hosted by third parties such as providers and STP partners can also be included.

9.6 Newsletter A periodic newsletter will be produced (quarterly at present, but subject to review). This is a digital first publication but print, large print and easy read versions will be provided on request. The digital version will be a simple series of direct links to key news items on the website with attention grabbing lead-ins to drive click through.

10.0 Data Protection

All activities described in this strategy will be carried out in accordance with the HWN’s data protection policy.

11.0 Equality and Diversity

All activities described in this strategy will be carried out in accordance with the HWN’s equality and diversity policy.

12.0 Budget and resources

Funding for all communication activities and public events will come from the communications budget which will be agreed in advance with the Operations Manager and formally approved by the board/finance sub group each year. Responsibility for day to day management will sit with the Communications and Engagement Manager.

There is an expectation on all staff to support communication and engagement activities as and when required.

13.0 Evaluation

The effectiveness of the communications and engagement strategy will be reviewed periodically, using the measures described below, with key indicators included in the quarterly board report.

13.1 Media Number of press mentions Potential reach Number of requests for comment

13.2 Social media Number of Twitter followers, new follows, impressions and mentions Number of Facebook Page Likes, posts, comments and overall reach Number of Linked- In Post views and mentions

13.3 Events Number of people engaged Number of reviews collected Number of events per CCG area Engagement of hard to reach groups Invitations to external events

13.4 Meetings Number of meetings attended Meeting invitations and presentation requests

13.5 Website Number of unique visitors Number of page views on specific areas. Number of reviews left online

13.6 Newsletter Newsletter Subscribers Open rate Click throughs/article views on website

13.7 General Signposting log Performance against budget

Appendices

Appendix 1 – SWOT Analysis Appendix 2 – Stakeholder Mapping Appendix 3 – Engagement Plan Appendix 4 – Meetings and Networks List Appendix 5 – Media Landscape Appendix 6 – Audience Insight Appendix 7 – Communications Protocol Appendix 8 – Engagement Protocol

Appendix 1 - SWOT analysis

Strengths: Weaknesses:

Impartial patient representation Under-utilised volunteers Coverage – Norfolk wide Limitations of I.T. capability (LHM/Hootesuite) Proven track record on delivering projects Provider contacts/reviews Links with VCSE Networks Lack of actionable feedback Strong ceo/board level links into commissioning Lack of intelligence in key areas i.e. social care and provider organisations Clarity needed over STP position Links with housing & local authorities Not privy to all discussions within the system Face to face engagement

Opportunities: Threats:

Support/challenge the work of STP Competition – Care Opinion, NHS Choices, In- Drive service improvement through actionable house feedback/research teams, volunteers, feedback commercial research firms e.g. Attain, UEA Give the public a greater voice Cuts to HWN Funding Speak out more, raise our profile Availability of funding for commissioned work Engage the business community Reputational risks – poor delivery of Build intelligence in new areas projects/engagement, breaches of Data Protection Better utilisation of volunteers Changes in Government Policy Generate revenue through commissioned work Sustain and grow the organisation

Appendix 2 - How we communicate: Stakeholder mapping

1. Key demographic groups

Audience Tools & targeting methods

Children and families • Children’s Centres • Libraries • Parent & baby/toddler groups • School Fetes • Hospital waiting areas – paediatrics • Supermarkets • Norfolk Show • Parks • Press • Radio • Website • Facebook Groups

Young people 11-25 • School visits/fetes • College visits/intranet/social media/focus groups/volunteer champions • University visits/open days/intranets/social media/focus groups/societies • Youth Clubs ie. Open • YMCA/MAP • Youth councils • Festivals • Children’s Centres (young parents) • Facebook Groups • YouTube • Pinterest • Snapchat Working age 25-65 • Libraries • Community Centres • Community Hospitals • Hospital waiting areas • Parent & baby/toddler groups • Gym/Sports Clubs/Slimming Clubs • Charity Events (e.g. Race 4 Life) • Flu Clinics/ Pharmacy/GP pop up • Surveys through employers/intranets/pop ups • All events – stand holders • Supermarkets/garden centres • Markets/shopping centres • School Fetes • Sports Centres/dentists – incentivised surveys • Parks / Park Run • Town/village Facebook groups

• Twitter / Linked-in • Local press/radio/website Older people • Flu Clinics/Pharmacy/GP pop up • Libraries • Knit & Natter (hobby groups) • Dementia Cafes • Sheltered Housing/Housing with Care - coffee mornings • Day Care Centres • Radio Norfolk • Local Press/website • Parish Newsletters • Care Homes (enter and view) • Healthcare events – Stalham/Swaffham • Older Persons Forum

2. Hard to reach groups

Audience Tools & targeting methods

Physical and Learning Disability • Rehabilitation Centres • Physiotherapy Dept at Hospitals • Community Groups - MENCAP • Carers Events • Norfolk Show • Disability festival

BME/Migrant communities • Cultural celebrations/events – Mosque open days, Magdalen Street/The Forum diversity celebration, Indian Mela • GYROS / KLARS etc. • Traveller sites • Bridge Plus/New Routes • University cultural societies Carers • Carers events • Coffee Mornings • Support Groups • Conferences • Dementia Cafes • Targeted comms through Carers Matter Norfolk/ Carers Council/Family Voice LGBT • PRIDE • LGBT Groups • LGBT Youth Groups • Online- through Facebook groups • Local media • Twitter MH service users • All public engagement • MIND/Wellbeing events • Facebook Groups • Facebook Advertising • Supported Housing • Men’s football groups

• Community gardening/walking groups • Press/radio • Twitter

3. Other key stakeholders

Audience Key interests Priority level Tools & targeting methods and issues (Based on their current levels of support, involvement, power, interest & influence) P1 Employees • Job security • Face to Face • Viability and • Phone/email performance of • Team meetings HWN • HWE comms • Feeling valued and good work recognised / rewarded • Personal growth and professional development • Safe working conditions • Clear direction P2 Volunteers • To feel • Newsletter involved/informed in • Website the work of HWN • Annual Report • Feeling valued and • AGM good work • Meetings recognised / • Training • Phone/email rewarded • Personal growth and professional development • Safe working conditions Board & sub • Performance P1 • Board papers • Risk management • Board meetings groups • Financial viability • Annual report • Face to Face • Phone/email Newsletter

P1 Funders - NCC • Meeting contractual • Twitter obligations • Board papers • Adding value • Board meetings

• Annual report • AGM P2 CCGs • Additional support – • Twitter engagement, Community engagement research, project panels management Committee/board/steering groups • Opportunities to Press releases collaborate Project reports • Scrutiny Intelligence reports • Reputation Statutory letters Management • Patient voice/representation • STP

P1 Board/committee HOSC & HWB • Intelligence • Patient meetings Voice/representation Project reports Government • Performance P1 Annual report Intelligence reports Bodies – CQC, • Intelligence • Patient voice HWE Local/regional • Scrutiny P2 Meetings • Patient Voice Project reports steering groups Intelligence reports • Opportunities to collaborate • Intelligence P2 Yammer Other local HW • Best practice • Collective voice Twitter • Boundary issues Linked-in Press releases • Opportunities to Regional Meetings collaborate HWE events/conference

VCSE • Opportunities to P1 Press releases collaborate Website

Organisations • Intelligence All Social Media STP Stakeholder Board Face to face meetings Telephone/email

P2 Feedback Centre Trusts/Providers • Additional support – engagement, Intelligence reports research, project Twitter Linked-in management Press Releases • Opportunities to Committee/board/steering collaborate groups • Scrutiny Involvement Panels • Reputation Face to face meetings Management Telephone/email

• Patient voice/representation • STP

Local Councils / • Opportunities for P2 Twitter collaboration Linked-in Housing Press releases • Health needs of Associations Networking events residents/tenants Information days Telephone/email/meetings MPs & • Health needs of P2 Twitter residents Linked-in

Councillors • Opportunties for Newsletter Press Releases collaboration HW Events / AGM • Issues raised by constituents • How we can support government agendas • Health & Social Care policy P1 Press releases Local Media • Changes to services • Holding local public Twitter organisations to Linked-in HW Events / AGM account Telephone/email/meetings • Ease of contact and speed of response • Community issues / human interest stories • HWN Performance P3 Telephone/email/meetings Suppliers • Viability/financial stability – ability to Financial Paperwork renew contracts and pay debts • Prompt payment • Being treated fairly

Appendix 3: How we communicate: Events Calendar

Planned engagement for the current financial year can be found in the ‘Engagement Plan 2018- 19’

Appendix 4: How we communicate: Meetings and Networks list

National Fora NHS England Armed Forces Patient and Public Participation and Involvement Group

Regional and County Fora Children & Adolescent Mental Health Services (CAMHS) Forum East of England Citizens Senate Health and Wellbeing Board Health and Wellbeing Board Strategy Implementation Group Men’s Wellbeing Network Local Dental Committee Local Medical Committee Local Pharmaceutical Committee (LPC) Norfolk and Suffolk Palliative Care Forum Norfolk and Waveney Sustainability and Transformation Plan Stakeholder Board Norfolk Child Bereavement Practice Norfolk Community Advice Network Norfolk County Council Adult Social Care Committee Norfolk County Council/Care Quality Commission Information Sharing Group Norfolk County Council’s Personal Budget Questionnaire Workshop Norfolk Health and Overview Scrutiny Committee Norfolk Mental Health Strategic Board Norfolk Older Peoples Strategic Partnership Norfolk Pharmaceutical Needs Assessment (PNA) Norfolk Public Involvement Forum Norfolk Public Sector Communications Group Norfolk Safeguarding Adults Board Norfolk Sexual Health Network Norfolk’s Suicide Prevention Strategy Implementation Group Quality Surveillance Group Independent Investigation Review Regional Healthwatch Board

Provider Fora Board Meetings East of England Ambulance Service Quarterly Quality Meetings IC24 Call Review Meetings for 111 and Out of Hour Service James Paget University Hospital Library Stakeholder Group Norfolk Community Health & Care Equality & Diversity Steering Group Norfolk Community Heath & Care Foundation Trust Programme Board Norfolk Community Health & Care Patient Experience Steering Group Norfolk Community Health & Care Quality & Risk Assurance Committee Norfolk Community Health & Care Quality Champions programme committee Norfolk Community Health & Care Bid/Business Tender Involvement Norfolk & Norwich University Hospital – Central Locality Safeguarding Adults Partnership Norfolk & Norwich University Hospital – Learning Disability Forum Norfolk & Norwich University Hospital – Nutrition Steering Group Norfolk & Norwich University Hospitals Governing Body Norfolk & Suffolk NHS Foundation Trust Service Users and Carers Group

Norfolk & Suffolk NHS Foundation Trust Preventing Death by Suicide Queen Elizabeth Hospital Patient Experience Steering Group Queen Elizabeth Hospital Patient Safety Committee

Commissioning Fora Adult Autism Steering Group All Age Autism Partnership Board Child Health & Maternity Commissioning Network Community Commissioning Network Drugs & Therapeutics Commissioning Joint Commissioning Board for Primary Care (All CCGs) Mental Health & Learning Disabilities Commissioning Network NHS England Evaluation Panel for Veterans Mental Health Services Non-Elective Clinical Network Norfolk Mental Health Strategic Board Norfolk & Wisbech 111 & Out of Hours Stakeholder Project Board Norfolk Child Bereavement Strategic Partnership Quality Leads Network Therapeutics Advisory Group Mental Health & Learning Difficulties Programme Board (Gt Yarmouth & Waveney CCG) Patient Participation Groups Forum (Gt Yarmouth & Waveney CCG) System Leadership (Health & Wellbeing) Partnership (Gt Yarmouth & Waveney CCG) Community Engagement Panel (North Norfolk CCG) Integrated Care Programme Board (North Norfolk CCG) Planned/Unplanned Care Clinical Network (North Norfolk CCG) Patient Experience Safety & Quality Committee (North Norfolk CCG) Unplanned Care Clinical Network (Norwich CCG) Wheelchair Services Task & Finish Group (Norwich CCG) Your Norwich Programme Board (Norwich CCG) Conflicts of Interest Committee (West Norfolk CCG) End of Life Care Programme Board (West Norfolk CCG) Health Acquired Infections & Public Health Initiatives (West Norfolk CCG) Mental Health Clinical Quality Review Group (West Norfolk CCG) Patient Safety & Clinical Quality Committee (West Norfolk CCG) Queen Elizabeth Hospital Clinical Quality Review Group (West Norfolk CCG) System Resilience Group (West Norfolk CCG)

Other CAMHS Strategic Partnership Carers Council for Norfolk Complaints Managers Forum DEAL Project – parent/carer steering group Dementia Advice & Information Task & Finish Group Great Yarmouth & Waveney Patient Advisory Group Healthwatch Intelligence and Informatics Reference Group Learning Disabilities Health Checks Project Group Locality Provider Fora (x5) Maternity Services Liaison Committees Birth Voices

Mental Health & Learning Disabilities Steering Group Mental Health Transformation Group SEND reform Steering Group Suicide Prevention Forum Trinity Children’s Advisory Board West Norfolk Engagement Forum Young Adult Carers

Appendix 5 - Media landscape

Healthwatch Norfolk operates across a clearly defined geographical area.

This analysis explores the reach of different types of local/regional media present within our region to help inform how we can reach key target audiences through communications channels other than our own.

Regional TV Both BBC Look East and ITV Anglia can reach up to half a million people but this audience is spread over several counties which makes it difficult for HWN to deliver a message which is relevant to all viewers. Opportunities for regional coverage are therefore limited to highly topical issues with a much wider regional or national appeal.

Local newspapers Local newspapers are seeing a decline in reach but expansion across online platforms means there is potential for further sharing of content through social media as well as enabling us to specifically target different parts of the county.

While the reach of the Eastern Daily Press spans beyond our borders it is still predominantly a Norfolk based audience.

The key functions that local newspapers fulfil has been identified as: celebrating the community; raising awareness and generating pressure about important community issues; holding local politicians and public organisations to account and encouraging them to take action; and acting as a platform for community-based fundraising. Research by Local Media Works identified that local media was important in helping people feel a sense of pride in their community. This agenda fits very well with the aims of Healthwatch Norfolk and our key messages.

Key local titles are as follows:

Local newspapers Circulation (print & online) EDP 123,473 Norwich Evening News 26,203 Yarmouth Mercury 22,789 Lynn News 30,000 (estimate) Dereham & Fakenham Times 3,945* North Norfolk News 7,704* Yarmouth Advertiser 40,500 Norwich Extra 59,088 My local paper unavailable Source: ABC Figures Jul-Dec 2017 *figure for print only

Local radio stations There are a number of local radio stations operating in the area. Some are extremely localised and stations such as Heart use syndicated news across their wider network so although it tends to attract a slightly older demographic BBC Radio Norfolk is most definitely a key channel for reaching a wider audience.

Although the exact reach of the smaller community stations is unknown, they are very receptive to Healthwatch’s aims and keen to support localised projects.

Radio station / areas Potential reach % reach 15+ BBC Radio Norfolk 191,000 24% Heart (Norfolk) 127,000 19% KLFM 59,000 31% Radio Norwich 53,000 16% The Beach 47,000 26% North Norfolk Radio 15,000 16% Future Radio Not known Harbour Radio Not known Source: Rajar December 2017

Regional/ Parish magazines There are hundreds of titles across the county, highly localised all with varying frequency and publication schedules, reaching audiences ranging from a hundred to a few thousand. Keeping contacts up to date and servicing them is very labour intensive, but utilsing key titles for specific projects should not be overlooked.

Digital access The most comprehensive research undertaken of adults use of the internet is by Ofcom and The Communications Market Report 2017 shows that: • Almost 9 in 10 adults say they use the internet. • Just 1 one in 10 (13%) do not use the internet at all. Of this 13%: o 8 out of 10 said they have did not intend to go online in the future. o Nearly 50% of them did not see any advantages to them being online.

Ofcom categorises online users into four categores: 1. Broad users who carry out 11-18 of 18 different types of online activity. 2. Medium users who carry out between seven to ten types. 3. Narrow users whow only ever carry out between one to six types of activities. Narrow users are more likely to be less confident in their use of the internet and more likely to not trust websites to be secure and be more reluctant to share their personal details online. Narrow users are more likely to be older adults and DE households. 4. Newer users are identified as those who have been online for less than five years - across all adult internet users, around 1 in ten are classed as newer users. Around 22% of DE users are also newer users.

Although Norfolk figures roughly mirror the national picture, a range of localised factors such as the digital infrastructure of more rural locations and an ageing population mean there is a higher

liklihood of digital exclusion across many of the communities we serve, meaning digital only routes should be avoided.

Local Likelihood % Basic Use of % Excluded % 4G % Long % Over Authorit of digital Offline digital basic skills broadband Excluded term 65 y exclusion skills in last 3 10mpbs+ health months need Norwich Medium 11.40% 79% 42% 1% 1% 18.40% 14.70% Broadland Medium 11.40% 79% 47% 6% 27.88% 18.70% 25.00% Breckland High 13.80% 75% 44% 8% 57.74% 19.70% 24.30% South High 13.80% 77% 46% 9% 64.43% 17.90% 23.90% Norfolk North High 10.20% 75% 44% 8% 64.90% 23.30% 32.10% Norfolk Great High 11.40% 76% 42% 2% 17.56% 22.50% 23.60% Yarmouth King's High 10.20% 75% 44% 8% 39% 21.30% 25.30% Lynn & West Norfolk Waveney Medium 10.10% 77% 44% 3% 23% 22.30% 26.50% * Source: Get Digital Heat Map 2017 http://heatmap.thetechpartnership.com/

Social Media

The 2017 Ofcom report states that 70% of the UK have at least one social media account.

The platforms currently used by HWN have the following number of UK users:

Facebook 39.7 million Twitter 21.6 million Linked-in 15.9 million

YouTube and Instagram also have a massive user base and Snapchat is growing significantly amongst younger demongraphics.

UK Facebook users in each demographic are estimated as follows:

16-24 83% 25-44 61% 45-64 55% 65-74 46%

53% of 75+ (use the internet in general)

Facebook is still currently the most appropriate platform to target a wide range of demongraphics and is more locally appropriate to the needs of HWN, but emerging trends will be closely monitored.

A brief analysis below shows that some local Facebook groups have a more powerful reach than the smaller local newspapers.

Facebook Groups

Name City/Town/Area CCG Reach Dereham Community Dereham South Norfolk 16,000 Notice Board Good Old King's Lynn King's Lynn West Norfolk 13,737 Thetford Forum Thetford South Norfolk 12,000 Hunstanton Area Hunstanton West Norfolk 11,745 Cromer Cromer North Norfolk 6470 Wymondham Ways Wymondham South Norfolk 6354 Original Fakenham Fakenham North Norfolk 6071 Community Notice Board North Norfolk Notice North Norfolk North Norfolk 5300 Board Diss Community Diss South Norfolk 5112 Notice Board Watton Community Watton South Norfolk 4600 Notice Board Hemsby Local Chat Hemsby Gt. Yarmouth 4464 Enjoy Cromer More Cromer North Norfolk 2851 Life in Sprowston Sprowston Norwich 2758 Swaffham Swaffham West Norfolk 2617 Community Notice Board Wymondham Notice Wymondham South Norfolk 2300 Board Official Fakenham Fakenham North Norfolk 2194 Community Board Attlebourouh Attleborough South Norfolk 1900 Community Wells Forum for Wells-next-the-sea North Norfolk 1700 visitors and locals Great Massingham Great Massingham West Norfolk 1636 Items for Sale & Community News Methwold, Methwold West Norfolk 1325 Methwold Hythe & Brookville Community Page Holt and District Holt North Norfolk 1000 Stalham News Stalham North Norfolk 1000 Aylsham Mums Aylsham North Norfolk 900 Total Reach 114,034

Appendix 6: Healthwatch England – Audience Insight

Appendix 7 – Communications Protocol

The following document provides general guidance around communications and the use of social media channels.

General Ensure you have explicit consent for any photos and credit image owners where appropriate.

All projects and events requiring communications or engagement support should be discussed/agreed with the communications and engagement team at the earliest opportunity to ensure an effective communications plan can be put in place.

Media All press releases should include a quote from the HWN Chief Executive or Chair and be signed off in advance of publication.

Sign off must also be obtained for any third-party quotes and advanced notification should also be given to any organisation who is directly named or likely to be impacted as a result. Where possible this should be to the chief officer and/or communications manager in addition to any operational contacts.

All press releases should include the following key message where possible:

Anyone can provide feedback to Healthwatch on any local health or social care service at any time by visiting www.healthwatchnorfolk.co.uk

This includes pharmacies, GPs and NHS dentists, as well as all hospital, mental health, community health, care homes and other social care services.

Healthwatch use your anonymous feedback to inform local commissioners about where services are working well and where provision needs to be improved.

Interviews should generally be given by the Chief Executive or Chair but can be other members of staff at the Chief Executive’s discretion.

Media training is available on request and staff should avoid answering anything they are unsure about or questions of a politically sensitive nature.

Where possible the key messages above should be conveyed at all times.

Social media All staff are encouraged to talk about their work, promote HWN and build professional networks on their personal social media accounts, but should be mindful of how any content linked to their account can impact the reputation of HWN.

Further guidance on the use of each HWN platform is included below:

Twitter Primarily used for B2B communication, with the tagging of prominent local organisations extending our reach to local communities.

All tweets should include a picture and utilise the use of hashtags and organisation/influencer tagging to widen reach Targeting can be improved using geographic/issue specific hashtags i.e. ‘Do you know someone in #Norfolk affected by #Dementia’ etc. Our feed will include general posts about meetings, events and day to day activities to illustrate our work. We will also signpost information for other organisations and engage with third party content to ensure traffic is not one-way.

Facebook To be used primarily as a business to consumer channel. Posts should use images and tags where appropriate. Facebook groups will be utilised to reach into local communities and target condition specific/hard to reach groups. Facebook advertising for specific projects can also be used subject to suitability and budget approval.

Linked-in To be used as a B2B channel but on a person to person level, which will rely on staff involvement. Staff are ctively encouraged to talk about their work and build their professional networks online, tagging HWN where appropriate. Only key news will be shared on the HWN page, which can then be shared by staff to widen reach.

Appendix 8 – Engagement Protocol

The following document provides a general guide for HWN’s public engagement activities.

General Explicit consent must be obtained to record information and you must explain how it will be used. Copies of our Public Liability insurance and data protection notice should be available on the stand.

Attire Staff should wear branded HWN clothing and have their ID badge clearly displayed For professional events normal office attire may be more appropriate.

Equipment The HWN tablecloth, pop up banner and leaflets should be used for all events. The rate your experience counter boxes are optional, acting merely as an icebreaker and no results are recorded. The use of pens and other merchandise should be limited. Surveys and business reply envelopes can be handed out in time pressured environments – such as hospital/sport club foyers etc. but face to face engagement is the preferred option.

Language/body language ‘Do you have a minute to talk about the NHS?’ or ‘Can you spare 2 minutes to talk about local health services?’ can work well at breaking through barriers to engagement. Staff should be professional and friendly at all times. If engaging outside a venue, just saying hello and smiling at someone on their way past, can make them more likely to engage when they come out.

Stand up rather than sitting down and avoid eating or using mobile phones in the vicinity of the stand where possible.

Data capture Ask for the name of the service and when it happened – ask for an address or rough location if necessary to check later. Ask them to rate the experience (you can come back to it if necessary) Ask questions to clarify your understanding, break reviews into the different services involved, using separate sheets if necessary. Unless there is a specific reason you’re there ask about recent visits to the doctor, dentist, hospital etc. Experiences relating to children or babies Stress they can be as a friend, family member or professional – not necessarily as a patient. If they’re wearing glasses ask them about their optician, ask if they use a pharmacy As well as any experiences with mental health services, community health or social care.

You must explain what we’ll do with the information and that it will appear on our website in anonymous form unless they want to leave a first name.

You should request an email address, explaining that they will be notified if the provider gives a response to their comment – but stress their email address will be kept confidential. You can also ask if they’d like to sign up to our newsletter to stay up to date with HWN news.

Post event All reviews collected should be entered onto the feedback centre asap following the event. Check with the data officer for any comments you are unsure on where to assign. If the service has not received a review before contact the provider to introduce HWN and request an email address so they may be alerted of any comments we receive in the future. Details of the number of people engaged and comments collected should be added to the engagement comments spreadsheet. Follow up on any signposting requests and update the signposting log.

APPENDIX 3

HWN GENERAL ENGAGEMENT PLAN APRIL 2018 - MARCH 2019 APRIL MAY JUNE 3rd April - Prince Henry Sheltered House SOCIAL CARE SURVEY MAY/JUNE

4th Library event (Easter hol) 8th May – Mencap Group TBC Community hospital - Dereham 5th Library event (Easter hol) TBC – Dereham Market 6th April - Dementia Café – Costessey 13th May - Race for life TBC – Dereham Comm Centre/GP 14th May - N&N Dementia Event 10th April - Supermarket/Library TBC 15th May - Dying Matters – The Forum 11th June - Carers Event, The Forum 11th April – Sheringham PPG 17th May - James Paget Hospital 13th June - N&N Carer Event 12th April - Supermarket/Library TBC 18th May – Disability Festival - UEA 14th June - N&N Carer Event 21st May - Dementia Roadshow 16th June - N&N Summer Fete 18th April – North Norfolk GP Event 22nd May – Dementia Roadshow 19th April – James Paget Hospital 23rd May – Dementia Roadshow TBC - Learning Disability Week 21st April – Cromer Community Day TBC Community hospital – Swaffham 27th June - Royal Norfolk Show 24th April – Childrens Centre/Baby group TBC – Swaffham Market 28th June - Royal Norfolk Show 25th April – Childrens Centre/Baby group TBC – Swaffham Comm Centre/GP 29th June - James Paget Hospital 26th April – Baby group/QEH

JULY AUGUST SEPTEMBER TBC School/village fete 1st August - NSFT Summer Fete Tbc - GP Flu Clinic TBC School/village fete 16th August – James Paget Hospital Tbc - GP Flu Clinic TBC School/village fete Tbc - GP Flu Clinic Tbc – Market/High Street Tbc – Market/High Street Tbc - GP Flu Clinic Tbc – Library Tbc – Library Tbc - GP Flu Clinic Tbc - Fakenham Medical Centre Tbc – Market/High Street Tbc - GP Flu Clinic 17th July - NSFT Roadshow Tbc - Library Tbc - GP Flu Clinic 18th July - NSFT Roadshow Tbc - GP Flu Clinic 19th July - James Paget Hospital Tbc - Community Hospital - Cromer 20th September – James Paget Hospital 24th July - AGM 28th July - Pride APPENDIX 3 OCTOBER NOVEMBER DECEMEBER 8th October - Carers Event 15th November – James Paget Hospital 20th December - James Paget Hospital 10th OCTOBER - * MENTAL HEALTH SURVEY 18th October - James Paget Hospital Tbc – Queen Elizabeth Hospital Headway rehab centre Sheltered x 2 Tbc - GP Flu Clinic Tbc – Community Hospital - Kelling Housing with Care Tbc - GP Flu Clinic Sheltered housing x 2 Day Care Centre Tbc - GP Flu Clinic Housing with Care Children’s Centre Tbc - GP Flu Clinic Day Care Centre Community Café Tbc - GP Flu Clinic Children’s Centre Parent & baby/toddler group Community Café Tbc - Swaffham health event Supermarket/garden centre Employer Tbc – Library (half term) School/college Tbc – Library (half term) Employer Tbc – Library (half term) School/college/uni

JANUARY FEBRUARY MARCH 17th January – James Paget Hospital Ogden Court – rehab centre Tbc – Family Voice Conference Sheltered housing x 2 21st March - James Paget Hospital Tbc – Queen Elizabeth Hospital Housing with Care Tbc – Queen Elizabeth Hospital Day Care Centre Sheltered x 2 Headway rehab centre Children’s Centre Housing with Care Sheltered x 2 Community Café Day Care Housing with Care Parent & baby/toddler group Children’s Centre Day Care Community Café Children’s Centre 21st February – James Paget Hospital Parent & baby/toddler group Community Café KEY Parent & baby/toddler group Tbc – Queen Elizabeth Hospital North Norfolk CCG Employer Tbc – Library (half term) West Norfolk CCG School/college Tbc – Library (half term) Great Yarmouth/Waveney CCG Tbc – Library (half term) South Norfolk CCG

Norwich CCG

Link to HWN events calendar for full details http://www.healthwatchnorfolk.co.uk/events/

Agenda item: 7.3 Communications and Engagement Report & Report on: Intelligence Report Author: Fennie Gibbs & Rosie Sherrell Date: 16 April 2018

Purpose of the paper: For information

Healthwatch Norfolk Engagement Activity: Jan-Mar, 2018 Fig. 1

People Engaged With at Engagement Events How We Gathered Views

Where had people heard of us from?

Where We Gathered Views People Who Shared Their Experience With Us

3 Online and social media activity, Jan-Mar, 2018 Fig. 2

Website Number of Time on site Most popular pages (exc Home) sessions JAN 2,417 02:26 STP Thorpewood Surgery feedback page FEB 2,227 02:13 (534 views) Thorpewood Surgery feedback page MAR 2,365 01:34 (609 views) Twitter Visits Impressions Mentions New follows Followers JAN 889 37.3k 35 22 2,233 FEB 676 26.1k 41 36 2,262 MAR 726 26.4k 33 22 2,285 Facebook Total page Total reach Posts Most popular posts likes Safety concerns over region’s JAN 541 7,337 37 ambulance service (1.8k reach) FEB 541 4,006 36 Autism survey (875 reach) Weather related post! (250 MAR 550 2,983 48 reach) Newsletters Opens Bounced Subscribers Clicks WINTER 467 8 1,272 10.9%

Media activity, Jan-Mar, 2018 Fig. 3

Printed publications (Newspaper/magazine) Month Mentions Potential reach Where? Lynn News (x2), EDP JAN 5 66,477 (x2), Evening News EDP (x2), Holt FEB 3 38,970 Chronicle EDP (x2), Evening MAR 4 36,477 News (x2)

Website Month Mentions Potential reach Where? 113,199 (plus Lynn Lynn News (x2), EDP24 JAN 5 News – unknown reach) (x2), Evening News 24 FEB 2 94,503 EDP24 (x2) EDP24 (x2), Evening MAR 4 113,199 News 24 (x2)

4 Radio Month Mentions Potential reach Where? JAN 1 191,000 Radio Norfolk FEB 1 191,000 Radio Norfolk MAR 1 191,000 Radio Norfolk

Overall: Month Mentions Potential reach Where? JAN 11 370,676 Print, online, radio FEB 6 324,473 Print, online, radio MAR 9 341,176 Print, online, radio

Topics included:

• Dental services in West Norfolk • PFI at NNUH • Ambulance service x2 • Unpaid family carers • What is the STP? • North Norfolk extended access – GP Pilot • GP access • Breast cancer mortality rates

What does this tell us? Healthwatch Norfolk would like to highlight three interesting areas in terms of gathering views, raising awareness and engaging with the public from January to March 2018: • In the last quarter the engagement team have engaged with 1378 individuals face- to-face in the community and we have an average media reach of 345,441 each month. • In January and February, the engagement team got over 300 reviews per month (394 and 312, respectively), which was due to them supporting the priority projects (dental services and autism), starting a series of library visits, baby groups to support some work as part of the STP and notably, in February, they started attending sheltered house schemes in the county and spending time with the residents. • For the last quarter, we have received more reviews through our website’s Feedback Centre than we ever have before, which may reflect the increased awareness of Healthwatch Norfolk, given our increased presence in the media and also given our targeted communications for reviews regarding the Ambulance Service in January.

5 Intelligence Report Healthwatch Norfolk gathers experiences from local people about health and social care services from a number of sources. Between January and March we gathered 1371 individual reviews, relating to 258 different services delivered in Norfolk. This includes the data obtained from NHS Choices, which has been added to our evidence base for inclusion the overall average star ratings. Please note: the NHS Choices data will not be coded for themes. The following section provides analysis of this data in order to help the Board understand the experiences of local people.

The services local people have been talking to us about: Jan-Mar, 2018 Fig. 4 & 5 Below (figure 4) shows the top ten service areas that people have shared their experiences about between January and March. The average rating for each service type reflect the overall experience of care the reviewer felt that they or their friend/relative received.

Additionally, figure 5 below shows the top 15 services that people have specifically left their feedback about. The numbers for Norfolk County Council are fairly high given the inclusion of the project feedback we received as a result of completing work on unpaid family carers, which details experiences of Carers Assessments, predominantly. We usually receive most feedback about the three acute settings in the county and as previously mentioned, the Ambulance Service features near the top thanks to all the people who left their feedback after a call for experiences following concerns of the service.

7 Themes

All the experiences we When people talk to us about local services, they talk predominantly about staff, access to services and about the gather (except for NHS treatment and care they received. Additionally, issues relating to commissioning and individuals’ rights are often noted. Choices comments) are Below is a snapshot of the themes that we coded the comments to: coded manually by Healthwatch Norfolk Fig. 6 staff. Of the 1371 reviews in our database for October to December, 1,019 were reviews collected by Healthwatch Norfolk and therefore coded. As noted, NHS Choices comments are not coded for their content. Also note, some of our reviews do not contain content that can be put into themes. Where this occurs, the star rating for that review usually reflects the overall content of the review. Lastly, one review may have multiple themes, so the number of themes, may not reflect the overall number of reviews.

The snapshot of the last three months shows the five main theme areas that our reviews relate to. As you will see, these are largely mixed in terms of whether the reviews are positive or negative in nature, but within each theme are several subthemes and there are certainly some which are extremely positive and some areas where people are not so happy. Due to the nature of the ‘commissioning’ theme and its’ subsequent subthemes, is it inevitable that this area will be largely negative in nature.

Below is a bit more information surrounding the content of the reviews relating to the subthemes that are assigned to reviews:

Commissioning: Of the 49 comments relating to commissioning… • Fee/charges typically relate to expensive services such as dentists. • Changes and gaps in services were noted by 49 individuals which tend to relate to a lack of a personalised/tailored service, funding cuts resulting in services being cut/moved, lack of local services (especially dental practices accepting NHS patients).

Rights: Of the 34 comments relating to rights…

• Equality (5): Three reviews related to accessibility to dental practices with two negative due to mobility issues and the consultation rooms being upstairs, or practice not being “disabled” friendly and one being positive as they were able to move the reviewer to a downstairs room. One review noted difficulty getting a disabled spot at JPUH and one was offered a carer’s assessment by telephone but wears hearing aids so couldn’t do it.

9 • Confidentiality/privacy noted issues around information sharing with family members and staff dealing with issues in front of other service users, which were positive and negative • One review was negative around being fully informed about a procedure before consenting and a lack of information given, making for a poor aftercare experience (QEH) • One family member mentioned their complaint being poorly handled by staff at the Fermoy Unit.

Treatment: Of the 349 comments relating to treatment and care…

• Food/hydration, cleanliness and prescribing/medication were all very mixed in nature as were waiting times, which relates to the wait to be seen when actually in the health settings, i.e. in the waiting room before an appointment • Discharge typically related directly to the three acute settings. Key issues appeared around post-birth discharge and long waits due to busy staff, discharge at unsociable hours and lack of info/advice given following discharge • Issues around diagnosis for ASD; not identifying a problem or able to say what the problem was and mis-diagnosis. Positives related to quick diagnosis and RTT • Environment/facilities was very mixed. Positive include the Children’s waiting area in the NNUH, Children’s centres and the facilities/support offered, pharmacies on site at GP’s, up-to-date equipment at Opticians and lots of services offered at Cromer Hospital which has a nice environment too.

10 • Negatives included several people being put onto a “dementia ward” but didn’t have dementia, noisy wards in general, old buildings (JPUH and Gayton Rd Dental Centre), poor layout (QEH) and lack of entertainment in waiting rooms and outdated entertainment (old magazines). • Administration and organisation featured in a lot of our reviews especially given our work speaking about maternity services which have elicited lots of responses around the organisation of community midwife and health visitor’s appointment and continuity of care (mixed in nature). Similar responses have appeared in other areas of care – dentists, doctors. Other aspects of this theme relate to paperwork issues, chasing up appointments/test results, poor phone system.

Access: Of the 313 comments relating to access to services…

• Largely unsurprising results, with a mixed set of reviews relating to appointment availability and opening times and referral to treatment times • Transport/location negative usually relate to poor/expensive car parking and location of services • We received 24 reviews about the Ambulance Service which were assigned to this theme, as a result of our communications requesting feedback following concerns with the service. We received a lot of very positive reviews.

11 Staff: Of the 319 comments relating to staff…

• We receive a lot of reviews which mention the staff and this is typically very positive (88% positive) • Issues surround staffing levels noted by 27, usually within a hospital setting • The knowledge of staff and their training was very mixed.

Sharing our intelligence with other organisations

Date Reporting on… Reporting to… 18/01/2018 Compass Clinic, Wells CQC 18/01/2018 Sheringham Medical Practice CQC 23/01/2018 Central Healthcare Centre CQC 23/01/2018 Denteam Dental Care CQC 23/01/2018 J G Plummer, GY CQC 23/01/2018 Mattishall Surgery CQC 25/01/2018 EEAST NHS England 20/03/2018 Watton Medical Practice CQC 29/03/2018 Attleborough Surgeries CQC 29/03/2018 EEAST EEAST 29/03/2018 QEHKL CQC

Healthwatch Norfolk shares anonymised feedback from local people with the CQC and other organisations on a regular basis. We have made a continued effort to build relationships with the Inspectors and Inspection Managers at the CQC to ensure they are taking our feedback into account when planning their inspections and also to share our intelligence with them when we have concerns, for example.

12 Secondary patient/service user experience data sets Updated in this report: • Children and young people’s survey (CQC) • Community Mental Health Survey (CQC) • Complaints • Emergency Department (CQC) • Maternity Survey (CQC) • Patient Led Assessment of Cleanliness and Environment (PLACE)

Children and young people’s survey (CQC, 2016) The CQC surveyed young people and their parents/carers about their hospital experience and questions included:

• Choice and guarantee of admission date • What the ward was like (activities, food, privacy, etc) • The staff (speaking with staff, involvement etc) • The facilities for parents and carers (access to hot drinks, facilities to stay overnight and food preparation) • Pain management • Operations (Distracting a child before the operation etc) • Leaving hospital (advice on self-care, what to do in case of concern etc) • Overall (dignity, friendliness, being well looked after etc) Each was given an average response score out of ten and compared to other trusts in the country, as either ‘about the same’, ‘better’ or ‘worse’. On the whole, the Norfolk and Norwich University Hospital (NNUH) compared with other trusts as ‘about the same’. However, for five categories the trust performed ‘worse’: • Facilities for parents and carers: Food preparation • The hospital staff: Children’s Medical History • Individual or special needs and help when needed • The hospital ward • Sleep The James Paget University Hospital (JPUH) performed better. No category scored worse, six scored ‘better’ and 57 scored ‘about the same’, again, when comparing to other trusts. JPUH performed better compared to other trusts in:

• The hospital ward: Enough time for young children • The hospital staff: Able to ask questions • Pain management • Distracting a child before an operation or procedure • Friendliness • Being well looked after

13 Community Mental Health Survey (CQC) The CQC received 246 responses from service users of the NSFT Community Mental Health, out of 12,139 across England. NSFT was ‘worse’ than most trusts in the country at ‘crisis care’. As with the other CQC surveys service users were asked to score the category out of 10. The table below shows how patients have scored Community Mental Health services since 2015.

2015 2016 2017 Listening 7 7.9 7.9 Time 7.3 7.1 7.5 Understanding 6.9 6.5 7.3 Being informed 7.4 6.7 7.9 Contact 9.5 9.5 9.5 Organisation 8 7.8 7.8 Agreeing Care 5.8 5.5 5.9 Involvement in planning care 7 6.7 7.1 Personal Circumstances 7.3 7.2 7.7 Care Review 7.2 6.9 7.1 Involvement in care review 7.2 6.8 7.3 Shared Decisions 7.7 6.8 7.3 Explanations 5 6.1 Continuity of care 6.7 Information 4.6 6.2 Contact 6.7 6 6.3 Support during a crisis 5.4 4.8 4.7 Involvement in decisions 6.6 6.6 6.7 Understandable information 6.4 6.3 7 Medicine review 7 6.8 7.7 Explanantions 8.4 7.8 Involvement in deciding other treatments or thearapies 6.7 7.4 6.8 Help finding support for physical health needs 4.6 4.5 4.7 Help finding support for financial advice or benefits 4.3 4.4 4 Help finding support for finding or keeping work 3.7 2.8 3.6 Local Activities 3.9 3.9 4.1 Involving family or friends 7 6.3 6.6 Information on support from others 3.3 3.4 3.8 Support 5.8 5.8 6 Contact with services 5.6 5.6 5.8 Respect and dignity 8.3 8 8 Overall view of mental health services 6.6 6.4 6.7

14 Complaints In order to compare the level of complaints across each trust on a more level playing field the total number of complaints the department at the trust received was divided by the number of thousands of staff that work there. This gives complaints per 1,000 staff.

Accident and Emergency

Ambulance Service

Complaints per 1,000 members of staff increased in the third quarter of 2017-18. This number has also steadily increased since 2015: 2015-16 average per quarter was 94; 2016-17 average was 108 and average of Q1-Q3 is 117.

15 Mental Health

Emergency Department Survey (CQC) Patients to Accident and Emergency were asked to score the department out of ten. Thirty three of the thirty five categories at James Paget Hospital were rated ‘about the same’. Two categories were recognised as ‘better’:

• ‘Tests’: ‘Timely and fast results’ • ‘Doctors and Nurses’: ‘involving friends and family’

Meanwhile, Norfolk and Norwich University Hospital was rated ‘about the same in all possible categories, scoring highest (9.4/10) for Doctors and nurses acknowledging patients.

16 Maternity Survey (CQC, 2017) Both the NNUH and JPUH achieved ‘about the same’ in all categorised of the maternity survey. The figure below all of the categories for this survey and NNUH (green) scores compared to JPUH (pink).

The NNUH scored a lot more favourably than the JPUH in several categories: • ‘Feeling the stay in hospital after birth was the right amount of time’ • ‘Discharge from hospital being delayed’ • ‘If attention was required after the birth, a member of staff helped within a reasonable amount of time’ • ‘That their partner who was involved in there care was able to stay with them as much as they wanted’

17 Patient Led Assessment of Cleanliness and Environment (PLACE) Score

2017-2018 2016-2017 2015-2016 NNUH JPUH NNUH JPUH NNUH JPUH Cleanliness 100 98 99 99 98 97 Condition 91 95 93 93 88 91 Dementia 69 89 74 83 68 84 Food 84 86 89 85 89 90 Privacy 72 87 74 90 76 93 Disability 77 87 82 79 52 89

Both the NNUH and JPUH have decreased in their privacy score since 2016-17. Disability, food, dementia and condition have all also decreased over the past year in the NNUH.

What does this tell us?

• Staff in the most part are highly praised by reviewers. Issues relating to staff usually relate to staffing levels. This can also impact on other areas of treatment and care such as discharge, continuity of care and communication. • Issues around location – particularly due to the rural nature of the county – are noted as they always are, as is the poor car parking in some hospital and GP services. • Lots of comments were assigned to the treatment and care theme, which is a large part of a person’s experience and there a lots of subthemes under this. • Where there are subthemes that are very mixed, there are examples of very positive experiences as well as some which are not so good and these may be worth following up. The service provider does however have the right to reply to any of these reviews on our website so we will continue to promote this function in hope that this enhance service user/service provider engagement. • Thanks to Rosie, we have lots of external data sets to complement our intelligence and this may prove extremely useful when deciding on areas that are worthy of further investigation.

Agenda Item: 7.5 Report on: Risk Register Author: Judith Bell Date: April 2018 Things that may impact upon success Likelihood x Possible mitigations Increasing Risk/Decreasing of HWN consequence Risk/No change in risk rating score 1. Insufficient financial reserves to 4 x 4 = 16  Ongoing quarterly review of → deal with significant funding cuts. expenditure and forecasts against budget for 2018-19 by Finance Sub Group.  Sourcing alternative funding opportunities.

2. Poorly defined and poor delivery of 3 x 5 = 15  Continual dialogue with all → HWN role in STP stakeholders. consultation/engagement around  Ongoing review of Sustainability and Transformation resources within HWN to Plan (STP). deliver as HWN role is defined.  STP Board Sub group formed and meeting to direct future actions on this.

3. Insufficient preparation and 3 x 4 = 12  Following guidance and using understanding of GDPR resulting in policies from HW England Newly reported risk breaches in data security, potential  All staff/volunteers being/to be prosecution and damage to trained/informed reputation.  Action plan in place

4. Failure to respond promptly and 4 x 2 = 8 Discussions continue at local and appropriately to media requests regional level with CQC following publication of Care representatives – joint lobbying with → Quality Commission (CQC) Reports other stakeholders that are not shared in advance with HWN. 5. Failure in timely delivery of 2 x 4 = 8 Ongoing robust monitoring of project quality outcomes by organisations delivery by Quality Control Sub who are successful in bids for Group. Letter of agreement now → projects resulting in potential includes clause relating to financial damage to HWN reputation. penalty should the project be delayed

6. Insufficient preparation for and 2 x 3 =6 Advice and guidance being sought understanding of VAT registration Newly reported risk from accountants. resulting in financial loss if VAT not processed correctly.

HWN Board – Quality Control Sub Group Minutes of meeting held on 4th April 2018 at HWN Offices, Wymondham

Present: David Trevanion (DT) – Chair, William Armstrong (WA), Mary Ledgard (ML), Alex Stewart (AS), Judith Bell (JB), Sonia Miller – minutes

1. Apologies – none

2. Minutes of last meeting (8.1.18)

These had been circulated and were agreed as read.

3. Matters Arising

Point 4. – the PNA report has been adopted by the Health & Wellbeing Board. Also AS said that NHSE commented that HWN were the only ones to get good survey responses throughout the county.

Point 5. – DT said that the Sub Group needed to look at the process for authorising projects and approval. The first two projects submitted for approval both needed to be completed very quickly. ML said that it would be good to do this virtually especially when the timescale is very short. JB said that we do keep the Trustees informed of work coming in and it would be useful to make the Project Officers aware of commercial behaviours when doing a piece of work.

ACTION: AS & JB to discuss process for authorising pieces of work for discussion at the next meeting.

4. Progress Reports GP Out of Hours/NHS 111 Project – the Sub Group agreed to withdraw this project from presentation at this time.

Dental Project – Fennie Gibbs (FG) joined the meeting FG explained that a summary had not been produced due to time restrictions but will be prepared prior to the report going to the Board on the 16th April.

FG said that the question asked in the survey may have appeared more focussed on the dentist rather than the dental practice. FG said she would

look at the data in more detail to highlight how easy members of the public found it to access the service.

It was agreed that the “What Next” section should be put into a table of Recommendations and the introduction should be split into two sections – about the public in West Norfolk and RAF Marham personnel, also the Summary of Findings needs further work. In addition on page 5, paragraph 4 it should refer to the ”NCC Communities Committee”.

The results of a mystery shopping exercise will be included in the final report to be published.

The report has brought a range of organisations together to work with HWN to help in improve services, i.e. West Norfolk Community Transport, NSHE and the MOD regarding the services available at RAF Marham and the strain on the services within the local community around the base.

Meetings with HOSC and RAF Marham will take place in the next few weeks.

DT thanked FG for an extensive piece of work, working with other organisations and community groups.

ACTION: FG to prepare report for Board

Autism Project

ST presented a summary of the progress on this project. The survey has now closed and 170 responses have been received to date.

ST said that NCH&C have redesigned their service to cover a single pathway – one point of access and then clinicians to be involved depending of the specific needs of the patient. This is similar to the service currently run in GY&W.

ST said that she had attended a number of autism events in Norfolk and met with Zandrea Stewart (Lead, Autism Strategy, NCC) regarding the proposed engagement tool for the autism strategy which is currently being developed.

As a result of the work HWN have done we have been asked to oversee the election of the Autism Partnership Board and AS has agreed to do this. It was noted that Autism services for Thetford are provided by Suffolk.

ST said that the project will be completed by the end of June. DT thanked her for pursuing a complex area, where there is considerable dissatisfaction amongst parents and carers.

5. Future of the Sub Group

AS said that as no internal projects will be done in the future: we need to look at other methods of monitoring external projects which are bid for. We need to look at the intelligence gathered and go back to the providers to make recommendations based on this about the type of work which HWN could do to support improvements to a service and the costs involved to carry this out.

The QC Sub Group should look at the Intelligence Report and use volunteer/board/staff knowledge to identify areas to work on. It was agreed that the projects need to be more succinct and have a shorter timescale for completion.

It was also agreed that there needs to be time for the reports to be reworked, where necessary, before presentation to the Board. It was agreed to change the QC Sub Group meeting dates to enable this to happen.

It was also noted that the Engagement Team are also improving the way they are gathering intelligence from the public.

AS will prepare new Terms of Reference for the Sub Group for discussion at the next meeting.

The QC Sub Group will inform the Board of these discussions.

ACTION: AS to prepare new ToRs for next meeting JB to look at new dates for meetings

6. Any Other Business

None

7. Dates of Future Meetings

Next meeting - 27 June 2018 – future meeting dates to be confirmed

HWN BOARD – Finance Sub Group Minutes of meeting held 4th April 2018 at HWN Offices, Wymondham Present: William Armstrong (WA) Chair, David Trevanion (DT), Graham Dunhill (GD), Alex Stewart (AS), Judith Bell (JB), Sonia Miller – minutes

1. Apologies – none

2. Minutes of meeting held on 8th January 2018

Point 3 – should read “AS sent a letter on behalf of WA to the Communities Committee regarding the funding cuts.”

Point 5 should read Subscriptions/licenses – this figure includes £6000 for website software licence costs, the TV licence, and our INTRAN subscription fee.

3. Matters Arising Point 8 - Evaluation of Commissioned Projects – the committee need to look at the criteria for this evaluation as some of the decisions for taking on new commissions of work require a quick turnaround time. AS will discuss this further with DT.

ACTION: AS TO DISCUSS PROJECT EVALUATION CRITERIA WITH DT

4. Management Accounts (paper B)

This report shows the quarter’s figures to the end of December 2017. Net Income/Expenditure - £20,781.38 Balance – end of year – Net Assets - £430,087.86 (this includes £114,500 shown as Deferred Income - NCC SLA payment for Jan-Mar 18 was received in December 2017) Net Current Assets - £517,641.86

5. Budget v Actual to date and Bank Balances (paper C)

The paper shows actual figures to 27th March 2018 against last year’s budget.

Last year’s budget anticipated a loss for the year of £88,532, but in fact there has been a surplus of £41,902 using these latest figures (not final quarter’s figures from accountants). A significant factor in this has been the receipt of other income of £84,918 primarily for individual commissions (other income is detailed on a separate sheet).

JB explained the “Other Income” figures and highlighted the following:

PPV £8,000 – monies held for NHSE. AS advised that HWN will be charging £1000 p.a. in 2018-19 for administering these funds. JB will speak to Larking Gowen to clarify the book-keeping treatment of these funds held particularly as we are likely to be registering for VAT shortly.

ACTION: JB TO SPEAK TO LARKING GOWEN REGARDING PPV FUNDS HELD AND ADMINISTERED

Swaffham Provider Partnership - £1,200 – this was part of a project undertaken by the Project Manager which did not run to full completion. We invoiced for the work that had been undertaken.

AS said that we need to look at our Letters of Agreement carefully to highlight that a charge will be made for the full amount, if time is set aside and costed for project work.

£11,487 was received for the Pharmaceutical Needs Assessment work which was c.£2K more than originally quoted. NCC had agreed to pay for the additional work needed to ensure completion.

Acle Medical Practice - £3,681.10 – work is progress on this evaluation of a Winter Pressures GP Referral Pilot Scheme.

North Norfolk Primary Care Ltd – an engagement piece of work about patients’ preferences for accessing GP services outside of usual hours/methods. 50% of this has been paid (£9,938) with the other 50% due on completion.

JB explained other variances to the budget:

Bank Charges – a refund was received earlier this year. Computer Costs – a new server was purchased last year Legal & Professional fees – £1,360 was for IFA fees re. Pension auto enrolment advice and a group life cover arrangement fee. Payroll expenses are shown across three lines: Employer NI, Employer Pension and Net Salary totalling £337,789 which is £74,563 below budget Project costs – no costs were allocated in the original budget Training & Development – one course was paid for (£2000), cancelled and a refund received. Course will be rearranged. AS confirmed all training is approved by the CEO.

Bank Balances Current Account £208,227 Barclays Savings £23,227 Cambridge Savings £87,517 CAF £60,000 Nationwide Savings £60,071

Free reserves are at least c.£340,000

It was suggested that some money could be moved out of the current account to another savings account to earn a higher rate of interest. JB will investigate interest rates for other accounts and share this information with the Sub Group for recommendations to be considered.

ACTION: JB to look at interest rates on other accounts and circulate information to Sub Group

Lease & Reserve information – we are currently about to enter Year 4 of the 5 year lease. Redundancy costs calculated as at 1.4.18. These are statutory redundancy costs and need to be updated periodically as staff numbers, ages and length of service increase.

WA thanked JB for her work on the accounts.

6. Revised Budget (paper D)

AS explained that Sam Revill had left as Project manager at HWN in December 2017 to work at NNUH but has since left NNUH. He had recently met with her to discuss the possibility of returning to HWN to work on income generation to assist financial stability and also offer expertise and support to the Project Officers.

AS explained that the revised 2018-19 budget includes salary costs for Sam to return in a 0.4 FTE position. After discussion the Sub Group agreed that AS should speak to Sam to offer her a position at HWN for 2 days per week on a fixed term contract for one year (to March 2019) with the option for an extension or to make the role permanent.

This appointment is recommended by the sub group subject to approval by the HR Sub group.

ACTION: AS to inform and seek approval of the HR sub group of this decision

The previous budget for 2018-19 presented to the Board showed a forecast deficit of £140650 but has been revised in the knowledge of other income now expected. A deficit position of £126868 is now anticipated within the budget for 2018-19 which would be funded from existing reserves or from other (yet unknown) income from commissioned work.

Income NCC - £338K to be paid in quarterly instalments

Other Income Forecast A Letter of Agreement is used stating that 50% of monies are to be paid at the start of a project and 50% on completion.

EEAST £6000 NNPC £9938 SNCCG £6944 Standeasy £4800 Norwich CCG CHC £14,250 (HOSC have instructed the CCG to approach HWN to carry out this piece of work) PPV £1000 (administration fee for handling funds).

DT asked about the outcome of our Lottery application. AS said that the Big Lottery application had not been successful and a decision on the application to the Forces in Mind Trust is due at the end of April.

JB said she could share a spreadsheet at future meetings showing successful bids, those turned down and applications/bids outstanding.

ACTION: JB to share spreadsheet of bids/commissions for Sub Group meetings

GD said it would be useful to see a spreadsheet detailing the spending costs for project work both internal and external. AS explained we will not be doing internal projects in the future. The Intelligence that HWN gathers will be analysed and we will make recommendations to other agencies as to what services could warrant further investigation.

External work is currently costed out in detail to include staff time and other direct costs such a printing/ room hire/travel etc.

AS said that there are possible contracts coming in for work outside Norfolk where HWN could work with other counties to offer our expertise.

AS said that HWN staff should not continue to service the STP Stakeholder Board unless this is funded in the future. AS and WA will meet with Patricia Hewitt and Jane Harper-Smith to discuss this.

ACTION: AS and WA to meet with Patricia Hewitt & Jane Harper Smith

7. VAT

AS and JB are meeting with accountants Larking Gowen in the next 2 week to seek further advice on VAT. We are approaching the VAT threshold of £85K and the accountants are currently proposing that we register for VAT from 1st May 2018.

8. Any Other Business - none

9. Date of future meetings

27 June 2018.

JB agreed to look at the sequence of future meetings for the Finance and QC Sub Groups and the Board to avoid proximity to Bank Holidays and also to link in more usefully with the production of Quarterly Management accounts.

ACTION: JB to revise timetable of future meetings

MENTAL HEALTH SUB GROUP MEETING 10 – 11.30 – TUESDAY, 20TH FEBRUARY 2018

Present: William Armstrong (WA) – Chair, Marcus Hayward (MH) NSFT, Alex Stewart (AS), Judith Bell (JB), Helen Jackson (HJ), Sheila Preston (SP), Sonia Miller – minutes

1. Apologies – received from Robert Ashton, Julie Cave, Gary Page

2. Notes from meeting held on 21 11 17 These had been circulated prior to the meeting and the following changes were noted:

Item 3 Matters Arising - second paragraph should read: MH explained that NSFT had begun work on the carer’s triangle of care at Stage 1. Stage 2 is self-assessment of community services by staff providing the services that has just been completed and at Stage 3 they are also obtaining carers responses… Item 5 Update from HWN MH Conference - third paragraph, 4th line – should read …and how this would help to fill this void,… Item 5 Update from HWN MH Conference - penultimate sentence should read … paramedics could refer to the Emergency Duty Team …

Item 6 Conference outcomes – second paragraph, third sentence – should read …It will be a 7 day a week service, and the Crisis Hub will…

3. Matters Arising Actions from last meeting: The link to MH Improving Services group survey to be sent to JB - complete Line forwarded to Mr Connell – complete

Circulate Mazars Report to Group – complete

Conference outcomes – produce a report with action points – complete

MH updated the meeting with the following points:

There is a meeting of the NSFT Improvement Plan Service User and Carer Focus Group (last of 5) this afternoon. This meeting is open to service users and carers and third sector organisations who advocate for them. Julie Cave is presenting the Improvement Plan. Table top discussions will take place to talk about how we can better involve people in quality improvement. MH said he is recommending this is done in individual service lines and parent/carers are specifically looked at as a group. Following this there will be regular meetings during the year which will be used for quality improvement.

HJ asked what the outcomes were from the Improvement Board meetings. MH said that the biggest theme is communication, within the Trust. A mailing list has now been compiled and a newsletter will be sent out bi-monthly and an on-line survey

form has been created for use by mental health patients and other members of the public with an interest in mental health. AS agreed that HWN would put a link in our newsletter and on the website for this form.

ACTION: MH/SM to obtain link for on-line form for HWN website/newsletter

MH said there will also be communication between the clinical pathway and customer service training will also be undertaken and followed through with outcomes and actions.

Sheila Preston joined the meeting.

MH said that families have been disempowered or feel disempowered and they need to know that NSFT are listening. NSFT then need to feed back to them to show what has been done to improve the service.

SP said that financial considerations also have to be taken into account. MH said that the questionnaire also covers finance and how satisfied service users are with their mental health worker.

SP asked if NSFT were aware of how many carers are cut out of the triangle of care.

MH said that the group which have made the biggest impression are parent carers of people up to the age of 25. There are issues of not sharing information with parent carers and it is essential that this is resolved.

WA said that staff are aware of confidentiality of information. The way this information is shared needs to be improved and documented. These issues are emerging from the NSFT survey.

MH agreed to prepare a report of the outputs from the survey and bring it to the next meeting and circulate to attendees.

ACTION: MH to report back outcomes of survey to March meeting

4. Update form HWS MH Focus Group

HWS had not attending these meetings recently and it was agreed that JB would speak to HWS and/or AS will raise with this Andy Yacoub when he meets with him later today.

ACTION – AS/JB TO SPEAK TO HWS RE ATTENDANCE AT THE MEETING

5. Mental Health of Refugees

HJ said she is continuing to meet with the voluntary agencies who are supporting this group and a number of things are becoming more apparent. A major area of concern is the single point of access and how patients are triaged. Also of concern is incorrect treatment as patients often have multiple issues. Some have been

referred to the Well Being Service but this support has not appeared to be effective for these patients.

There are also issues around the correct use of the translation service.

HJ said she had met with Ewan Williamson to discuss improving engagement and he is keen to resolve this. HJ asked MH if it would be possible to set up a meeting with the manager of the single point of access and some of the people involved and talk about how to move forward. MH agreed to look at this and the use of the translation service.

ACTION: MH to meet with Service Manager re engagement and translation

HJ said that there is a settled refugee population in Norwich. There is a group who are unsure of their immigration status and a group who have immigration status but then still need support. There is a lack of secondary/therapeutic services in terms of mental health.

MH agreed to set up a meeting over the next 4 weeks with HJ, Roger Kingerlee (who works with veterans) and Raffee?? To discuss these issues. HJ will email a list to MH of those who should be involved.

ACTIONS: MH to set up meeting, HJ to send list to MH

6. NSFT Oversight & Assurance Board Meeting

JB attended the last two meetings in AS’s absence.

Two of the main issues discussed at the meeting held on 9th January: Ligature points – significant resource is being spent to eliminate the risk associated with these and it is anticipated this work will be completed by the end of May.

AS said that he could take this to the “Board” and raise it as an observation that significant resource is being deployed on this risk issue which statistically is a less significant risk than other issues.

Staffing and resources – was also covered at the January NFST OA Board January. Procedures to mitigate daily risks arising from staff shortages were explained as well as what is being done to address the longer term problems of recruitment. There are acute staff resourcing problems in some locations. Incentives were discussed to recruit and retain staff.

Points raised at the meeting held on 13th February: JB said that this meeting had a very positive feel. Work is currently being done which is revealing weaknesses. The NSFT culture of the use of prone restraint has been recognised as needing to be addressed and training of staff will need to be undertaken. The NHSI Improvement Director Philippa Slinger had said she had not been able to find that there is a specific requirement for accredited training of staff to a national standard in restraint.

HJ said that in Children’s Services several years ago there were different forms of behaviour management and a new approach was implemented and joint training carried out across different agencies. This joint working changed the culture.

At the NFST OA Board meeting Joan Maughan (Chair of Norfolk Safeguarding Adults Board) said a Memorandum of Understanding regarding restraint had been established by the Norfolk Safeguarding Adults Board and would be shared with NFST . MH said that PMA training is largely around de-escalating claims.

Philippa Slinger said that the issue of lack of completed care plans is a multi- faceted issue – time, IT system (Lorenzo), confidence, kit available, training etc. Each area needs to be systematically worked through t Philippa said that the Dashboard of actions required will most likely show more areas in red at the next OA Board meeting but this is because the work currently being undertaken is uncovering issues to be addressed.

AS said that the CQC are failing to understand that staffing is an issue in all Trusts throughout Norfolk and should look at this as a whole and not just for specific Trusts, and link this into the STP plans.

Kevin Vaughan said at the NSFT OA Board meeting that the documentation provided does not provide enough detail the outcomes achieved so far. It was agreed this will be amended for the next meeting to provide more detail.

Alison Leather, SNCCG had submitted a paper regarding the development of a protocol on joining up physical/mental care. It is anticipated that a policy could be written and in place by September 2018. Clinical Review – Ed Fraser (HWN) has been involved in this review. There had been 35 people involved in this review at 7 NFST sites across Norfolk and Suffolk. Ed had reported that staff said they felt supported and felt positive about change. Ed also reported, however, that staff had not been clear where to find policies and procedures. There was a presentation at the NFST OA Board meeting about the Butterfly Unit in Lowestoft.

7. Mental Health Conference – review of comments

AS said that those who attended the conference agreed with the comments which came out of the conference. It was agreed that this would be referred back to the Board at the next meeting to discuss whether a second conference should be organised later in the year.

ACTION: Agenda item for April Board meeting

8. Any Other Business

MH concordat meetings - HWN has signed up to the Concordat but AS said that due to capacity constraints it was difficult for us to attend the meetings. AS said that HWN will attend when staff are available. WA suggested that a member of the HWN Trustee Board may wish to attend.

ACTION: Refer back to Board at April meeting.

SP said that the NSFT 25 points of improvement are being worked through, (following the CQC inspection report) but that not all of them have been dealt with. They are now reported as per service line. She said that there was some concern that 40 admin staff had been appointed – at what cost?

MH said that the issues with Lorenzo were not expected, and these new appointments will free up clinician time. SP said that she would report back to the next MH Sub Group meeting.

ACTION: SP to report back to meeting on 20th March

9. Date of Next Meeting – 20 Mach 2018 – 10 – 12.00 at HWN offices

Distribution: William Armstrong – Chair – HWN Julie Cave – CEO - NSFT Marcus Hayward – Head of Recovery, Participation & Partnership, NSFT Gary Page – Chair – NSFT Debbie White – Director of Operations – NSFT Dan Pennock – Community Development Officer, HWS Alex Stewart – CEO – HWN Judith Bell – Operations Manager - HWN Robert Ashton – Board member – HWN Helen Jackson – Board member - HWN Anthony Woods – Volunteer – HWN Sheila Preston – Volunteer - HWN

Agenda item: 8.0

Report on: Co-option of New Trustee

Author: David Trevanion Vice Chair Healthwatch Norfolk

Date: 16th April 2018

1. Introduction

At the October 2017 Board meeting there was a discussion about Diversity and Equality, specifically whether there was sufficient experience and understanding amongst existing Board members, to ensure that healthwatch Norfolk is representative of all sections of the community. It was agreed that co-option of at least one additional Trustee with relevant experience should be pursued, with this in mind. This was followed at the January 2018 Board with the suggestion that Dr Katherine Deane, Senior Lecturer in Research in the School of Health Sciences at the University of East Anglia, could be considered as a suitable candidate.

2. Follow Up

Dr Katherine Deane was initially asked whether she would be interested in being considered for co-option to the healthwatch Norfolk Board. She expressed a keen interest and it was therefore agreed that she would submit a CV and meet with a panel of Trustees and the Chief Executive, to explore the issues from her point of view and from that of healthwatch Norfolk.

Dr Deane’s CV demonstrates that she specialises in “the management of long term conditions (LTCS) with co-created care conditions”. In her own words she states that: “I have a number of LTCs and am a wheelchair user. I use this insight to ensure my research is pragmatic and relevant to people facing health challenges”. Her CV also states that “I am leading the development of a Values Charter program to teach undergraduates across 10 health and social care professions how to demonstrate professional values in their practice”. Dr Deane has also published over 70 journal articles and gained “nearly £1 million pounds in research grants”. At the University of East Anglia Dr Deane has established the Access All Areas working group in order to improve accessibility of the UEA campus as a whole and acts as an adviser to external organisations on improving accessibility.

Dr Deane met with William Armstrong, Helen Jackson, Alex Stewart and myself on 20th February 2018 at the healthwatch Norfolk office. Dr Deane

was asked to expand on her CV, particularly on Equality and Diversity. She explained that the Values Charter, which she has developed, means precisely that she works on a full range of the issues of Diversity and Equality with undergraduate medical and social care staff. She is also a member of Parkinson’s UK Inclusion panel trying to improve the inclusivity and diversity of research.

Dr Deane explained that she has endeavoured to explore the aims, objectives and powers of healthwatch Norfolk and would be very interested in sharing her knowledge, experience and expertise with us.

Dr Deane was also asked whether she envisaged there could be joint working opportunities between healthwatch Norfolk and the School of Health Sciences at UEA. She said that she envisaged definite possibilities of pursuing both research opportunities and grants and it was agreed that this should be explored further.

It was explained to Dr Deane that the decision about co-option would be made at the April 2018 Board of healthwatch Norfolk, following which she would be contacted.

3. Recommendation

It is recommended that Dr Katherine Deane should be invited to be co-opted to the Board of healthwatch Norfolk as a trustee.